Elsevier

Lung Cancer

Volume 60, Issue 1, April 2008, Pages 22-30
Lung Cancer

Impact of respiratory symptoms on lung cancer: 30-year follow-up of an urban population

https://doi.org/10.1016/j.lungcan.2007.09.002Get rights and content

Summary

We investigated the relationship between respiratory symptoms reported at one time and incidence of lung cancer the subsequent 30 years in an urban Norwegian population. A cohort of 19 998 persons, aged 15–70 years living in Oslo, was randomly selected for a respiratory survey in 1972. The response-rate was 89% and 17 670 respondents were followed up. The relationship between respiratory symptoms and lung cancer incidence was investigated separately for each symptom group, symptom score and sex, with adjustment for age, smoking habits and occupational exposure. Lung cancer developed in 352 persons (228 men and 124 women) during follow up. We found a significant positive association between the incidence of lung cancer and cough symptoms in both sexes, asthma-like symptoms among women and dyspnoea when walking uphill among men. The relative risk for lung cancer increased with the number of symptoms reported at baseline and was strongest the first decade and decreased with duration of follow up. This association was more pronounced for non-small cell lung cancer than for small cell lung cancer.

Introduction

Although cigarette smoking may explain 80–85% of lung cancers in the Nordic countries [1] several studies have indicated an association between lung cancer and non-malignant pulmonary diseases as chronic bronchitis, emphysema, bronchial asthma, pneumonia and lung tuberculosis, even in non-smokers and after adjustment for smoking habits [2], [3], [4], [5]. Patients with chronic obstructive lung disease have an increased risk for lung cancer, even after adjustment for smoking habits. Moreover, this risk increases inversely with level of pulmonary function expressed as forced expiratory volume in one second [6]. Further, it has been proposed that chronic inflammatory process in the lung may stimulate cell-proliferation and growth, leading to lung cancer [7], [8]. Thus, it seems likely that disorders associated with airway inflammation are risk factors for lung cancer.

Respiratory symptoms are often markers of inflammatory processes in the lungs and airways, and might be present before other clinical manifestations. The literature about the association between respiratory symptoms and incidence of lung cancer is, however, sparse [9].

In previous studies we found an association between respiratory symptoms and mortality from all causes and from obstructive lung disease [10], [11]. The aim in the study reported here was to investigate the association between respiratory symptoms in a general population and the incidence of lung cancer during the next 30 years. We also examined this association in separate time windows during the follow up.

Section snippets

Study population, questionnaire and variables used in the analysis

The study population was derived from a cross sectional survey conducted in Oslo in 1972 [12]. The sample frame was an updated list from the Central Population Register of 345 630 men and women aged 15–70 years living in Oslo on 1 June 1972. From this population, an age-stratified sample of 19 998 persons was selected and sent a postal respiratory questionnaire. The response rate was 89%. During autumn 1972, 12 persons among the respondents died or emigrated, and lung cancer was diagnosed in

Results

During the follow up, lung cancer developed in 352 persons and the crude incidence rate among males was more than twice that in women (Table 1). The mean age at the time of diagnosis was 69 years in both men and women, with a range of 42–90 years. The crude incidence rate increased with age at baseline in both men and women and was 1.6 times higher among those persons who had been exposed to dust or gasses at work than those not exposed.

Of the 352 cases of lung cancer diagnosed in the cohort,

Discussion

Our study showed a significant increased risk of developing lung cancer in both sexes reporting cough symptoms, women reporting asthma-like symptoms and men reporting dyspnoea when walking uphill. The association was strongest during the first decade and decreased with duration of follow up but was still increased, although not significantly, during the last decade. The risk increased with the number of symptoms reported at baseline, to a greater extent for non-small cell lung cancer than for

Conclusion

We found an increased risk of lung cancer among persons reporting respiratory symptoms compared to those reporting no symptoms. This association was strongest during the first decade and decreased with duration of follow up and was more pronounced for non-small cell lung cancer than for small cell lung cancer.

Conflict of interest statement

No conflict of interest to declare.

Acknowledgements

This follow-up study was financed by EXTRA funds from the Norwegian Foundation for Health and Rehabilitation. We thank co-workers at Cancer registry of Norway for support and especially thank Bjarte Aagnes for technical help with the data.

References (32)

  • J. Vestbo et al.

    Are respiratory symptoms and chronic airflow limitation really associated with an increased risk of respiratory cancer?

    Int J Epidemiol

    (1991)
  • A. Frostad et al.

    Respiratory symptoms as predictors of all-cause mortality in an urban community: a 30-year follow-up

    J Intern Med

    (2006)
  • A. Frostad et al.

    Respiratory symptoms and 30 year mortality from obstructive lung disease and pneumonia

    Thorax

    (2006)
  • A. Gulsvik

    Prevalence of respiratory symptoms in the city of Oslo

    Scand J Respir Dis

    (1979)
  • D.R. Cox

    Regression models and life-tables

    J R Stat Soc (B)

    (1972)
  • E.L. Korn et al.

    Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale

    Am J Epidemiol

    (1997)
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