Lung Cancer (Bronchial Carcinoma): Prevention

To prevent bronchial carcinoma (lung cancer), attention must be paid to reducing individual risk factors. Behavioral risk factors

  • Diet
    • Too little fruit and vegetable consumption (scientifically, the role of a deficiency of vitamin A is not fully understood).
    • Micronutrient deficiency (vital substances) – see prevention with micronutrients.
  • Insufficient supply of vital substances
  • Consumption of stimulants
    • Alcohol (women more than 10 g per day; men more than 20 g per day) – promotes the development of bronchial carcinoma, among other things.
    • Tobacco (smoking, passive smoking) – the risk of a man who smoked two packs per day for 20 years is 60 to 70 times that of a non-smoker. After quitting smoking, the risk decreases, but never again reaches the level of a non-smoker.A quarter of all smokers who are carriers of the “breast cancer gene” BRCA2, develop the disease in the course of their lives
  • Physical activity
    • Physical inactivity; high cardiorespiratory fitness (average 13.0 MET ≈ 13 times basal metabolic rate) in middle age resulted in 55% reduced lung cancer mortality (lung cancer mortality rate)
  • Psycho-social situation
    • High work stress: + 24% bronchial carcinoma (lung cancer).
    • Night duty (+ 28 %)

Medication

  • ACE inhibitors-angiotensin-converting enzyme metabolizes bradykinin, an active vasodilator, in addition to angiotensin I; bronchial carcinomas express bradykinin receptors; bradykinin may stimulate vascular endothelial growth factor release (= promote angiogenesis and thus tumor growth). In patients receiving ACE inhibitors, the incidence was 1.6 per 1,000 person-years versus 1.2 per 1,000 person-years in the other hypertensive patients; ACE inhibitor therapy increased the risk by 14% relative
  • Selective serotonin reuptake inhibitors (SSRIs) ?
  • Tricyclic antidepressants (TCAs) ?

Environmental exposure (including workplace exposures) – Intoxications (poisonings).

  • Occupational contact
    • With carcinogens – e.g., asbestos, man-made mineral fibers (MMMFs), polycyclic aromatic hydrocarbons (PAHs), arsenic, chromium VI compounds, nickel, halogenated ethers (“haloethers”), especially dichlorodimethyl ether, radioactive materials, etc.
    • Coke oven raw gases
    • Handling tar and bitumen (road construction).
    • Inhalation of coal dust (miners).
    • Inhalation of nickel dust, quartz dust.
  • Arsenic
    • Men: mortality risk (risk of death)/relative risk (RR) 3.38 (95 percent confidence interval 3.19-3.58).
    • Women: Mortality risk/relative risk 2.41 (95-percent confidence interval 2.20-2.64).
  • Tetrachloroethene (perchloroethylene, perchloro, PER, PCE)?, in women.
  • Diesel exhaust (due topolycyclic hydrocarbons, PAH).
  • Air pollutants: particulate matter (due to car exhaust, combustion processes in industry and domestic heating) – already particulate matter concentration below the European limit increases the likelihood of developing lung cancer
  • Ionizing rays
  • Radon – after smoking, involuntary inhalation of radioactive radon in the home is the most common trigger of lung cancer; it is responsible for about 5% of all lung cancer deaths in Germany

A significant reduction in lung cancer-specific mortality (death rate) was demonstrated for current and former smokers (>30 packyears) aged 55-74 years by the National Lung Screening Trial (NLST) in a first-of-its-kind randomized controlled lung cancer screening trial.

Prevention Factors (Protective Factors)

  • Nutrition
    • High intake of nuts (walnut, hazelnut, almond, peanut, seed): inversely correlated with overall lung cancer risk (highest lowest quintile, OREAGLE = 0.74; 95% CI, 0.57-0.95; HRAARP = 0.86; 95% CI, 0.81-0.91), independent of smoking status
    • Diet high in polyunsaturated fatty acids: 8% lower risk of disease (HR: 0.92) than participants in the lowest quantity quintile group
    • High consumption of dietary fiber and yogurt (bronchial carcinoma risk 33% lower).
  • Physical activity
    • High versus low leisure-time physical activity is associated with a lower risk of bronchial cancer (-26%; HR 0.74, 95% CI 0.71-0.77).
    • Subjects in the highest fitness category ≥ 12 MET:
      • 77% lower risk of bronchial cancer than least fit participants; incidence rates: 0.28 and 2.00 per 1,000 person-years, respectively; risk of dying after a lung cancer diagnosis during follow-up was reduced by 44% for the fittest patients.
      • 61% lower risk of colorectal (colon and rectal) cancer; incidence rates 0.27 and 0.97 per 1,000 person-years, respectively); risk of dying after a colorectal cancer diagnosis during the follow-up period was reduced by 89% for the fittest patients.
  • Medication
    • BCG vaccination in school-age children: a follow-up of six decades in the retrospective study showed that bronchial carcinoma (lung cancer) was significantly less frequent in study participants with BCG vaccination than in the placebo group.
    • Metformin – Type 2 diabetics who took metformin and were nonsmokers were 43% less likely to develop bronchial carcinoma. The protective effect increased with duration of use: non-smokers who took metformin for at least 5 years were 52% less likely to develop lung cancer.
  • Environment: staying at high altitudes: Decrease in bronchial carcinoma incidence (incidence of new cases) with each 1,000 m increase in altitude by 7.23 per 100,000 population.