Are there differences by sex in lung cancer characteristics at diagnosis? —a nationwide study

Abstract

Background: Lung cancer causes approximately 25% of all cancer deaths. Despite its relevance, few studies have analyzed differences by sex at the time of diagnosis in terms of symptoms, stage, age or smoking status.We aim to assess if there are differences between men and women on these characteristics at diagnosis. Methods:We analyzed the Thoracic Tumour Registry (TTR), sponsored by the Spanish Lung Cancer Group using a case-series design. This is a nationwide registry of lung cancer cases which started recruitment in 2016. For each case included, clinicians fulfilled an electronic record registering demographic data, symptoms, exposure to lung cancer risk factors, and treatment received in detail. We compared men and women using descriptive statistics.Results: A total of 13,590 participants took part in this study, 25.6% women. Women were 4 years younger than men (64 vs. 69), and men had smoked more frequently. Adenocarcinoma was the most frequent histological type in both sexes. Stage IV at diagnosis was 50.8% in women compared to 43.6% in men.Weight loss/anorexia/asthenia was the most frequent symptom in both sexes and there were no differences in the number of symptoms at diagnosis. There were no relevant differences in the frequency or number of symptoms by sex when non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) were analyzed separately. Smoking status did not appear to cause different lung cancer presentation in men compared to women. 2 Ruano-Ravina et al. Sex differences at lung cancer diagnosis

Lung cancer trends and tumor characteristic changes over 20 years (2000–2020): Results of three French consecutive nationwide prospective cohorts’ studies

“…In 2000, 16·5% of LCs diagnosed were SCLCs, a proportion which had fallen to 13·5% in 2010 and 12·6% in 2020. This histology spectrum was similar to that observed in the Spanish study reported by Ruano-Ravina et al 17 Notably, this trend has been noticed since the early 1980’s, 16 according to the type of tobacco use.…”

“… 16 In a nationwide registry of cancer patients that is still ongoing in Spain and involving 13,590 participants, Ruano-Ravina et al reported a proportion of 25·6% women. 17 In the UK, a serial, cross-sectional, observational study derived from the National Cancer Registration and Analysis Service (NCRAS) and based on 27,795 patients suffering from LC reported a 44·4% percentage of women with a mean age of 72 years. 18 In a systematic review pertaining to gender-associated differences in fatal and non-fatal LC risk, O'Keefle and colleagues were, however, unable to identify any evidence-based difference in smoking-related LC risk among men and women.…”

“… 29 In the Spanish registry study, Ruano-Ravina et al reported 50.8% of Stage IV cases at diagnosis in women and 43·6% in men. 17 The proportion of early-stage cancer diagnoses can be used as a surrogate marker of the effectiveness of the screening strategy. Indeed, LCs evolve for a long time in a subclinical way and become symptomatic only at an advanced stage, which is more difficult to treat.…”

Sociodemographic and clinical characteristics associated with never-smoking status in patients with lung cancer: findings from a large integrated health system

“…The high percentage of stage IV diagnoses among never-smoking patients with lung cancer in our study emphasizes the importance of this understanding among physicians. As Ruano-Ravina et al point out, a large percentage of patients are asymptomatic at the time of lung cancer diagnosis, including 25% of those diagnosed with stage IV disease ( 30 ). Thus, it is critical to consider both patient and radiologic characteristics in order to guide lung nodule management and avoid missing potential diagnoses.…”

New biochemical, immune and molecular markers in lung cancer: Diagnostic and prognostic opportunities

“…3 The main symptoms of lung cancer, that can occur separately or in combination, are cough, dyspnea, pain, hemoptysis, aphonia or hoarseness, weight loss or asthenia, and superior vena cava syndrome, although an asymptomatic course at the time of diagnosis is not unusual. 4 Moreover, distant metastases are frequent, especially to the central nervous system. In the early stages of NSCLC, brain metastases are present in 0.6-3% of patients 5 and this increases up to 50% in the course of the disease.…”