Search

Background Small cell lung cancer (SCLC) has the strongest association with smoking among lung cancers. The characteristics of never smokers with SCLC is not known. Research Question Are the clinical characteristics, prognostic factors, survival, genomic alterations, and tumor mutational burdens of SCLC in patients who have never smoked different from those who have smoked? Study Design and Methods A retrospective multicenter cohort study of patients with clinician-confirmed SCLC was performed with the use of a longitudinal and nationally representative electronic medical records database. Smoking history was assessed through technology-enabled abstraction and confirmed for never smokers via chart review. Genomic characteristics of never smoker patients with SCLC were examined with the use of a next-generation sequencing-based gene panel and whole exome sequencing. Results One hundred of 5,632 patients (1.8%) with SCLC were never smokers. Relative to smokers, never smokers were more likely to be female (66.0% vs 52.4%; P = .009) and present with extensive stage (70.0% vs 62.2%; P = .028). Never smokers had a higher proportion of patients in age groups 35 to 49 years (7.0% vs 3.0%; P = .006) and ≥80 years (17.0% vs 8.2%; P = .006). Known risk factors for lung cancer were found in Interpretation The sex- and age-specific distribution of SCLC among never smokers, along with differences that were identified by genomic analyses, suggests a distinct biology of SCLC in never smokers compared with smokers.

BACKGROUND: Small cell lung cancer (SCLC) has the strongest association with smoking among lung cancers. The characteristics of never smokers with SCLC is not known. RESEARCH QUESTION: Are the clinical characteristics, prognostic factors, survival, genomic alterations, and tumor mutational burdens of SCLC in patients who have never smoked different from those who have smoked? STUDY DESIGN AND METHODS: A retrospective multicenter cohort study of patients with clinician-confirmed SCLC was performed with the use of a longitudinal and nationally representative electronic medical records database. Smoking history was assessed through technology-enabled abstraction and confirmed for never smokers via chart review. Genomic characteristics of never smoker patients with SCLC were examined with the use of a next-generation sequencing-based gene panel and whole exome sequencing. RESULTS: One hundred of 5,632 patients (1.8%) with SCLC were never smokers. Relative to smokers, never smokers were more likely to be female (66.0% vs 52.4%; P = .009) and present with extensive stage (70.0% vs 62.2%; P = .028). Never smokers had a higher proportion of patients in age groups 35 to 49 years (7.0% vs 3.0%; P = .006) and ≥80 years (17.0% vs 8.2%; P = .006). Known risk factors for lung cancer were found in

Background Miners inhale dust at work and are at a risk for coal workers pneumoconiosis (CWP), a preventable and potentially fatal lung disease. After regulations were implemented in the 1970s, declines were reported in both dust levels and the prevalence of simple and advanced CWP until about 2001, when despite stable reported dust levels, disease levels sharply increased. Methods A structured, retrospective chart review was performed to describe the demographics and disease progression for 138 coal miners with progressive massive fibrosis (PMF) whose claims were approved by the West Virginia State Occupational Pneumoconiosis Board between January 2000 and December 2009. Results PMF, a complication of CWP, developed in 138 West Virginian coal miners at a mean age of 52.6 years after an average of 30 years work tenure. The time of progression averaged 12.2 years from the last normal chest radiograph until PMF was detected. Lung function declined sharply in both smokers and nonsmokers, averaging 87 mL/y for FEV 1 and 74 mL/y for FVC. The board has confirmed 21 deaths in this group. The most common job activities were operating continuous-mining machines (41%) and roof bolting (19%). Virtually all of these miners' dust exposures occurred after the implementation of current federal dust regulations. Conclusions Contemporary occupational dust exposures have resulted over the past decade in rapidly progressive pneumoconiosis and massive fibrosis in relatively young West Virginian coal miners, leading to important lung dysfunction and premature death.

Miners inhale dust at work and are at a risk for coal workers pneumoconiosis (CWP), a preventable and potentially fatal lung disease. After regulations were implemented in the 1970s, declines were reported in both dust levels and the prevalence of simple and advanced CWP until about 2001, when despite stable reported dust levels, disease levels sharply increased.A structured, retrospective chart review was performed to describe the demographics and disease progression for 138 coal miners with progressive massive fibrosis (PMF) whose claims were approved by the West Virginia State Occupational Pneumoconiosis Board between January 2000 and December 2009.PMF, a complication of CWP, developed in 138 West Virginian coal miners at a mean age of 52.6 years after an average of 30 years work tenure. The time of progression averaged 12.2 years from the last normal chest radiograph until PMF was detected. Lung function declined sharply in both smokers and nonsmokers, averaging 87 mL/y for FEV(1) and 74 mL/y for FVC. The board has confirmed 21 deaths in this group. The most common job activities were operating continuous-mining machines (41%) and roof bolting (19%). Virtually all of these miners' dust exposures occurred after the implementation of current federal dust regulations.Contemporary occupational dust exposures have resulted over the past decade in rapidly progressive pneumoconiosis and massive fibrosis in relatively young West Virginian coal miners, leading to important lung dysfunction and premature death.