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      Global lung cancer mortality trends and lifestyle modifications: preliminary analysis

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          Abstract

          Background:

          According to the Independent High-level Commission on Non-communicable Diseases (NCD) of the World Health Organization (WHO), global reduction in lung cancer mortality has been achieved since the year 2000, although this effect is not sufficient to reach the 30% reduction of mortality from NCDs by the year 2030, as stipulated by the United Nations Sustainable Development Goal 3.4. The objective of this study was to analyze whether the lifestyle changes implemented by the WHO at country level could have an impact on mortality from this form of cancer.

          Methods:

          WHO statistics, based on the unified mortality and causes-of-death reports of Member-State countries, were used to evaluate global lung cancer mortality trends and make comparisons and assessments of different types of community-based, country-wide interventions.

          Results:

          The lung cancer mortality decline was associated with the anti-tobacco campaign initiated by the WHO in the last 15 to 20 years. Comprehensive tobacco control remained the major and most successful lifestyle modification measure. In countries with declining lung cancer mortality, 91% of countries had decreasing tobacco prevalence in males and 82% in females. Country- wide measures to increase physical activity had a strong tendency to be better implemented in countries with declining lung cancer mortality ( t = 1.79, P > 0.05). Other WHO “best-buy” lifestyle modification campaigns (diet and alcohol) had been carried out for shorter periods, and their associations with lung cancer were less strong than tobacco. There was no significant difference between countries with declining and increasing lung cancer mortality in the measures for reduction of harmful alcohol use ( t = 0.92, P > 0.05) and unhealthy diet reduction measures ( t = 0.84, P > 0.05).

          Conclusion:

          Following WHO “best-buys” should facilitate to move countries towards the NCD including lung cancer mortality reduction targets. Governments and communities must embrace these targets with coordinated effective action for better health.

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          Most cited references20

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          Fruits, vegetables and lung cancer risk: a systematic review and meta-analysis.

          Lung cancer is the most common cause of cancer death. Fruits and vegetables containing carotenoids and other antioxidants have been hypothesized to decrease lung cancer risk. As part of the World Cancer Research Fund International Continuous Update Project, we conducted a systematic review and meta-analysis of prospective studies.
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            The International Agency for Research on Cancer (IARC) evaluation of the carcinogenicity of outdoor air pollution: focus on China

            The International Agency for Research on Cancer (IARC) has classified outdoor air pollution and the particulate matter (PM) in outdoor air pollution as carcinogenic to humans, as based on sufficient evidence of carcinogenicity in humans and experimental animals and strong support by mechanistic studies. The data with important contributions to the evaluation are reviewed, highlighting the data with particular relevance to China, and implications of the evaluation with respect to China are discussed. The air pollution levels in Chinese cities are among the highest observed in the world today and frequently exceed health-based national and international guidelines. Data from high-quality epidemiologic studies in Asia, Europe, and North America consistently show positive associations between lung cancer and PM exposure and other indicators of air pollution, which persist after adjustment for important lung cancer risk factors, such as tobacco smoking. Epidemiologic data from China are limited but nevertheless indicate an increased risk of lung cancer associated with several air pollutants. Excess cancer risk is also observed in experimental animals exposed to polluted outdoor air or extracted PM. The exposure of several species to outdoor air pollution is associated with markers of genetic damage that have been linked to increased cancer risk in humans. Numerous studies from China, especially genetic biomarker studies in exposed populations, support that the polluted air in China is genotoxic and carcinogenic to humans. The evaluation by IARC indicates both the need for further research into the cancer risks associated with exposure to air pollution in China and the urgent need to act to reduce exposure to the population.
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              Alcohol consumption and risk of lung cancer: a pooled analysis of cohort studies.

              Although smoking is the primary cause of lung cancer, much is unknown about lung cancer etiology, including risk determinants for nonsmokers and modifying factors for smokers. We hypothesized that alcohol consumption contributes to lung cancer risk. We conducted a pooled analysis using standardized exposure and covariate data from 7 prospective studies with 399,767 participants and 3137 lung cancer cases. Study-specific relative risks (RRs) and CIs were estimated and then combined to calculate pooled multivariate RRs by using a random-effects model. We found a slightly greater risk for the consumption of > or = 30 g alcohol/d than for that of 0 g alcohol/d in men (RR: 1.21; 95% CI: 0.91, 1.61; P for trend = 0.03) and in women (RR: 1.16; 95% CI: 0.94, 1.43; P for trend = 0.03). In male never smokers, the RR for consumption of > or = 15 g alcohol/d rather than 0 g alcohol/d was 6.38 (95% CI: 2.74, 14.9; P for trend or = 30 g alcohol/d than with no alcohol consumption. Alcohol consumption was strongly associated with greater risk in male never smokers. Residual confounding by smoking may explain part of the observed relation.
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                Author and article information

                Journal
                Chin Med J (Engl)
                Chin. Med. J
                CM9
                Chinese Medical Journal
                Wolters Kluwer Health
                0366-6999
                2542-5641
                5 July 2020
                19 June 2020
                : 133
                : 13
                : 1526-1532
                Affiliations
                [1 ]Global Alliance Against Chronic Respiratory Diseases, Geneva 1208, Switzerland
                [2 ]High School of Health Administration, First Moscow Medical Academy, Moscow 119991, Russia.
                Author notes
                Correspondence to: Dr. Nikolai Khaltaev, 4 Chemin Francois Joulet, 1224 Chene Bougeries, Geneva 1224, SwitzerlandE-Mail: khaltaevn@ 123456bluewin.ch
                Article
                CMJ-2020-436 00003
                10.1097/CM9.0000000000000918
                7386357
                32568874
                9ee0b845-9721-45df-b0c4-8458b29cfca1
                Copyright © 2020 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                : 25 February 2020
                Categories
                Original Articles
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                lung cancer,lifestyle modifications,tobacco,physical activity

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