Alberto Ruano Raviña

Cambios en la tendencia sobre la mortalidad por enfermedad pulmonar obstructiva crónica: ¿realidad o ficción?

Because of its high prevalence, morbidity and mortality and associated costs, chronic obstructive pulmonary disease (COPD) is today a major health problem.1 The cumulative effects of exposure to tobacco smoke, progressive population ageing, less under-diagnosis and the effect of new treatments and better living conditions are all factors that could change COPD prevalence and mortality rate. Both prevalence and mortality are expected to peak in the next 20–30 years1–3 but several Spanish, European and US cohort studies in COPD mortality trends have raised doubts as to whether prevalence really is stabilising or even falling.2,4,5 Of particular relevance is the work of López-Campos et al.5 in analysing COPD mortality patterns in 27 European countries (including Spain) between 1994 and 2010. The study shows a steady downward trend in mortality among men, although far less so among women, in most of the countries studied, suggesting a rather more optimistic view of the future of the disease. The discrepancies between these results and those of other studies force us to reflect on the findings and consider whether COPD mortality rates are actually falling, or whether the study methodology is flawed, since it is notoriously difficult to establish the specific cause of death and precipitating factors in patients with this disease, particularly those of more advanced age and disease severity.3,5,6 Several studies have shown that mortality from COPD is under-reported in patients with very severe COPD, so that only 22% of death certificates list this as the primary causes of death.7 Paradoxically, in nearly half of all cases in which COPD is given as the cause of death, obstruction was not detected on spirometry, illustrating the prevalence of diagnostic imprecision in COPD.7 Factors such as improvements in systems used to register and encode causes of death together with greater accuracy in diagnosing COPD could, according to the authors,5,8 be affecting these results. The steady increase in the mean age of patients dying from COPD in

Abstract 1274: Alcohol and lung cancer risk: a pooled analysis using International Lung Cancer Consortium studies

Proceedings: AACR Annual Meeting 2014; April 5-9, 2014; San Diego, CA Background: Alcohol consumption is known to be associated with risk of developing several cancers. It is unclear, however, whether alcohol consumption is a risk factor for lung cancer. The relationship between lung cancer and alcohol consumption is likely to be confounded by smoking. To minimize potential confounding by tobacco consumption, we conducted a pooled analysis to examine the association of alcohol consumption with lung cancer risk in a large sample of never-smokers. Methods: We pooled data from 22 case-control and cohort studies from North America, Europe and Asia within the International Lung Cancer Consortium (ILCCO) and SYNERGY Consortium. We examined the association of average lifetime alcohol consumption (expressed as average grams per day intake) with lung cancer risk in never smokers using logistic regression to model categories of alcohol consumption (0<5g per day, 5<10g per day, 10<20g per day, 20<30g per day, 30<45g per day, 45+ g per day). To investigate the shape of the dose response relationship, we applied restricted cubic spline models to examine the association for lung cancer risk overall and by histological subtype. Additional analyses examined wine, beer and liquor consumption in relation to risk, with mutual adjustment for each alcoholic beverage. All analyses were adjusted for age, sex, education, ethnicity and study. Results: A total of 2548 never-smoking cases and 9362 never-smoking controls were included in the analysis. The results showed lower risk among consumers of alcohol with strongest evidence found for moderate drinkers relative to non-drinkers with ORs of 0.80 (95% CI 0.70-0.90) and 0.82 (95% CI 0.69-0.99) for <5grams and 5-10 grams of alcohol per day respectively. Non-linear restricted cubic splines showed reduced lung cancer risk among moderate drinkers relative to non-drinkers with risk increasing towards the null as consumption increased. Similar results were seen for adenocarcinoma and squamous cell carcinoma. Associations with lung cancer differed for wine and beer consumption. Reduced risk was observed for wine drinking particularly at low levels of drinking, OR of 0.80 (95% CI=0.69-0.94) for <5g per day. Risk for beer consumption increased from close to null among occasional drinkers to 1.54 (95% CI 0.90-2.65) among consumers of 20-30g of alcohol per day (test for trend P=0.09). Conclusions: These results indicate an inverse association between moderate drinking and lung cancer risk relative to never drinkers. However, the inverse association was restricted to wine consumption, not consumption of beer. Lifestyle differences between consumers of beer and wine may play a role in differing patterns of risk found by alcohol type. Citation Format: Gordon Fehringer, Darren Brenner, Zuo-Feng Zhang, Yuan-Chin Amy Lee, Keitaro Matsuo, Isabelle Stucker, Paolo Vineis, Paolo Boffetta, Paul Brennan, Maria T. Landi, Hal Morgenstern, Curtis C. Harris, Qing Lan, Yun-Chul Hong, Jack Siemiatycki, John R. McLaughlin, Philip Lazarus, Joshua Muscat, Ann G. Schwartz, Juan M. Barros Dios, Alberto R. Ravina, Gad Rennert, David C. Christiani, Adonina Tardon, Loic Le Marchand, Irene Orlow, Eric J. Duell, Angeline S. Andrew, Hermann Brenner, Dario Consonni, Ann Olsson, Kurt Straif, Rayjean J. Hung. Alcohol and lung cancer risk: a pooled analysis using International Lung Cancer Consortium studies. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1274. doi:10.1158/1538-7445.AM2014-1274