Weeks 191 & 192: Not much to report & fake news in The Guardian

Written by Lars Haakon Soraas

Weeks 191 and 192 in the war on lung cancer have passed. It has been two rather uneventful weeks, which is good! Dyanne has been in increasingly good shape and she has put on more weight. We have also done research on what our next steps should be, and we are still working on that.

As there is not much else to report, I wanted to mention an article on lung cancer in never-smokers in The Guardian: https://www.theguardian.com/lifeandstyle/2019/apr/26/you-do-think-why-me-the-shocking-rise-of-lung-cancer-in-non-smokers. The article provides great focus on a major public health issue: lung cancer in never-smokers. However, the headline, which claims there is a “shocking rise”, and much of the storyline is, basically, fake news built on fake science. There is no good data showing that there is a shocking rise in lung cancer among never-smokers. Disturbingly many never-smokers get lung cancer, that much is true. However, a careful evaluation of the available data does not allow one to conclude there is any increase in lung cancer in never-smokers.

Since widespread dissemination of misinformation about an important public health topic is rather unfortunate, I decided to try to get to the bottom of why The Guardian story got this fact so dramatically wrong. And the reason seems to be this article which was published a few days ago in a journal called Journal of the Royal Society of Medicine (JRSM):

Lung cancer in never-smokers: a hidden disease

In the introduction, this article claims:

“Furthermore, the absolute numbers and rates of lung cancers in never-smokers are increasing, and this does not appear to be confounded by passive smoking or misreported smoking status.”

And in the conclusion the authors claim:

“Lung cancer in never-smokers is more common than most people think and on the rise” (my underlining).

The reference they provide for the claim that lung cancer in never-smokers is on the rise is this article from 2012:

Lung cancer in never-smokers – a review

The problem is that that article does not conclude that there is any increase in incidence of lung cancer in never-smokers. Here is what the authors of this article writes on the topic (“LCINS” stands for “lung cancer in never smokers”):

“Debate continues on where the reported incidence of LCINS in recent years represents a true increase. In 2001, Bofetta et al. observed a significant increase in the incidence of LCINS in a Swedish cohort: from 1.5/100 000 in 1976–1980 to as much as 5.4/100,000 in 1991–1995. Their results seemed to confirm earlier observations suggesting a progressive increase in LCINS since the 1930s and the emergence of non-tobacco related lung cancer risks. However, in a large analysis of cohorts and registries, Thun et al. observes no significant temporal trend in LCINS incidence and mortality among United States of America (US) never smokers from 1959 to 2004. The authors of a recent work found a decrease incidence in men but increase in women when compared to the preceding generation.”

So there is a debate, and most of the data is really old. The only fair conclusion one can draw from the above paragraph is that we really don’t know if the incidence of lung cancer in never-smokers is increasing, decreasing or flat. We simply don’t know.

I have emailed the author of the article in JRSM and asked that he corrects his article. I hope that he will.

I hope everyone has had a good weekend!

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