A Comprehensive Review of Lung Cancer: Epidemiology, Diagnosis, Treatment, and Risk Factors in Iraq
A Typical Review of Lung Cancer
DOI:
https://doi.org/10.29409/j7y8dw42Keywords:
Cancer, lung cancer, smoking, non-small-cellAbstract
Lung cancer, which is characterized by uncontrolled cell division in the lungs, is the leading cause of cancer-related death worldwide, accounting for one-fifth of all cancer deaths. This review aims to provide a comprehensive analysis of lung cancer, focusing on its epidemiology, diagnosis, treatment, and risk factors, particularly non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). The objective is to explore recent advancements in diagnostic techniques, including low-dose computed tomography (LDCT), liquid biopsies, and biomarker-based approaches, which enhance early detection and monitoring. Additionally, the review examines treatment strategies, including surgical interventions, chemotherapy, radiation therapy, targeted therapies, and immunotherapy, with a focus on personalized treatment plans based on cancer type and stage. Emerging risk factors, such as genetic predispositions and environmental exposures, are also discussed to highlight their implications for prevention and early intervention. In conclusion, this review underscores the importance of integrating the latest research and clinical advancements to improve diagnostic accuracy, develop innovative treatments, and implement preventive measures. By doing so, it aims to contribute to reducing the global burden of lung cancer and improving patient outcomes.
References
1. Chandraprasad MS, Dey A, Swamy MK. Introduction to cancer and treatment approaches. Paclitaxel Sources, Chem Anticancer Actions, Curr Biotechnol. 2021;1–27.
2. Al-Fartusie FS, Hafudh A, Mustafa N, Al-Bermani H, Majid AY. Levels of Some Trace Elements in Sera of Patients with Lung Cancer and in Smokers. Indian J Adv Chem Sci. 2017;5(4):344–52.
3. Klein AP. Pancreatic cancer epidemiology: understanding the role of lifestyle and inherited risk factors. Nat Rev Gastroenterol Hepatol. 2021;18(7):493–502.
4. Pandey A, Tripathi S. A brief description on cancer and natural remedies with potential anticancer activity: A review. J Pharm Biomed Anal Lett. 2014;2(1):85–95.
5. Marcu LG. Imaging biomarkers of tumor proliferation and invasion for personalized lung cancer therapy. J Pers Med. 2020;10(4):1–17.
6. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7–33.
7. Bade BC, Dela Cruz CS. Lung Cancer 2020: Epidemiology, Etiology, and Prevention. Clin Chest Med. 2020;41(1):1–24.
8. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49.
9. Batra H, Pawar S, Bahl D. Current clinical trials and patent update on lung cancer: A retrospective review. Lung Cancer Manag. 2021;10(2).
10. Statistics Canada. Canadian Cancer Statistics: A 2020 special report on lung cancer. Can Cancer Stat [Internet]. 2020;1–4. Available from: https://cc-arcc.ca/canadian-cancer-statistics-a-2020-special-report-on-lung-cancer/
11. Reem Nooreldeen, Horacio Bach. Current and Future Development in Lung Cancer Diagnosis. Int J Mol Sci. 2021;22(8661):1.
12. Simon GR, Turrisi A. Management of small cell lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132(3 SUPPL.):324S-339S.
13. Alexander M, Kim SY, Cheng H. Update 2020: Management of Non-Small Cell Lung Cancer. Lung. 2020;198(6):897–907.
14. CDPH. California Department of Public Health. Am Cancer Soc. 2010;1–14.
15. Al-Tarawneh MS. Leonardo Electronic Journal of Practices and Technologies Lung Cancer Detection Using Image Processing Techniques. 2012; Available from: http://lejpt.academicdirect.org
16. Edge SB, Compton CC. The american joint committee on cancer: The 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4.
17. Jin X, Pan Y, Zhai C, shen H, You L, Pan H. Exploration and machine learning model development for T2 NSCLC with bronchus infiltration and obstructive pneumonia/atelectasis. Sci Rep. 2024;14(1).
18. Magnoni F, Colleoni M, Mattar D, Corso G, Bagnardi V, Frassoni S, et al. Contralateral Axillary Lymph Node Metastases from Breast Carcinoma: Is it Time to Review TNM Cancer Staging? Ann Surg Oncol. 2020;27(11):4488–99.
19. He J, Xu S, Pan H, Li S, He J. Does size matter? - A population-based analysis of malignant pleural mesothelioma. Transl Lung Cancer Res. 2020;9(4):1041–52.
20. Menon B, Kulshrestha R, Aggarwal B, Sharma S, Jain P. A Rare Case of Non-Small Cell Lung Carcinoma in an 18-Year-Old Female. Indian J Chest Dis. 2006;(Figure 1):11–4.
21. Thangaraju P, Barkavi G, Karthikeyan T. Mining Lung Cancer Data for Smokers and Non Smokers by Using Data Mining Techniques. Int J Adv Res Comput Commun Eng. 2014;3(7):145–8.
22. Tanoue LT. The IASLC Lung Cancer Staging Project: Proposals for the Revision of the TNM Stage Groupings in the Forthcoming (Seventh) Edition of the TNM Classification of Malignant Tumors. Yearb Pulm Dis. 2009;2009:157–9.
23. Iams WT, Porter J, Horn L. Immunotherapeutic approaches for small-cell lung cancer. Nat Rev Clin Oncol. 2020;17(5):300–12.
24. 20. Refshauge A KD and GA. Lung cancer in Australia: an overview. Australian Institute of Health & Welfare. 2011;
25. Hoda SA, Hoda RS. Robbins and Cotran Pathologic Basis of Disease. Vol. 12, Advances in Anatomic Pathology. 2005. p. 103.
26. Travis WD. Update on small cell carcinoma and its differentiation from squamous cell carcinoma and other non-small cell carcinomas. Mod Pathol. 2012;25:18–30.
27. Chan BA, Coward JIG. Chemotherapy advances in small-cell lung cancer. J Thorac Dis. 2013;5(SUPPL.5).
28. Daly ME. Management of Stage III NSCLC: ASCO Guideline. J Clin Oncol [Internet]. 2022; Available from: www.asco.org/thoracic-cancer-guidelines
29. Crinò L, Weder W, van Meerbeeck J, Felip E. Early stage and locally advanced (nonmetastatic) non-small cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(SUPPL. 5).
30. Alfonse M, M. Aref M, M. Salem A-B. An Ontology-Based System for Cancer Diseases Knowledge Management. Int J Inf Eng Electron Bus. 2014;6(6):55–63.
31. Ruano-Raviña A, Provencio M, Calvo De Juan V, Carcereny E, Moran T, Rodriguez-Abreu D, et al. Lung cancer symptoms at diagnosis: Results of a nationwide registry study. ESMO Open. 2020;5(6).
32. 21. Anthony H., MM TE and GZ. Preventing Pulmonary Recurrence of Cancer With Lipid-Complexed Cisplatin - Anthony Forrest H. 2014; Available from: https://www.freepatentsonline.com/y2014/0065205.html
33. Ünal AA, Yazarkan Y, Sönmez G, Tenekeci AK. Revolutionizing Lung Cancer Care: the Multifaceted Approach of Artificial Intelligence, Liquid Biopsies, and Circulating Tumor Dna in Screening, Diagnosis, and Prognosis. Turkish Med Student J. 2024;32–9.
34. Ye J, Liu H, Xu ZL, Zheng L, Liu RY. Identification of a multidimensional transcriptome prognostic signature for lung adenocarcinoma. J Clin Lab Anal. 2019;33(9).
35. Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, et al. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA - J Am Med Assoc. 2021;325(10):962–70.
36. Kumar R, Reddy C, Kazerooni EA, Leard LE, Reid ME, Lackner RP, et al. Lung Cancer Screening, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2018;16(4):412–41.
37. Horeweg N, Scholten ET, de Jong PA, van der Aalst CM, Weenink C, Lammers JWJ, et al. Detection of lung cancer through low-dose CT screening (NELSON): A prespecified analysis of screening test performance and interval cancers. Lancet Oncol. 2014;15(12):1342–50.
38. Long B, Xiong Z, Habou M. Lung cancer screening, diagnosis, and treatment: The radiologist’s perspective. Meta-Radiology. 2024;2(1):100066.
39. Baeza S, Gil D, Sanchez C, Torres G, Carmezim J, Tebé C, et al. Radiomics and Clinical Data for the Diagnosis of Incidental Pulmonary Nodules and Lung Cancer Screening: Radiolung Integrative Predictive Model. Arch Bronconeumol. 2024;
40. Zyla J, Marczyk M, Prazuch W, Sitkiewicz M, Durawa A, Jelitto M, et al. Combining Low-Dose Computer-Tomography-Based Radiomics and Serum Metabolomics for Diagnosis of Malignant Nodules in Participants of Lung Cancer Screening Studies. Biomolecules. 2024;14(1).
41. Dziedzic R, Marjański T, Rzyman W. A narrative review of invasive diagnostics and treatment of early lung cancer. Transl Lung Cancer Res. 2021;10(2):1110–23.
42. Panakkal N, Lekshmi A, Saraswathy VV, Sujathan K. Effective lung cancer control: An unaccomplished challenge in cancer research. Cytojournal. 2023;20(16).
43. Noor FR, Iskandar H, Ilyas M, Santoso A, Arief E, Lihawa N, et al. Possitivity Rate of Sputum Cytology Compared to Bronchoscopy and Transthoracic Needle Aspiration in Lung Cancer Patients at Wahidin Sudirohusodo Hospital, Indonesia. J Cancer Tumor Int. 2023;13(2):14–20.
44. Gangopadhyay G, Siddiqui B. Pathological spectrum of lung lesions diagnosed by sputum cytology: A three years retrospective study in a tertiary health care center of North India. IP Arch Cytol Histopathol Res. 2023;8(2):95–8.
45. Soukiasian HJ, Leung A, Imai T, Bose S, Kim S, Mosenifar Z, et al. Highly sensitive noninvasive early lung cancer detection using DNA methylation topology in sputum-derived epithelial cells. JTCVS Open. 2023;13:389–410.
46. Wang G, Jin Y, Xiong K, Jin X, Wang L, Li C. Utility of auto fluorescence-guided biopsy in suspected lung cancer patients with bronchial mucosal lesions. Photodiagnosis Photodyn Ther. 2024;46.
47. Skouras VS, Gkiozos I, Charpidou AG, Syrigos KN. Robotic Bronchoscopy in Lung Cancer Diagnosis. Cancers (Basel). 2024;16(6):1179.
48. Wang S, Amar L, Zhu PS. Role and performance of bronchoscopy with cytologic samplings in lung cancer. Eur Respir J. 2023;PA5138.
49. Devi L, Verma Y, Kumar A, Khan F, Verma S, Kumar A. Understanding the Landscape of Bronchoscopy in Lung Cancer: Insights From Lesion Location, Gender, and Diagnostic Efficacy. Cureus. 2024;16(2).
50. Satapathy S, Thirunavukkarasu B, Jain D. Application of liquid biopsy in lung cancer management. Indian J Pathol Microbiol. 2024;
51. Trulson I, Klawonn F, Von Pawel J, Holdenrieder S. Improvement of differential diagnosis of lung cancer by use of multiple protein tumor marker combinations. Tumor Biol. 2024;46:S81–98.
52. B. Dilmaghani-Marand B, M. Oremek G. Tumor Markers in Patients with Benign and Malignant Pulmonary Diseases; Competitive Evaluation of ProGRP, NSE and Cyfra 21-1. Recent Pat Biomark. 2013;3(2):145–52.
53. Cheng T, Chen J, Ying P, Wei H, Shu H, Kang M, et al. Clinical risk factors for carbohydrate antigen-125, cytokeratin fragment 19, and neuron-specific enolase in liver metastases from elderly lung cancer patients. Front Genet. 2022;13.
54. Mohamed E, García Martínez DJ, Hosseini MS, Yoong SQ, Fletcher D, Hart S, et al. Identification of biomarkers for the early detection of non-small cell lung cancer: a systematic review and meta-analysis. Carcinogenesis. 2024;45(1–2):1–22.
55. Ma L, Xie XW, Wang HY, Ma LY, Wen ZG. Clinical evaluation of tumor markers for diagnosis in patients with non-small cell lung cancer in China. Asian Pacific J Cancer Prev. 2015;16(12):4891–4.
56. Wang L, Wang D, Zheng G, Yang Y, Du L, Dong Z, et al. Clinical evaluation and therapeutic monitoring value of serum tumor markers in lung cancer. Int J Biol Markers. 2016;31(1):e80–7.
57. Cedrés S, Nuñez I, Longo M, Martinez P, Checa E, Torrejón D, et al. Serum tumor markers CEA, CYFRA21-1, and CA-125 are associated with worse prognosis in advanced non-small cell lung cancer (NSCLC). Clin Lung Cancer. 2011;12(3):172–9.
58. Riaz Khan R, Javed A, Kumar V. Role of Serum Tumor Biomarkers in Evaluating Lung Cancer. SSRN Electron J. 2020;
59. Boutsikou E, Hardavella G, Fili E, Bakiri A, Gaitanakis S, Kote A, et al. The Role of Biomarkers in Lung Cancer Screening. Cancers (Basel). 2024;16(11).
60. Van Den Broek D, Groen HJM. Screening approaches for lung cancer by blood-based biomarkers: Challenges and opportunities. Tumor Biol. 2024;46(s1):S65–80.
61. Lobera ES, Varela MA, Jimenez RL, Moreno RB. miRNA as biomarker in lung cancer. Mol Biol Rep. 2023;50(11):9521–7.
62. Landi, M. T., Pastorino, U., Terlizzi, G., Iezzi, M., Nunzi, S., Veglia F. MicroRNA expression as a surrogate for smoking exposure in the bronchial epithelium. J Natl Cancer Inst. 2011;103(23):1808–19.
63. Castro D, Moreira M, Gouveia AM, Pozza DH, De Mello RA. MicroRNAs in lung cancer. Oncotarget. 2017;8(46):81679–85.
64. El Alam R, Hammer MM, Byrne SC. Factors Associated With Delay in Lung Cancer Diagnosis and Surgery in a Lung Cancer Screening Program. J Thorac Imaging. 2024;
65. Chen, G., Gharib, T. G., Hummel, M., Krebs, V., Driscoll, J., Wang L. Discordance between gene-expression-based and pathology-based classification of lung adenocarcinoma. N Engl J Med. 2003;348(14):1285–93.
66. Lemjabbar-Alaoui H, Hassan OUI, Yang YW, Buchanan P. Lung cancer: Biology and treatment options. Biochim Biophys Acta - Rev Cancer. 2015;1856(2):189–210.
67. Rami-Porta R. The evolving concept of complete resection in lung cancer surgery. Cancers (Basel). 2021;13(11).
68. Gao S, Qiu B, Li F, Tan F, Zhao J, Xue Q, et al. Comparison of thoracoscopic anatomical partial-lobectomy and thoracoscopic lobectomy on the patients with pT1aN0M0 peripheral non-small cell lung cancer. Zhonghua Wai Ke Za Zhi. 2015;53(10):727–30.
69. Zhao Y, Wang W, Liang H, Yang CFJ, D’Amico T, Ng CSH, et al. The Optimal Treatment for Stage IIIA-N2 Non-Small Cell Lung Cancer: A Network Meta-Analysis. Ann Thorac Surg. 2019;107(6):1866–75.
70. Varghese TK. General Thoracic Surgery. Perioper Med Manag Outcome, Second Ed. 2021;505–10.
71. Handbook of cancer chemotherapy. Biomed Pharmacother. 1993;47(2–3):119.
72. Ball D. Curing Non-Small Cell Lung Cancer With Radiotherapy: No Longer an Oxymoron. Semin Radiat Oncol. 2015;25(2):65–6.
73. Tanoue LT. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. Yearb Pulm Dis. 2011;2011:89–91.
74. Anand U, Dey A, Chandel AKS, Sanyal R, Mishra A, Pandey DK, et al. Cancer chemotherapy and beyond: Current status, drug candidates, associated risks and progress in targeted therapeutics. Genes Dis. 2023;10(4):1367–401.
75. White MN, Piper-Vallillo AJ, Gardner RM, Cunanan K, Neal JW, Das M, et al. Chemotherapy Plus Immunotherapy Versus Chemotherapy Plus Bevacizumab Versus Chemotherapy Alone in EGFR-Mutant NSCLC After Progression on Osimertinib. Clin Lung Cancer. 2022;23(3):e210–21.
76. Besse B, Ropert S, Soria JC. Targeted therapies in lung cancer. Ann Oncol. 2007;18(SUPPL. 9).
77. Pal SK, Figlin RA, Reckamp K. Targeted therapies for non-small cell lung cancer: An evolving landscape. Mol Cancer Ther. 2010;9(7):1931–44.
78. Abourehab MAS, Alqahtani AM, Youssif BGM, Gouda AM. Globally approved egfr inhibitors: Insights into their syntheses, target kinases, biological activities, receptor interactions, and metabolism. Molecules. 2021;26(21).
79. D’Angelo A, Sobhani N, Chapman R, Bagby S, Bortoletti C, Traversini M, et al. Focus on ros1-positive non-small cell lung cancer (Nsclc): Crizotinib, resistance mechanisms and the newer generation of targeted therapies. Cancers (Basel). 2020;12(11):1–18.
80. Bhalla AT. Developing Alectinib-based Small-Molecule Antagonists to Treat Anaplastic Lymphoma Kinase Positive Non-Small Cell Lung Cancer. 2017;9:101–11.
81. Putzu C, Canova S, Paliogiannis P, Lobrano R, Sala L, Cortinovis DL, et al. Duration of Immunotherapy in Non-Small Cell Lung Cancer Survivors: A Lifelong Commitment? Cancers (Basel). 2023;15(3).
82. Sadeghirad H, Bahrami T, Layeghi SM, Yousefi H, Rezaei M, Hosseini-Fard SR, et al. Immunotherapeutic targets in non-small cell lung cancer. Immunology. 2023;168(2):256–72.
83. Akhtar M, Rashid S, Al-Bozom IA. PD−L1 immunostaining: what pathologists need to know. Diagn Pathol. 2021;16(1).
84. Baxevanis CN, Goulielmaki M, Adamaki M, Fortis SP. The thin red line between the immune system and cancer evolution. Transl Oncol. 2023;27.
85. Lee MJ, Ye AS, Gardino AK, Heijink AM, Sorger PK, MacBeath G, et al. Sequential application of anticancer drugs enhances cell death by rewiring apoptotic signaling networks. Cell. 2012;149(4):780–94.
86. Wu M, Sirota M, Butte AJ, Chen B. Characteristics of drug combination therapy in oncology by analyzing clinical trial data on clinicaltrials.gov. Pacific Symp Biocomput. 2015;68–79.
87. Meng J, Dai B, Fang B, Nebiyou Bekele B, Bornmann WG, Sun D, et al. Combination treatment with MEK and AKT inhibitors is more effective than each drug alone in human non-small cell lung cancer in vitro and in vivo. PLoS One. 2010;5(11).
88. Steiner P, Joynes C, Bassi R, Wang S, Tonra JR, Hadari YR, et al. Tumor growth inhibition with cetuximab and chemotherapy in non-small cell lung cancer xenografts expressing wild-type and mutated epidermal growth factor receptor. Clin Cancer Res. 2007;13(5):1540–51.
89. Wu L, Leng D, Cun D, Foged C, Yang M. Advances in combination therapy of lung cancer: Rationales, delivery technologies and dosage regimens. J Control Release. 2017;260:78–91.
90. Riely GJ, Wood DE, Ettinger DS, Aisner DL, Akerley W, Bauman JR, et al. Non–Small Cell Lung Cancer, Version 4.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw [Internet]. 2024;22(4):249–74. Available from: https://jnccn.org/view/journals/jnccn/22/4/article-p249.xml
91. Yang CFJ, Chan DY, Shah SA, Yerokun BA, Wang XF, D’Amico TA, et al. Long-term survival after surgery compared with concurrent chemoradiation for node-negative small cell lung cancer. Ann Surg. 2018;268(6):1105–12.
92. Yang CFJ, Chan DY, Speicher PJ, Gulack BC, Wang X, Hartwig MG, et al. Role of adjuvant therapy in a population-based cohort of patients with early-stage small-cell lung cancer. J Clin Oncol. 2020;34(10):1057–64.
93. Paz-Ares, L., Vicente, D., Tafreshi, A. et al. A randomized, placebo-controlled trial of pembrolizumab plus chemotherapy versus chemotherapy for metastatic squamous NSCLC: KEYNOTE-407 update. J Thorac Oncol. 2021;16(11):2109–2120.
94. Johnson ML, Cho BC, Luft A, Alatorre-Alexander J, Geater SL, Laktionov K, et al. Durvalumab with or Without Tremelimumab in Combination with Chemotherapy as First-Line Therapy for Metastatic Non-Small Cell Lung Cancer: The Phase III POSEIDON Study. J Clin Oncol. 2023;41(6):1213–27.
95. Videtic GMM, Donington J, Giuliani M, Heinzerling J, Karas TZ, Kelsey CR, et al. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol. 2021;11(3):163–176.
96. Takahashi, T., Yamanaka, T., Seto, T. et al. Prophylactic cranial irradiation versus hippocampal avoidance whole-brain radiation therapy in small-cell lung cancer: A multicenter, randomized phase III trial. J Clin Oncol. 2021;41(12):1345–1355.
97. Remon J, Soria JC, Peters S. Early and locally advanced non-small cell lung cancer: an update of the ESMO Clinical Practice Guidelines focusing on diagnosis, staging, systemic and local therapy. Ann Oncol. 2021;32(12):1637–42.
98. Wu YL, Tsuboi M, He J. Osimertinib in Resected EGFR-Mutated Non–Small-Cell Lung Cancer | Enhanced Reader. N Engl J Med. 2020;383:1711–1723.
99. Shaw, A. T., Bauer, T. M., de Marinis, F. et al. First-line lorlatinib or crizotinib in advanced ALK-positive lung cancer. N Engl J Med. 2020;383(21):2018–29.
100. Rudin CM, Awad MM, Navarro A, Gottfried M, Peters S, Csoszi T, et al. Pembrolizumab or placebo plus etoposide and platinum as first-line therapy for extensive-stage small-cell lung cancer: Randomized, double-blind, phase III KEYNOTE-604 Study. J Clin Oncol. 2020;38(21):2369–79.
101. Reck, M., Ciuleanu, T. E., Cobo, M. et al. First-line nivolumab plus ipilimumab combined with two cycles of chemotherapy in metastatic non-small cell lung cancer: CheckMate 9LA. J Clin Oncol. 2021;39(15):2655–2666.
102. Horn, L., Liu, S. V., Rafei, H. et al. Efficacy and safety of first-line atezolizumab plus carboplatin and etoposide in extensive-stage small-cell lung cancer: IMpower133 updated overall survival analysis. J Thorac Oncol. 2023;18(3):289–298.
103. Corrales L, Rosell R, Cardona AF, Martín C, Zatarain-Barrón ZL, Arrieta O. Lung cancer in never smokers: The role of different risk factors other than tobacco smoking. Crit Rev Oncol Hematol. 2020;148.
104. Benusiglio PR, Fallet V, Sanchis-Borja M, Coulet F, Cadranel J. Lung cancer is also a hereditary disease. Eur Respir Rev. 2021;30(162).
105. Hecht SS. Lung carcinogenesis by tobacco smoke. Int J Cancer. 2012;131(12):2724–32.
106. Peruga A, López MJ, Martinez C, Fernández E. Tobacco control policies in the 21st century: achievements and open challenges. Mol Oncol. 2021;15(3):744–52.
107. Proctor RN. The history of the discovery of the cigaretteelung cancer link: Evidentiary traditions, corporate denial, global toll. Tob Control. 2012;21(2):87–91.
108. Hackshaw AK, Law MR, Wald NJ. The accumulated evidence on lung cancer and environmental tobacco smoke. Pneumologie. 1998;52(1):55.
109. Al-Fartusie FS, Hafudh A, Mustafa N. Serum Concentrations of Vitamins a, C and D in Iraqi Patients With Lung Cancer and Smokers. Ijrpc [Internet]. 2015;2015(4):683–8. Available from: www.ijrpc.com
110. Samet JM, Avila-Tang E, Boffetta P, Hannan LM, Olivo-Marston S, Thun MJ, et al. Lung cancer in never smokers: Clinical epidemiology and environmental risk factors. Clin Cancer Res. 2009;15(18):5626–45.
111. Choi H, Mazzone P. Radon and lung cancer: Assessing and mitigating the risk. Cleve Clin J Med. 2014;81(9):567–75.
112. Boffetta P. Human cancer from environmental pollutants: The epidemiological evidence. Mutat Res - Genet Toxicol Environ Mutagen. 2006;608(2):157–62.
113. Strohmeier BR, Huntington JC, Bunker KL, Sanchez MS, Allison K, Lee RJ. What is asbestos and why is it important? Challenges of defining and characterizing asbestos. Int Geol Rev. 2010;52(7–8):801–72.
114. De Matteis S, Consonni D, Bertazzi PA. Exposure to occupational carcinogens and lung cancer risk. Evolution of epidemiological estimates of attributable fraction. Acta Biomed l’Ateneo Parm. 2008;79(SUPPL. 1):34–42.
115. Al-Naseri, A. S., & Al-Hadithi TS. Tobacco use and lung cancer epidemiology in Iraq: A cross-sectional study. East Mediterr Heal J. 2021;27(3):287–294.
116. Al-Mayahi, F. K., & Al-Salihi MM. Radon gas concentrations in residential areas of Southern Iraq and associated health risks. Environ Geochem Health. 2020;42(8):2567–2576.
117. Al-Dabbas, M. A., & Al-Khafaji RS. Air quality and respiratory health in urban Iraq: A case study of Baghdad. Environ Pollut. 2020;278(11):832.
118. Al-Zubaidy, M. H., & Al-Azzawi FH. Occupational exposure to carcinogens in Iraq’s oil and construction industries. Int J Environ Res Public Health. 2019;16(12):2159.
119. The Common polymorphisms in P21 and MDM2 genes as a risk factor for susceptibility and poor prognosis of non-small cell lung cancer in Iraqi population. J Popul Ther Clin Pharmacol. 2023;30(7).
120. Lawi ZK, Al-Shuhaib MBS, Amara I Ben, Alkhammas AH. Two missense variants of the epidermal growth factor receptor gene are associated with non-small cell lung carcinoma in the subjects from Iraq. Mol Biol Rep. 2022;49(12):11653–61.
121. McKay, J. D. et al. Large-scale GWAS identifies new lung cancer susceptibility loci and highlights genetic heterogeneity across histological subtypes. Nat Genet. 2020;52(3):237–248.
122. Zhang, X. et al. Novel Genetic Variants in TP53 and KRAS Associated with Lung Adenocarcinoma Risk in Non-Smokers. J Thorac Oncol. 2021;16(4):789–797.
123. Denholm R, Schüz J, Straif K, Stücker I, Jöckel KH, Brenner DR, et al. Is previous respiratory disease a risk factor for lung cancer? Am J Respir Crit Care Med. 2014;190(5):549–59.
124. Szyf M, Cheishvili D, Franco E, ... Dna methylation biomarkers for early detection of cervical cancer. US Pat App 17 … [Internet]. 2022;12(1):1–15. Available from: https://patents.google.com/patent/US20220073994A1/en
125. Li, Y. et al. Hypermethylation of CDKN2A as a Non-Invasive Biomarker for Early-Stage NSCLC. Epigenomics. 2022;14(4):321–335.
126. Yanaihara, N. et al. Circulating microRNAs as biomarkers for lung cancer diagnosis and prognosis. Cancer Res. 2020;80(12):2314–2325.
127. Wang, L. et al. A panel of circulating miRNAs for distinguishing benign pulmonary nodules from early-stage lung cancer. Mol Cancer. 2023;22(1):1–12.
128. Chen, Z. et al. Circulating tumor DNA analysis for EGFR mutation detection in NSCLC: A prospective multicenter study. J Clin Oncol. 2024;42(5):567–575.
129. IARC. Estimated Cancer, Incidence Mortality and Prevalence Worldwide in 2012No Title. Globcam [Internet]. 2014;1–6. Available from: http://globocan.iarc.fr/old/Factsheets/populations/graphs/pc21801.png
130. Hussain AMA, Lafta RK. Cancer trends in Iraq 2000–2016. Oman Med J. 2021;36(1):1–8.
131. Jalal Al-Mosawi A. The Pattern of Cancer in Iraq (2015-2018): An Overview. Arch Oncol Cancer Ther. 2020;3(2):11–3.
132. HashimAl Araji HM, Hassan BA. Evaluation Levels of IL-17 and IL-10 in Serum Patients of Lung Cancer in Both Types Non-Small Cell Carcinoma and Small Cell Carcinoma in Al Najaf province/Iraq. BIO Web Conf. 2024;108.
Additional Files
Received
Revised
Accepted
Published
Issue
Section
License
Copyright (c) 2025 Iraqi Journal of Cancer and Medical Genetics
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
