Lung Cancer
                   St. Anthony’s Hospital
                          1987 – 2005   

All analytic cases of lung cancer collected by the cancer registry at St. Anthony’s (SAH) from 1987 through 2005 were reviewed and the data compared with national data from SEER and the NCDB data base for the year 2000.


Lung Cancer is the second most common cancer seen at SAH accounting for 15% of all cases (n = 2,055 / 13, 705,  with breast #1 at 18% and prostate #3 at 14%). The number of cases per year has been stable (see figure 1). The median age of all patients was 71 (nationally 70y) and the 5-year relative survival was 16%. (SEER reported 15% 5-year relative survival for the period 1995 – 2000). Stage distribution and survival are similar to national data.

Small Cell Carcinoma of the Lung (SCLC)

Small cell carcinoma (SCLC) accounted for 17.5 % of all lung cancer cases (NCDB was 18.6%) or 360 cases with the male: female ratio of 48% to 52%, (NCDB ratio was 53% to 47%). The racial distribution was 93% white and 6% black (NCDB was 88% white and 7% black). The median age at diagnosis was 70 y. The survival with SCLC is worse than non-small cell with a median survival of 8 months and relative survival of 15%/ 2 years and 6.9% at 5 years (observed survival at 5 year was 5.37% and NCDB 5 year observed survival 5.3%).

NonSmall Cell Carcinoma (NSCL)

There were 1,695 cases with the male: female ratio of 53% to 47% (NCDB 58% to 42%).  The race distribution was white 92% and black 8%. The median age was 72.  The median survival was 8 months and the relative survival was 29% at 2 years and 18% at 5 years. The observed survival at 5 years was 13.53% and NCDB reported 14% 5 year observed survival.

Discussion: The incidence of lung cancer has been stable or declining nationally, related to effective smoking prevention and cessation programs. Small cell carcinoma accounts for 18% of all cases which is similar to national figures and women make up a larger percent of these cases. In modern chemoradiation programs the survival for limited stage SCLC is 14 – 18 months with survival rates in the 40% range at 2 years and 20% at 5y. In our group, the survival for local stage SCLC (median 17 months, 38%/2y and 25%/5y) and for regional stage (median 14 months/ 26%/2y and 12%/5y) was comparable. For extensive stage SCLC the survival is 6 – 12 months and 5%/ 2y (at SAH for distant stage the median survival was 6 months and 18.9%/1y, 6%/2y, 1.8%/5y) The experience with non-small cell carcinoma is also similar to national data.

                               Survival with Small Cell Carcinoma of the Lung

There has been increased interest in the incidence of lung cancer in non-smokers. It is estimated that of the 162,400 Americans who will die this year from lung cancer 15,000 will be non-smokers (9%). Among this group, women are 2-3 times more prevalent though a recent NCI paper found that the death rate from lung cancer among non-smokers was higher in men than women (17.1 versus 14.7 per 100,000). The apparent predominance of women presumably related to a higher prevalence of older women than men. We reviewed the experience at SAH with patients who were recorded as non-smokers in the cancer registry. this group made up 9% of all cases and women predominated (accounting for 68% of their group). All told, 5% of men with lung cancer were non-smokers but 13% of all women. The survival of non-smokers was similar to smokers, but the histology was different. Non-smokers were more likely to have adenocarcinoma or bronchoalveolar and smokers more likely to have squamous or small cell.

In conclusion, despite advances in management, lung cancer remains the biggest cancer killer and the greatest impact on reducing mortality may come from prevention and screening. The Oncology Committee endorses national efforts at smoking prevention and participation in high risk screening studies (e.g. low dose spiral CT.) If non-smoking lung cancer becomes more common then other aspects of prevention and screening may become even more important.

Robert Miller, MD / Sept 2006