Effects of Smoking and Other Risk Factors for Lung Cancer in A Lung Screening Test Cohort Amongst Men in Australia

Aims of Lung Screening Test

Smoking is injurious to health and it is directly associated with lung cancer. It is one of main underlying risk factor that lead to lung cancer or promote the development of lung cancer in an individual. There are other underlying risk factors as well, but smoking is shown to have a direct impact on an individuals’ health (Laaksonen, 2018). Both first hand and second hand smoking can be fatal for the person, especially if the person is having other respiratory problems as well. This study will help in evaluating the risk of the same in a larger population of men. It will help in determining the various other causative factors leading to lung cancer. It will also help in determining as how effective is the lung screening process in examining the effect of smoking contributing to the manifestation of lung cancer in men in Australia (Wong, 2017). The data will be able to give a reflective quality result, especially when tested in a group of individuals or within a larger group of population.

The study will be one of its kind as it will be able to get a unified information after considering a larger group of population. It will also be helpful in correlating other risk factors in terms of degree of harm they can cause in attributing to lung cancer manifestation. Participants in the study will be recruited with the information taken from Lung Health Australia (Lung Health Australia, 2019). The patients having multiple risk factors will be taken in to consideration for the study purpose. The details of socio-economic characteristics will be also be defined for the study group taken into consideration for the study purpose. The study will be further helpful in determining the effectiveness of the screening process for lung cancer and will also be helpful in providing an insight about developing intervention strategies for preventing the manifestation of lung cancer in men in Australia.

Objectives of Lung Screening Test

Primary objectives-

  1. To determine the gravity of risk of lung cancer in the population or men in Australia who have a history of smoking.
  2. To determine the risk of other factors attributing to the development of lung cancer in men in Australia.
  3. To determine the impact of smoking as well as other risk factors for lung caner in men in Australia.

Secondary objectives-

  1. To determine the effectiveness of screening process in evaluating the impact of smoking in causing lung cancer in men in Australia.
  2. To determine the effectiveness of screening process in evaluating the impact of risk factors apart from smoking, in causing lung cancer in men in Australia.

Hypothesis of Effects of Smoking

The main hypothesis of this study is to determine the impact of smoking and other risk factors attributing to the development of lung cancer in men. The same is to be evaluated with eth help of screening tests. Another hypothesis can be formulated as per the interaction between modifiable as well as non-modifiable risk factors that can be associated with lung cancer.

Hypothesis 1- There is significant impact of smoking and other risk factors for lung cancer as per lung cancer screening tests.

Hypothesis 2- There is no significant impact of smoking and other risk factors for lung cancer as per lung cancer screening tests.

Background of Effects of Smoking

lung cancer in Australia is the fourth leading cause of death. The number of deaths caused by lung cancer are greater in number as compared to number of deaths caused by bowel or breast cancer on an annual basis. Until a recent survey done in 2019, lung cancer still remains the fifth most commonly diagnosed cancer in Australian population (Australian Government, Cancer Australia, 2019). The number of cases of lung cancer however, are observed to be more in men as compared to women in Australia. The number of deaths has also been rising constantly with the years due to prevalence of lung cancer in individuals. The rate of mortality has also shown to be higher in advancing age (Dunn, 2017). However, with the advanced screening process available the survival rates of patients having lung cancer has been improved drastically. At the end of 2014, there were 7,286 people living who had been diagnosed with lung cancer that year, 17,603 people living who had been diagnosed with lung cancer in the previous 5 years (from 2010 to 2014) and 28,089 people living who had been diagnosed with lung cancer in the previous 33 years (from 1982 to 2014) (Yu, 2017).

Numerous risk factors have been identified over the past few years, contributing to the formation of lung cancer in individuals. Some risk factors can be modifiable in nature such as environmental risk factors, while other can not be modified such as factors including genetics as well as family history. People having lung cancer are also usually found to be having one or more factors at the same time. Still the development of cancer in any individual is to be analysed from an individual’s perspective as well. The groups on the basis of which lung cancer in the study will be examined will be broadly classified as per inclusive of age, socio-economic factors, cultural factors, personal history as so on.

The few crucial risk factors that can be associated with manifestation of lung cancer in Australian men population can be as follow: -

  • Smoking- The evidence of smoking is directly associated with manifestation of lung cancer in any individual. Up to 90 %of the cases have been reported for lung cancer having a severe smoking history (Evans, 2019). Cumulative smoking intensity including number of cigarettes smoked as well as the duration of smoking are the main factors contributing to the development of lung cancer in individuals. The pack years of an individual are also a direct indicator of the intensity and severity of development of lung cancer in the person. The greater the duration and intensity of smoking, the larger impact it has on increasing the chances of mortality from the same. The mortality rate can be observed to be much higher in an individual having a smoking history with advancing age as compared to a young individual. Studies have shown that the effect of smoking duration and intensity on development of lung cancer has been observed to be increasing linearly as the intensity and duration increases (McIntyre, 2017). Studies have also shown that when a smaller number of cigarettes were smoked for a prolonged duration, the same was shown to cause a greater exposure for the manifestation of the disease (Tobacco in Australia, 2019). More than 20 cigarettes per day, the risk has been shown to decrease as well as the intensity and duration progresses. The manifestation of lung cancer is thus, found to be impacted directly with the individual’s habit. Smoking has not only shown to increase the underlying risk of lung cancer, but is also shown to adversely impact the prognosis, once the patient is diagnosed with lung cancer. Survival rate in various different types of lung cancer is also shown to be different and it is also varied along with the mortality rate.
  • Lifestyle modifications- The main life style modification is the person having current to former smoker status. The risk of development of lung cancer in individuals is comparatively more who began smoking at an early age. Even if the person is having a higher smoking consumption but has started smoking at an advanced age, the underlying risk factor is still less (Morampudi, 2017).
  • Environmental or occupational factors- The main factor contributing to the same can be second hand smoke. The constant exposure to second hand smoking is found to have more detrimental effects than the first hand smoking itself. The patient is prone to get more infectious manifestation post exposure to the same. The occupational hazards such as exposure to asbestoses, diesel exhaust as well as silica and other environmental pollutants can be hazardous to health as well (Malhotra, 2016). These exposures are also found to have a direct impact in the limning of the lung tissues leading to its constant damage and thus, leading to the development of lung cancer. Exposure to air pollution can also be another major contributing factor for the same.
  • Personal factors- These can be inclusive of the person’s age, genetics, family or personal history or any other associated lung disease or infection. The age factor can be of vital importance in evaluating the manifestation of lung cancer in patients. Individuals having a smoking history from an early inset of age are more prone to develop lung cancer. With the advancing age the disease is also found to have more detrimental effects and having lesser treatment options in individuals (Ten, 2019). The advancing age is also a factor contributing to decreased immunity in an individual leading to the development of more profound and advanced infections and impacts secondary to the development of lung cancer in an individual. Genetic factors can also be directly linked as a potential risk factor for the development of the lung cancer in an individual. Some individuals might be having deficiencies leading to the development of lung cancer in them. Individual person history is also of vital importance. The patient having person history of any lung condition are also prone to develop lung cancer. The immunity of the individuals suffering from the same can be very low, leading them to the chances of development of recurrent infections (Kanwal, 2017). These conditions left untreated for prolonged duration can lead to the manifestation of lung cancer in an individual. Some of the chronic lung conditions in which patients have been observed to develop lung cancer are inclusive of cystic fibrosis, chronic bronchitis, chronic obstructive pulmonary disease, interstitial lung disease and so on.

Research Plan on Effects of Smoking

Study Design

The study will be based on men population- based cohort study. The screening process will be conducted with the help of Lung Health Australia. The data base will be able to provide with the information regarding the statistics of number of cases as well the mortalities associated with lung cancer. The study will also be inclusive of patients that are bound for a CT-scan or PET- scan for their lung cancer. All males between the age group of 40-60 years will be included in the case study having a set diagnosis of lung cancer. The baseline parameters of various risk factors will be evaluated for the patients. Due consideration to smoking as well as other health and personal related risk factors will be examined. The diagnosed lung cancer cases for over a duration of one year will be taken into consideration for the research purpose.

Outcome

Outcome of the study will be based on a one-year follow-up post diagnosis of lung cancer and patient ongoing with the treatment of the same. The data base will help in identifying the individuals who have been regularly following up for their routine scanning and screening process. The outcome will also help in identifying the effectiveness of the scanning process in determining the progression of the cancer. It will also be helpful in examining the severity of other risk factors in contributing to the formation of breast cancer in the individuals.

Study factors

The study will be inclusive of patient having an active smoking status. The participant can be having one or more associated risk factor at a same given point of time. Individual information such as personal as well professional history will also be taken in to due consideration. Person’s pack years will be dully noted. The participant will also be examined for their current diagnosis and ongoing treatment intervention for managing their condition. The study will be based on self- reported information given by the participants, inclusive of their dietary habits, smoking habits, occupational information, family history and so on. Screening and prognostic history will also be taken into deep consideration for the study purpose. This will help in relating the symptoms reflected by the patient as well as their stage of cancer, as expressed by the diagnostic testing.

Sample size

The study will be based out of Queensland, Australia. The study will be conducted over a duration of a year’s time. The study will take into consideration a sample size of 10,000 recruits. The response rate will be sufficient enough to reflect upon significant findings from the study. All men having a currently active smoking status will be included in the study and they should also be having a follow-up scans available with a set diagnosis of lung cancer. The groups will be segregating on the basis of one group having smoking as the main risk factor and other group based on risk factors apart from smoking.

Recruitment

The participants will be selected randomly from the data base. They will be provided with a questionnaire having various options to mark from. The appointment letter will be sent on the basis of deep scanning and after dully examining the candidate for full filling all of the required criteria. The participants will be able to answer the questions as per their own ease and understanding of the matter. The participants have to dully fill the answers on their own without any additional support externally, to provide them with the freedom to answer as per their own comfort.

Sample collecting

The participants will be selected randomly from the database as per the researcher’s ease. They should however, be able to meet all of the criteria for the study purpose (Sharma, 2017). Each participant will be provided with a specific identification number to keep a close tab on the progress of the same. This will also be helpful in reducing the detailed effort required in compiling the data on a larger scale. The data will be selected randomly, as it enables a researcher to choose for the participants from a larger pool of individuals. It also loosens the constrain of streamlining the data collection and thus allows, lager sample size to be collected with much ease. The result obtained from each participant will be marked under a specific identification number to make it easy to reduce the chances of confusion while compiling the data in a conclusive manner.

Analysis

The cases of lung cancer will be evaluated mainly on the basis of risk factors and the screening interventions done to examine the impact of the same on lung cancer. The self-reported answers will be able to give a detailed insight on the factors that are not easy to collect ideally. This can be inclusive of noting for personal history of the patient and their smoking details which usually the patients are reluctant to answer about. The analytic strategy will also be based on the objectives determined for the study purpose. The study will be concluded with the help of thematic analysis of the data collected from the survey method (Braun, 2019). This will help in evaluating the univariate as well as bivariate association between the various risk factor contributing to the manifestation of the lung cancer in men. Thematic analysis method will also be able to link the risk factors with the screening process and thus, helping in determining their effectiveness in diagnosing the manifestation of lung cancer in the individuals.

Bias

The main bias of the study will be considering only men for the screening purpose. Also, the age group defined for the study purpose is very stringent. The risk factors can have different impact on the development of ling cancer in terms of gravity and intensity of the diseased condition. These risk factors can not be streamlined in terms of impact on the scanning and screening process as well. The accuracy of the results will also be directly impacted by the same. There are multiple base line parameters considered for the study purpose which might overlap during the research conduction process. It can also be difficult to streamline the results as the participants might not be having similar risk factors contributing to the development of lung cancer in them (Moser, 2017). The study is also constrained to one specific geographic region. The environmental factors can override other attributing factors causing lung cancer in men. The confounding factors such as age, socio-economic status, person history and so on will also be dully considered for analysis purpose and might not be able to provide a clear picture in terms of relating these individual factors with one another.

Ethical Consideration of Effects of Smoking

The study will be inclusive of the following ethical considerations:

  • The participants will be provided with an informed consent prior to conducting any step of the study.
  • The participants will be included in the study only after agreeing upon the consent by dully signing off the same (Kaewkungwal, 2019).
  • They will be given details about the study and its importance for future inferences.
  • They will also be regularly updated about the progress of the study through emails or via telephonic conversations.
  • The privacy and dignity of the participants will be maintained at all times during the conduction of the study (Schamp, 2019).
  • The subjects will not be subjected to any kind of harm or injury during the process.
  • The participants are allowed to withdraw their names from the study at any point of time, if they feel not comfortable participating in the research study.

Proposed Timeline of Effects of Smoking

The study will be conducted over a duration of one-year span. The parts of research will be divided over the months in the following manner:

Chapters/Time

Month 1

Month 2

Month 3

Month 4

Month 5

Month 6

Month 7

Pilot study

             

Participants requirement

             

Ethical approval

             

Data collection & analysis

             

Conclusion

             

Outcomes and Significance of Effects of Smoking

The study will be helpful in determining the main risk factors that is the leading cause, contributing to the development of lung cancer in men. The risk factors of smoking and other factors can also be correlated with each other. It will also provide and insight on the screening process and how it can be helpful in not only diagnosing lung cancer but also helping in managing the same. The cumulative effect of the analysis of the same will be able to determine the interventions helpful in early detection and prevention of lung cancer. This will also be helpful in reducing the overall mortality associated with the diagnosis of lung cancer. It will be helpful in improving the overall quality of life of the patient by reducing the negative impact on the condition of the individual.

References for Epidemiology of Non-Communicable Diseases

Australian Government, Cancer Australia, 2019. Retrieved from https://lung-cancer.canceraustralia.gov.au/statistics

Lung Health Australia, 2019. Retrieved from https://www.lunghealthaustralia.com.au/about-your-health/lung-and-sleep-health/lung-cancer-screening#:~:text=Unlike%20bowel%20cancer%20and%20breast,is%20mainly%20long%20term%20smokers.

Tobacco in Australia, 2019. Retrieved from https://www.tobaccoinaustralia.org.au/

Yu, X. Q., Luo, Q., Kahn, C., Cahill, C., Weber, M., Grogan, P., ... & O’Connell, D. L. (2017). Widening socioeconomic disparity in lung cancer incidence among men in New South Wales, Australia, 1987–2011. Chinese Journal of Cancer Research29(5), 395.

Wong, M. C., Lao, X. Q., Ho, K. F., Goggins, W. B., & Shelly, L. A. (2017). Incidence and mortality of lung cancer: global trends and association with socioeconomic status. Scientific reports7(1), 1-9.

Laaksonen, M. A., Canfell, K., MacInnis, R., Arriaga, M. E., Banks, E., Magliano, D. J., ... & Gill, T. K. (2018). The future burden of lung cancer attributable to current modifiable behaviours: a pooled study of seven Australian cohorts. International Journal of Epidemiology47(6), 1772-1783.

Morampudi, S., Das, N., Gowda, A., & Patil, A. (2017). Estimation of lung cancer burden in Australia, the Philippines, and Singapore: an evaluation of disability adjusted life years. Cancer Biology & Medicine14(1), 74.

Malhotra, J., Malvezzi, M., Negri, E., La Vecchia, C., & Boffetta, P. (2016). Risk factors for lung cancer worldwide. European Respiratory Journal48(3), 889-902.

Ten Haaf, K., Jeon, J., Tammemägi, M. C., Han, S. S., Kong, C. Y., Plevritis, S. K., ... & Meza, R. (2017). Risk prediction models for selection of lung cancer screening candidates: a retrospective validation study. PLoS medicine14(4).

Kanwal, M., Ding, X. J., & Cao, Y. (2017). Familial risk for lung cancer. Oncology Letters13(2), 535-542.

Sharma, G. (2017). Pros and cons of different sampling techniques. International Journal of Applied Research3(7), 749-752.

Braun, V., Clarke, V., Hayfield, N., & Terry, G. (2019). Thematic analysis. Handbook of Research Methods in Health Social Sciences, 843-860.

Moser, C. A., & Kalton, G. (2017). Survey Methods in Social Investigation. Routledge. United Kingdom

Kaewkungwal, J., & Adams, P. (2019). Ethical consideration of the research proposal and the informed-consent process: An online survey of researchers and ethics committee members in Thailand. Accountability in Research26(3), 176-197.

Schamp, C., Heitmann, M., & Katzenstein, R. (2019). Consideration of ethical attributes along the consumer decision-making journey. Journal of the Academy of Marketing Science47(2), 328-348.

Evans, S. M., Earnest, A., Bower, W., Senthuren, M., McLaughlin, P., & Stirling, R. (2016). Timeliness of lung cancer care in Victoria: a retrospective cohort study. Medical Journal of Australia204(2), 75-75.

Dunn, J., Garvey, G., Valery, P. C., Ball, D., Fong, K. M., Vinod, S., ... & Chambers, S. K. (2017). Barriers to lung cancer care: health professionals’ perspectives. Supportive Care in Cancer25(2), 497-504.

McIntyre, A., & Ganti, A. K. (2017). Lung cancer—a global perspective. Journal of Surgical Oncology115(5), 550-554.

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