Scar Cancer of the Lung

Our plain-English summary of Scar Cancer of the Lung, by O. Auerbach, L. Garfinkel, V.R Parks (1979).

The study

• Authors: O. Auerbach, L. Garfinkel, V.R Parks
• Published: Cancer, Volume 43 No2. February 1979
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

The authors reviewed autopsy records and lung tissue slides from the Veterans Administration Hospital in East Orange, New Jersey, from January 1955 to January 1976. They were looking at 'scar cancers': lung cancers in the outer part of the lung that grew around old scar tissue. Lung cancer was found in 1,186 of 7,629 autopsies. Of these, 183 were peripheral tumors and 82 were scar cancers. Scar cancers made up 1.8% of all lung cancers in 1955-1959 and 15.9% in 1970-1975. Of the 82 scar cancers, 59 were adenocarcinomas, 15 squamous cell and 8 large cell carcinomas, and none were oat cell. Scars were linked to infarcts in 56.1% and to tuberculosis in 23.2%. One case (1.2%) was linked to asbestosis, which the authors identified by asbestos bodies. Among smokers, the share of peripheral cancers with scars did not rise with the amount smoked. Differences between occupational groups were not statistically significant. The authors concluded that rising national lung cancer death rates probably reflect, at least in part, an increase in scar cancers. They noted that small tumors may have been missed at autopsy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of routine autopsy records and lung tissue slides at one hospital
• Who was studied: Male veterans autopsied at the Veterans Administration Hospital, East Orange, New Jersey, 1955-1976. There were 7,629 autopsies, of which 1,186 showed lung cancer; 183 of these were peripheral lung cancers. Smoking and occupational histories were available for 116 of the 183 peripheral cases.
• Exposure: Pre-existing lung scars, classified by origin: infarct, tuberculosis, granuloma, asbestosis (indicated by asbestos bodies) or not evident. The authors also looked at cigarette smoking amount and broad occupational groups. No asbestos fiber types are named.
• Main results:
  • 82 cancers in the periphery of the lung were associated with a scar.
  • Scar cancers were 1.8% of all lung cancers in 1955-1959, 2.1% in 1960-1964, 7.8% in 1965-1969 and 15.9% in 1970-1975.
  • 45% of all peripheral lung cancers originated in a scar, and 68% in the 1970-1975 period.
  • Of the 82 scar cancers, 59 were adenocarcinomas, 15 squamous cell and 8 large cell carcinomas.
  • None of the oat cell or small cell peripheral carcinomas was found with a scar.
  • Scar origin among the 82 scar cancers: infarct 56.1%, tuberculosis 23.2% (per Table 3), granuloma 1.2%, asbestosis 1.2% (1 case), not evident 18.3%.
  • The two upper lobes together contained 76.8% of the scar cancers.
  • Among the 116 peripheral lung cancer cases with histories, the percent with a scar did not increase with cigarette smoking. A scar cancer was found in 46% of those smoking less than 1 pack a day, 45% of 1 pack a day smokers and 58% of 2 pack a day smokers.
  • The percent of peripheral lung cancers with scars was 54.1% in blue collar workers with probable dust, fume or vapor exposure, 45.2% in blue collar workers probably without such exposure and 44.4% in white collar workers. The difference was not statistically significant.
  • Metastases to most sites were proportionally greater for bronchogenic than for peripheral carcinomas.
• The authors' conclusion: The authors concluded it seems probable that the continuing increase in national lung cancer death rates reflects, at least in part, an increase in scar cancers, at a time when quitting smoking should have produced a modest decrease.
• Limitations the authors state:
  • Small lung cancers may have been missed at autopsy.
  • The authors do not know whether the rise reflects more lung scarring or scars becoming more susceptible to cancer.
  • The apparent fall in mean age at death of scar cancer cases may reflect a younger veteran population coming to autopsy in later years.
  • Masons, painters and dye and chemical workers seemed to have high percentages of scar tumors, but there were too few workers in each group to be certain.

Topics

Medical terms in this study, explained in our Lexicon: Autopsy, Lung Cancer, Adenocarcinoma, Squamous Cell Carcinoma, Carcinoma, Asbestos Bodies.

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