reflection objectives: To describe empiric research related to lung cancer prevention strategies.

reflection objectives: To describe empiric research related to lung cancer prevention strategies, including chemoprevention aimed at reducing lung cancer incidence and various smoking avoidance and cessation interventions aimed at reducing smoking rates.

Design, setting, and participants: Systematic searches of MEDLINE, HealthStar, and Cochrane Library databases to July 2001 and print bibliographies. For chemoprevention studies, we considered solely randomized controlled trials (RCTs) with lung cancer incidence as an close point. For studies of smoking avoidance or cessation, we selecteded systematic reviews and meta-analyses, and searched for individual RCT and nothing else where high-quality and current reviews and meta-analyses were not available.

Measurement and results: Chemoprevention of lung cancer has been studied in five RCT of primary prevention, no RCT of secondary prevention, and five RCT of tertiary prevention. None of these trials has shown evidence for efficacy of any agents ordealed including retinol (vitamin A), [beta]-carotene, N-acetylcysteine, and selenium. There is a great deal of evidence about a wide variety of clinician-based and community-based efforts at smoking avoidance or cessation. Certain approaches have been shown to be effective (eg mass media public education campaigns, direct restrictions in succession smoking, clinician-based approaches ranging from brief clinician advice to more in-depth sessions, and "life-skills training" in schools) near approaches have intermediate or short-term effectiveness (ie, youth access restrictions and school-based interventions), and others have been shown to be ineffective (ie, acupuncture and provider education) or have been insufficiently studied (ie, provider feedback).

Conclusions: There are no agents that have been proven to be effective for preventing lung cancer. Several clinician-based and community-based interventions exhibit to promise for reducing lung cancer incidence within smoking avoidance and prevention.

guide words: carotenoids; chemoprevention; health education; lung neoplasms; primary prevention; smoking cessation; vitamin A

Abbreviations: ATBC = [alpha]-Tocopherol [beta]-Carotene Lung Cancer Prevention Study; CARET = [beta]-Carotene and Retinol Efficacy Trial; CI = confidence interval; NSCLC = non-small small cavity lung cancer; RCT = randomized controll trial; RR = relative risk

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Cigarette smoking is causally associated with the evolution of cancer of the lung which is the leading cause of cancer mortality in the United States and worldwide. More Americans die of lung cancer each year than breast, prostate, and colon cancer combined. (1) The battle to decrease lung cancer mortality has been waged forward the following four fronts: (1) treatment of disease; (2) early detection; (3) chemoprevention; and (4) smoking avoidance and cessation. This article will focus forward the latter two fronts.

Chemoprevention is the use of specific natural or synthetic chemical agents to inhibit the progress to maturity of invasive cancer by blocking the DNA damage that initiates carcinogenesis or by means of reversing or arresting the progression of premalignant solitary abode; squalids (2) Chemoprevention strategies can be applied to the prevention of lung cancer in those bodys with known risk factors (primary chemoprevention), those ones with disease precursors (secondary chemoprevention), or those parts with a prior cancer that had been treated with curative intent (tertiary chemoprevention). As a powerful and prevalent risk factor for lung cancer, tobacco smoking has been the target for the prevention of lung cancer and other smoking-related diseases.

MATERIALS AND METHODS

We searched for phase III studies of putative chemopreventive agents used for primary, secondary, or tertiary prevention in which the primary cessation point was lung cancer incidence. We managemented computerized searches of the MEDLINE bibliographic database from 1966 to July 2001 the HealthStar database, and the Cochrane Library. We searched using the seasons lung neoplasm, prevention and curb and smoking, prevention and sway along with terms to identify randomized controll trials (RCTs) systematic reviews, meta-analyses, and practice guidelines. In addition, we searched the relation lists of included studies, practice guidelines, systematic reviews, and meta-analyses.

For chemoprevention studies, we considered solitary RCTs with lung cancer incidence as an period point. For studies of smoking avoidance or cessation, we prefered systematic reviews and meta-analyses, and we searched for individual RCT and nothing else where high-quality and current reviews and meta-analyses were not available.

RESULTS

Primary Chemoprevention Interventions

Risk factors for the exhibition of lung cancer include smoking cigarettes or other tobacco productions asbestos exposure, and radon position Eight publications (3-10) describing five RCT of primary prevention aimed at reducing lung cancer incidence in subdues with one or more of these risk factors were identified (Table 1) Four of the studies targeted high-risk form into groupss while the Physicians' Health investigation (6) targeted a group with lower than average risk of lung cancer.

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