Wonder

Research Outline

Prepared for Ify A. | Delivered October 12, 2020

Lung Cancer in Premenopausal Women

Goals

To investigate the prevalence and incidence of lung cancer in pre-menopausal women (age >45 years). Identify risk factors, co-morbidities, and high-risk groups associated with Lung Cancer, support the findings with statistics. Report these statistics with the biological understanding of why a correlation exists between poor lung health or lung cancer in pre-menopausal women. 

Early Findings

Background: Lung cancer is one of the most common cancers in the world and one of the leading causes of cancer mortality among women in the United States.[1,2] In 2015, an estimated 105,590 women in the US were newly diagnosed with lung cancer and 71,660 died from this disease.[2]
One of the main risk factors associated with Lung Cancer is smoking, and the consumption of tobacco-derived carcinogens. However, sex-specificity is an additional risk factor. For example, women smokers have a three-times higher risk of developing lung cancer, compared to men.
Biologically, the onset of Lung Cancer is due to the occurrence of gene mutations, which is triggered by smoking. Further, the mutations are more frequent in women (compared to men), and amongst younger patients (compared to older patients). 
Although cigarette smoking is a strong risk factor for lung cancer in women. Whereas, nearly 10-15 percent of the cases occur among never-smokers, suggesting other independent factors play an important role in the etiology of lung cancer in women.
Sex-specific differences also exist amongst the type of lung cancers. Women largely present with adenocarcinoma, rather than squamous cell carcinoma, or large-cell lung cancer.
Relevant findings:According to a prospective study conducted between 1999 to 2016, in Mayo Clinic (Rochester, Minnesota), a cohort of 182 premenopausal women with lung cancer (age range 34-48 years) was enrolled in a follow-up study, with a mean age of 44 years at diagnosis. 
The study indicated that early menopause was associated with 64% of young females with a lung cancer diagnosis. 
In this study, early menopause was attributed to the chemotherapy-induced amenorrhea phenomenon.
According to the principal investigator of this study, Dr. Elizabeth Cathcart-Rake, "Chemotherapy for lung cancer patients appears to increase risk of early loss of menses in survivors."
Risk Factors:In a study that compared the sex-differences in the percentage of 'ever-smoking,' and 'never-smoking' groups; the study indicated that ever-smoking odds were higher in females (12.7), versus males (9.1).
With respect to lung cancer risk, given the level of smoking, women have a 1.7 times higher risk than men.
 Many recent studies have indicated a strong positive association between the consumption of hormone replacement therapy (HRT), and risk of lung cancer. Studies have shown that women, combined with the use of hormone therapy (estrogen plus progestin) demonstrated a 50% higher risk of lung cancer. 
In the Coronary Drug Research Project, men who received estrogen to reduce the risk of future cardiac events experienced increased mortality associated with lung cancer, compared to placebo; hence indicating a direct relationship between estrogen and lung cancer.
While, epidemiological data also supports the findings that estradiol and progesterone increase the risk of lung cancer diagnosis at a younger median age, with shorter median survival time. 
Cancer Treatment with chemotherapy or radiation therapy has been associated with early menopause.
Women with a family history of early menopause may also experience early menopause.
A Chinese study also highlighted other risk factors for lung cancer such as passive smoking, cooking oil fumes, and tea intake. 
In another study, early age i.e., age less than 40 years (compared to age > 40 years) was associated with a 70% decreased risk (odds ratio = 0.3) of lung cancer (adenocarcinoma). Whereas, the use of Estrogen replacement therapy significantly increased the risk of lung cancers amongst smoker women by 1.7 fold. While no interaction with body mass or weight was observed. 
Research Methodology:Please note that the purpose of this research strategy document is to: (i) translate the client's questions into addressable research aims; (ii) conduct one-hour preliminary research; (iii) outline the basic facts and statistics related to Lung Cancer incidence in premenopausal women, which shall serve as a groundwork for Wonder researchers; (iv) devise a research strategy based on project scopes.
Our preliminary research used Google Scholar, and Pubmed databases to search the terms: "lung cancer," "premenopausal women," "lung health," "risk factors," "incidence," "prevalence." Some researches that were restricted due to paywall were retrieved using the Countway Library access. Publications that cited a mean age <45 years were excluded. Relevant findings and an overview of the subject matter have been outlined in the early findings section. Most of the landmark studies that first indicated risk factors associated with Lung cancer in women were conducted between 1970 to 2010, some of these publications which have been published in reputable journals have also been cited. One of the main research challenges is that the client specifically asked for the age group 45 plus, which is a bracket for peri-menopausal women, where most of the women start experiencing early menopause and is not exactly a pre-menopause age. It is advised to include studies with women's mean/median age between 45-50 years, which will narrow down the search.
While it is recommended to conduct meta-analysis research and enter the information on the attached excel spreadsheet specifically tailored for this project. Link to the spreadsheet: https://docs.google.com/spreadsheets/d/1GpQF1ZQ34qio2rAtws8qIzIk-jV__fbp6G5tnNSV3-E/edit?usp=sharing

We will try to complete this research project by midnight 10/12/2020