Lungcancerina defined geographical area: history andhistological types

Lungcancerwas diagnosed in446patients during four years ina population living in adefined geographical areainnorthern Finland. Theseries comprised 420men and26women, with a male/female ratio of16-6:1. Thediagnosis was confirmed histologically or cytologically in431 cases(97%).Epidermoid carcinoma was themostcommon histological typeoftumourinthemen, followed bysmall cell anaplastic andadenocarcinoma, whereas inthewomen allthese typeswere of equal frequency. Almost all the men, butonlyabouthalf ofthewomen, were smokers orex-smokers. Theamountsmokeddaily hadno correlation withthehistological typeofcancer, whereasthose patients whohadstarted smoking early hadrelatively more Kreyberg group Itumours(epidermoid, small cell, andlarge cell carcinoma) thanthose whohadstarted smoking late. Cancer was usually detected on thebasis ofsymptoms,but17%emergedfrommass radiography or some health examination, and12% fromexaminations foranother disease. Fifteen per centofthepatients had no symptomsatthetimeofdiagnosis, this being more common among thepatients withepidermoid oradenocarcinoma than among those withanaplastic forms. A hospital series ofpatients gives adistorted or defective picture ofadisease. Eveninthecase ofaserious disease suchascancer, thepatients maybetreated indifferent wardsordepartments according totheapparent stageofthedisease andthis isreflected intheseries compiled from therespective wards.Some patients at an advanced stageofcancermay notbeadmitted tohospital atall, andifnospecial attention is paid toadisease, somecases ofitalmost certainly remainundiagnosed. Thismay happenamong oldpeople inparticular, iftheexactdiagnosis appears to be oflittle consequence forthe patient's outcome. In1968webeganasurvey forthepurpose of studying prospectively allcasesoflungcancer diagnosed during fouryearsinthepopulation living inalimited geographical area. We wanted especially toexamine thedistribution ofvarious histological typesofbronchial carcinoma, the clinical picture, andtheprognosis. Theproject wascarried through asplanned, giving atotal of 446casesoflungcancerdiagnosed inthis un- selected population overthefouryears. We