CHICAGO—First-degree relatives of lung cancer patients have a 2 to 3.5 times greater risk of developing lung cancer than the general population, and tobacco smoke plays a major role, even among those with a genetic predisposition, according to a study in the December 22/29 issue of JAMA.

Lung cancer is the leading cause of death from cancer among men and women in many Western countries, according to background information in the article. Death due to lung cancer in the United States exceeds the death rate from breast, prostate, and colon cancer combined. The dominant role of tobacco smoke as a causative factor in lung cancer has been well established. Other studies have indicated that there may be an inherited predisposition to lung cancer, but data have been limited.

Steinn Jonsson, M.D., of the Landspitali-University Hospital, Reykjavík, Iceland, and colleagues examined the contribution of genetic factors to the risk of developing lung cancer in the population of Iceland. The risks for developing lung cancer for first-, second-, and third-degree relatives of patients with lung cancer were estimated by linking records from the Icelandic Cancer Registry (ICR) of all 2,756 patients diagnosed with lung cancer within the Icelandic population from January 1, 1955, to February 28, 2002, with an extensive genealogical database containing all living Icelanders and most of their ancestors since the settlement of Iceland. The risk for smoking was similarly estimated using a random population-based group of 10,541 smokers from the Reykjavik Heart Study who had smoked for more than 10 years. Of these smokers, 562 developed lung cancer based on the patients with lung cancer list from the ICR.

"The nationwide genealogy database used in our study provided a means for uncovering the familial component by revealing more connections between patients, missed in most other populations," the authors write.

The researchers found that a familial factor for lung cancer was shown to extend beyond the nuclear family, as evidenced by significantly increased risks for first-degree relatives (for parents: 2.7 times increased risk; for siblings: 2.02 times increased risk; and for children: 1.96 times increased risk; second-degree relatives (for aunts/uncles: 1.34 times increased risk; and for nieces/nephews: 1.28 times increased risk; and third-degree relatives (for cousins: 1.14 times increased risk) of patients with lung carcinoma. This effect was stronger for relatives of patients with early-onset disease (age 60 or younger at onset) (for parents: 3.48 times increased risk; for siblings: 3.30 times increased risk; and for children: 2.84 times increased risk).

"...this risk ratio [RR] increase in first-degree relatives of patients with lung carcinoma is the result of a combination of environmental, genetic factors, or both. Using genealogy, our study goes further than other reported studies by demonstrating that this familial factor extends beyond the nuclear family as evidenced by significantly increased RR for second- and third-degree relatives of patients with lung carcinoma. In the more distant relationships, shared environmental factors are likely to be of less significance, providing a stronger evidence for genetic factors given that RR is in excess," they write.

CHICAGO—Two deaths have been attributed to a rare type of pneumonia that is occurring among U.S. troops in Iraq at a higher than normal rate, according to a study in the December 22/29 issue of JAMA.

Acute eosinophilic pneumonia (AEP) is a rare disease characterized by a fever, respiratory failure, and an infiltration of the lungs, according to background information in the article. Generally, patients with AEP present with respiratory failure requiring mechanical ventilation. Clinicians may initially confuse AEP with severe community-acquired pneumonia, acute respiratory distress syndrome (ARDS), or both.

Severe pneumonia was previously reported from March through August 2003 among 19 U.S. military personnel who were deployed in support of Operation Iraqi Freedom (OIF); two of these patients died. Ten of these 19 were diagnosed with AEP; an additional 8 patients were diagnosed through March 2004.

Andrew F. Shorr, M.D., M.P.H., of Walter Reed Army Medical Center, Washington, D.C., and colleagues examined 18 cases of AEP and the clinical features of this syndrome. They conducted a epidemiologic investigation of cases of AEP from March 2003 through March 2004.

The 18 cases of AEP were identified among 183,000 military personnel deployed in or near Iraq during the study period, yielding an AEP incidence of 9.1 per 100,000 person-years. The majority of patients (89 percent) were men and the median age was 22 (range, 19-47) years. All patients used tobacco, with 78 percent recently beginning to smoke. All but 1 reported significant exposure to fine airborne sand or dust. Known causes of this type of lung disorder (e.g., drug exposures or parasitic disease) were not identified.

Epidemiologic investigation failed to reveal evidence of a common source exposure, geographic clustering, person-to-person transmission, or an association with recent vaccination. Mechanical ventilation was required in 67 percent of cases for a median of 7 (range, 2-16) days. Two soldiers died; the remainder responded to corticosteroids and/or supportive care. Twelve individuals were reevaluated a median of 3 months after diagnosis. At that point, 3 patients reported mild difficulty breathing and 1 reported wheezing. All patients had finished treatment and had either normal or nearly normal respiratory testing results.

CHICAGO—Contrary to previous reports, new research shows that cancer patients can not intentionally postpone death to survive for significant personal events such as Christmas, Thanksgiving or a birthday, according to a study in the December 22/29 issue of JAMA.

Health care workers and others involved with patients dying of cancer commonly recall those who apparently held on to life and defied the odds by surviving a major holiday or significant event, only to die immediately thereafter, according to background information in the article. Previous studies have noted an apparent dip or peak death pattern associated with significant religious and social events.

Donn C. Young, Ph.D., and Erinn M. Hade, M.S., of The Ohio State University, Columbus, Ohio, used a large database to examine whether cancer deaths would demonstrate a dip or peak phenomenon around three events with potential religious, secular, and personal importance to the individual: Christmas, Thanksgiving, and the individual's birthday. The researchers analyzed death certificate data for all 1,269,474 persons dying in Ohio from 1989-2000, including 309,221 persons dying with cancer noted as the leading cause of death. They measured the total number of cancer deaths in the 2 weeks centered on the event of interest, and the proportion of these deaths that occurred in the week before and the week after the event to determine whether these proportions were significantly different.

"For Christmas, Thanksgiving, or the individual's birthday, during the 12-year period there was no significant difference in the proportion of patients dying in the week after the event compared with the proportion dying in the week before the event," the researchers write. "Although overall birthday data showed no effect, women dying of cancer were more likely to die during the week before their birthday compared with the following week. Men showed no significant differences. In no subgroup was a statistically significant decrease of deaths observed in the week before the event."

NEW STUDY SHOWS CANCER PATIENTS NOT ABLE TO POSTPONE DEATH FOR CHRISTMAS—FAMILIES SHOULD CELEBRATE WHILE PATIENT STILL ALIVE