Akciğer Kanser Epidemiyolojisi ve Risk Faktörleri
Özet
Akciğer kanseri, küresel düzeyde hem insidans hem mortalite açısından en önemli halk sağlığı sorunlarından biridir. 2022 yılında dünya genelinde 2,48 milyon yeni olgu ve 1,8 milyon ölüm bildirilmiş olup, 2050’ye kadar bu sayıların sırasıyla 4,62 milyon ve 3,55 milyona çıkacağı öngörülmektedir. Türkiye’de akciğer kanseri erkeklerde en sık, kadınlarda ise beşinci sırada görülen malignite olup kanser ölümlerinde ilk sırada yer almaktadır. Histolojik olarak akciğer kanserleri küçük hücreli (SCLC) ve küçük hücreli olmayan (NSCLC) tipler olarak sınıflandırılır; NSCLC olguların %85’ini oluşturur. Adenokarsinom, hem dünya genelinde hem de Türkiye’de en yaygın alt tip hâline gelmiş, skuamöz hücreli karsinomun oranı azalmıştır. Bu değişim, sigara kullanımı paternleri, tütün ürünlerindeki modifikasyonlar ve çevresel maruziyetlerle ilişkilidir. Moleküler epidemiyoloji verileri, Türkiye’de EGFR mutasyon oranlarının %10–17 arasında olduğunu ve bu mutasyonların özellikle adenokarsinom, kadın ve sigara içmeyen hastalarda daha sık görüldüğünü ortaya koymaktadır. ALK rearranjmanları ise %3 civarında bulunmuştur. Bu bulgular, kişiselleştirilmiş tedavi kararları açısından önem taşır. Başlıca risk faktörleri arasında tütün kullanımı, dizel egzozu, radon, hava kirliliği, genetik yatkınlık ve kronik akciğer hastalıkları yer almaktadır. Tütün kontrolü, hava kirliliğinin azaltılması ve radon iyileştirme programları birincil korunmanın temelini oluştururken, düşük doz BT taraması yüksek risk gruplarında mortaliteyi azaltmada etkilidir. Kanser epidemiyolojisi, risklerin nicel değerlendirilmesi, tarama stratejilerinin hedeflenmesi ve kaynak tahsisi için kritik bir bilimsel çerçeve sağlar.
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