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There is convincing evidence that tobacco smoking strongly increases the risk of lung cancer, with a relative risk of approximately 4.4 in men and 2.8 in women for current smokers compared with never-smokers.4 V-Ki-ras2 Kirsten rat sarcoma ( KRAS ) and epidermal growth factor receptor ( EGFR ) mutations are well documented in the pathogenesis of lung adenocarcinoma according to smoking status.5 KRAS mutations show no sex predilection but are more frequent in Caucasians than in Asians, and most patients with these mutations are former or current cigarette smokers.6 7 Unlike KRAS mutations, it has been reported that EGFR mutations are more frequently found in women, Asians, and never-smokers.8 9 Information regarding pack-years has been widely used to assess the risks of lung cancer and chronic obstructive pulmonary disease (COPD).10 11 Pack-years of smoking is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked

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