Lung cancer screening would benefit in the short, long and medium term

by time news

Lung cancer is the leading cause of cancer death in the world. And one of the reasons for this high lethality is its late diagnosis. It is estimated that about 80% of patients are diagnosed with the disease in advanced stages, and this makes treatment difficult. Fortunately all this ‘horror movie’ has a solution: early diagnosis through screening. The Lung Ambition Alliance Spain (LAA) has recently published “Lung cancer in Spain: A public health priority?” prepared with the collaboration of 21 experts belonging to the 10 Scientific Societies and Patient Associations involved, defines in 5 big lines a series of recommendations and proposals for improvement, based on the current situation in Spain, to guarantee access to innovative medicine, which accompanies strategies for early detection of lung cancer and combat its high mortality, improving the figures of survival.

“Lung cancer screening is like the holy grail,” said the Dr. Luis Seijo,Director of Pneumology at the Clínica Universidad de Navarra (Madrid) and Coordinator of the SEPAR Thoracic Oncology Area, during the meeting ABC Health organized in collaboration with AstraZeneca. First, screening was attempted with chest X-rays, “but it didn’t work,” he pointed out, but for more than 20 years computerized axial tomography (CAT) has been used to early identify pulmonary nodules that, when they are small, they can be operated and cured.

For Seijo, there is currently “a lot of evidence in favor of lung cancer screening with CT” in clinical trials, both in the US and in Europe, which “demonstrate a benefit in survival.”

In fact, he pointed out, the European Union has recently come out in favor of adding “staged lung cancer screening to the healthcare offer.”

With the incorporation of screening, the aim is to change the paradigm of lung cancer, he said. Florentino Hernando Tranchohead of the Thoracic Surgery Service of the San Carlos Clinical Hospital in Madrid.

“It is lethal because we are always late.” There is talk of a time-dependent lethality; that is, “it depends on the moment you diagnose and the time it takes to treat it.” However, he acknowledged that “if we are able to detect it early and prioritize the treatment process, the chances of success go up exponentially.” In localized stages, the survival figures are above 70 or 80% for a prolonged period of time.

A 4 year old movie

Approximately two thirds of lung cancers are diagnosed in advanced stages, but with screening the figure changes: 2/3 are early stages. We are used to -said Seijo- to see the film at the end, and it is “a film that lasts four years”. Now, he added, “if you intervene and catch that nodule before it grows and metastasizes, you completely change the picture.”

And that is what the population has to begin to understand, he stressed. “You can survive lung cancer.”

There are currently diagnostic tools that could be used to implement this screening in lung cancer, he assured. Luis Gorospethoracic radiologist at the Ramón y Cajal University Hospital in Madrid.

Gorospe considers that there is a low perception on the part of the population about the benefit that an annual TAC can have in people with risk factors for lung cancer. On the other hand, “if a woman is asked if a mammogram can help her detect breast cancer, almost all of her will say yes. And the same in the colon and prostate with their respective diagnostic tests.

In addition, he commented, performing a chest CT scan in people with risk factors not only reduces specific mortality from lung cancer, “but also overall mortality by 7%.” Gorospe explained that CT not only detects potentially cancerous lung nodules, “but also other alterations” in the lung itself (such as emphysema or interstitial alterations) or in the heart (such as coronary calcifications).

Molecular biology

“Lung cancer has been one of the paradigms within oncology,” he acknowledged. Xavier de CastroHead of Section of the Medical Oncology Service of the La Paz University Hospital in Madrid and of the Board of Directors of the Spanish Society of Medical Oncology (SEOM).

Fortunately, he added, advances in molecular biology have made it possible to know how to approach its treatment, especially in advanced disease.

And these biomarkers that have been identified in advanced disease have gradually been translated into locally advanced cancer and even surgical disease.

In addition, technological advances will make it possible not only to identify cancer with imaging techniques, but also in blood, even at even earlier stages.

Biomarkers are molecular or protein alterations that can be detected in tumor cells from biopsies but also in those that are circulating in the blood, which would be the concept of liquid biopsy, he explained. Margarita Mayemmedical oncologist at the University Hospital of Santa Creu and Sant Pau in Barcelona.

Initially all the biomarkers have been developed in the tumor, he added, “but now we have the possibility of detecting them in blood as well.”

In addition, liquid biopsy is useful both for diagnosis and for monitoring the evolution of treatments.

Now, Majem clarified, there is a limitation with the liquid biopsy in terms of its access, due to the “little coverage in the determination of biomarkers in the national health system.”

And to all these advances in diagnosis, Gorospe said, other technologies will be added, such as artificial intelligence and radiomics.

unquestionable scenario

The incorporation of lung cancer screening programs is a scenario that no one questions, he said. martha moreno, Director of Corporate Affairs and Market Access at AstraZeneca Spain. Moreno commented that she is working with those responsible for health and scientific and patient societies to advance screening programs to speed up the early diagnosis of this cancer.

The benefits of these programs will not only be seen in the long term, but also in the medium and short term, the experts acknowledged.

For example, Javier de Castro explained that, in the short term, “we are going to save lives”, while in the long term “we are going to impact the population globally”.

And he added: “resources must be put into something that may have a global impact in 10 or 15 years, but that individually will benefit many patients tomorrow.”

And the benefit would also be greater for women, whose number of cases has been growing for years due to their greater consumption of tobacco. «We know that women are diagnosed later because it is thought of as a male disease and less related to women; however, in the last 10 years it has been observed that the incidence of lung cancer is growing in women at a rate of 4% – 6% per year».

woman and tobacco

Majem recalled that women are more susceptible to the harmful effects of smoking. “It is known that a woman smoking for less time and less can have greater toxic effects of tobacco than men.” The cause, she points out, is because women are more vulnerable to the more than 200 carcinogens that tobacco has.

And, furthermore, he added, when a woman comes with symptoms, lung cancer is not identified as alarm signs, because other diseases associated with women are thought of before.

The experts recalled that 80% – 90% of lung cancers are preventable, as they are related to tobacco. “We are at a crucial moment in which the general population must understand that lung cancer is unavoidable,” said Hernando.

In this line Majen and Moreno manifested themselves. «As a society we would have to carry out awareness campaigns to stop smoking; there are other risk factors, but tobacco is the one that causes more than 80-90% of these tumors”.

However, de Castro clarified, “removing tobacco would eliminate most cancers within 10 or 20 years; That is why other measures must be taken with the 30,000 patients who are diagnosed each year.

In conclusion, the experts highlighted that today there are tools to carry out early detection, especially in populations that are known to be at higher risk of lung cancer. In this way, they added, lung cancer will no longer be such a deadly disease and a response rate can be achieved as in other tumors.

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