In Poland, the mortality of women from lung cancer has increased. There is one reason

When it comes to cancer incidence in men and women, lung cancer takes the infamous second place. Unfortunately, it ranks first as the cause of death in cancer patients. And yet we can prevent it ourselves. The main, well-documented risk factor for lung cancer is smoking, so it is enough to stop smoking and avoid exposure to tobacco smoke (so-called passive smoking). Thanks to this, we will avoid exposure to one hundred carcinogens and almost 900 potentially carcinogenic substances in tobacco smoke.

1. Among men, lung cancer accounts for approx. 16%. cases in relation to all cancers, and among women about 10 percent
2. The main risk factor for lung cancer is smoking, followed by cancer, genetic predisposition, air pollution and exposure to carcinogens, radioactive substances and asbestos.
3. The basic screening test is low-dose computed tomography
4. We divide lung cancer into non-small-cell (approx. 80-85% of all lung cancers), small-cell and large-cell
5. Lung cancer treatment is now personalized and the direction of therapy is guided by a multi-specialist council
6. More current information can be found on the Onet homepage.

Monika Zieleniewska, Medonet: Malignant lung neoplasms are among the most common in Poland, both in men and women. Statistics have not changed for many years, do you?

Łukasz Kuncman, MD, PhD: In terms of incidence, they are both in second place (prostate cancer is the first for men and breast cancer for women). They also cause the highest number of deaths in both sexes. This year, they overtook breast cancer in women, which confirms how important an epidemiological problem they are. According to the National Cancer Registry in Poland, 170 people suffer from all cancers annually. people. And so, among adult men, lung cancer is approx. 16 percent. cases in relation to all cancers, and among women about 10 percent. Translating percentages into numbers, the incidence of males is around 14. annually, while for women 8,5 thous.

Why the difference to the disadvantage of men?

We must remember that lung cancer risk factors do not translate into morbidity immediately, but with some delay, even over 20 years. In addition, the incidence of lung cancer is highest in people over 65 years of age, although there is also a fairly large group of young people among the patients.

And what do the statistics say about the survival rate of patients with this cancer?

Unfortunately, the ratios place us below the European Union average. However, we do not have statistics collected in relation to the stage of cancer, so our data is imprecise. It can be said that we are doing worse in general, while a numerical comparison is impossible precisely because of inaccurate reporting. It should also be noted that in terms of mortality from lung cancer among men, the downward trend has significantly increased in recent years. At the same time, mortality in women is increasing, which is indirectly due to the increased morbidity associated with the smoking trend, which lasted some time ago, mainly in the group of women.

The fashion of more than 20 years ago is bearing fruit, but smoking is not the only risk factor for lung cancer.

It is a major risk factor and it has been indisputably proven. The remaining factors are much less frequent. These include previous cases of malignant neoplasms (and genetic predisposition), air pollution or exposure to carcinogenic substances, such as chemical, radioactive compounds or asbestos. In the case of asbestos, it is mainly pleural mesothelioma. You can see that most of the risk factors are extremely difficult to modify, so you need to focus even more on the main one.

Should the smoking ban also apply to electronic cigarettes?

The harmfulness of electronic cigarettes is much lower, although some adverse effects have been proven. In answer to the previous question, I was talking about smoking in the traditional sense, also about passive smoking, i.e. staying in places where people smoke a lot. We consider this addiction a disease of civilization, but there is also effective treatment. It is worth noting that most people become addicted to cigarettes before the age of 30, so in order to protect this youngest age group from the later consequences of addiction, we should focus our attention on it.

Malignant lung cancer has more than one name, right?

When talking about lung cancer, we think of two main groups of cancers – non-small cell carcinoma, which accounts for about 80-85 percent. all lung cancers, and small cell carcinoma, accounting for 13 – 15 percent. The rarest is large cell carcinoma, which accounts for about 2 percent. tumors. We divide non-small cell carcinomas into glandular and squamous cell carcinomas. Currently, especially in the case of adenocarcinoma, we have more and more options for targeted treatment. Genetic mutations, and hence the molecular profile of these cancers, is of great importance, especially in the treatment of advanced changes in the stage of dissemination. For other types of lung cancer, too, we have a variety of treatment options that target specific molecular targets (e.g. immune pathways).

What is the most common stage of lung cancer?

In most cases it is symptomatic. They are characterized by the presence of shortness of breath, wheezing or hoarseness, the presence of hemoptysis, cough or a change in the nature of the cough. Of course, we would like to detect more and more asymptomatic cancers, which is what screening tests are for. Unfortunately, a large proportion of patients present with very advanced neoplasms accompanied by general symptoms such as fatigue, weight loss, pain in the chest, shoulders, or widening of the veins in the upper body (the so-called superior vena cava syndrome).

What screening tests do doctors have at their disposal?

We talk about screening when the test is acceptable for the patient, and at the same time allows us to detect the cancer early enough so that we can reduce the associated mortality. At the moment, the test that has a proven impact on the reduction of mortality is low-dose computed tomography, performed in lung cancer risk groups.

What is it about?

It is a computed tomography that provides a slightly lower dose of ionizing radiation. Each tomography is associated with the appropriate dose of radiation, and when we had performed ordinary tomography in the entire population, paradoxically, we could expect an increased incidence of lung cancer.

Is this study reimbursed?

Of course. The research program available in each voivodeship in specific risk groups has started. They are people aged 55 to 74 with a tobacco consumption of more than 20 pack-years. Pack years are counted by multiplying the number of years of smoking by the number of cigarettes smoked per day. 20 pack years results from smoking a pack of cigarettes a day for 20 years, or half a pack for 40 years. From the age of 50, people with the additional risk factors I mentioned earlier may be included. It is worth emphasizing that the risk of lung cancer after 15-20 years of abstinence drops significantly.

Is the program working?

In 2021, little research was carried out, around 2300, so at the moment it is difficult to say that it is a screening program, perhaps at most a pilot. It is funded by the European Union, so it was organized locally.

Then we could use a decent lung cancer prevention program.

Yes, and the first risk factor we will ask the patient about is the high consumption of tobacco defined at 20 pack-years. If the program is better coordinated, we will be able to detect lung cancer at a much earlier stage.

Once you detect it, what is the treatment like?

The basis is imaging tests and tests of lung function and cardiovascular system, as they allow to determine the further course of action. On this basis, the stage of cancer advancement is determined. We divide neoplasms into locally advanced and those with the spread of the disease. If a cancer is diagnosed and its stage of advancement is determined, a multidisciplinary council decides on the optimal form of therapy for a given patient.

Which specialists are part of such a consilium?

A thoracic surgeon, i.e. a thoracic surgeon, a clinical oncologist responsible for systemic treatment, i.e. chemotherapy and targeted therapy, and a radiotherapist oncologist who deals with the irradiation of lung cancer. The council bases its decisions on imaging tests, such as: computed tomography of the chest, abdominal cavity, head, head magnetic resonance imaging, PET, ultrasound and histopathological examination. Based on the results, we assign the neoplasm to one of two categories.

The first one is a tumor of local-regional advancement involving the lung and mediastinal lymph nodes, and the second is a disseminated tumor, except for the primary focus and the closest lymph nodes with metastatic changes in various parts of the body. If we are dealing with a local cancer, we think about combining local treatment, which is either surgery or radiotherapy, with systemic treatment, which consists of chemotherapy or targeted therapy. Topical treatment mainly concerns non-small cell carcinoma. In small cell carcinoma, however, we resort to systemic treatment along with radiotherapy. Surgical treatment is of less importance here.

And when the cancer is spreading?

Then the main form is systemic treatment, although local treatment may support it. Lung cancer treatment is becoming more and more personalized, tailored to each patient and each type of cancer. Multidisciplinary treatment using all available methods, i.e. radiotherapy, surgical, systemic and targeted treatment, and finally immunotherapy, gives the opportunity to achieve good results even in advanced neoplasms. Centers with all therapeutic possibilities and experience will be able to do them optimally. In Poland, we have from one to three such centers in each voivodeship.

The data show that in Poland 5 – 14 percent live for 15 years. lung cancer patients.

Survival depends on the stage of the tumor at which treatment was started. As most lung cancers are diagnosed in very advanced stages, the survival rate of this group of patients is also low. In addition, terminally diagnosed cancers are included in the statistics, which in turn reduces the survival rate. Meanwhile, in the case of the most advanced locally, but not yet disseminated, lung tumors, the survival rates increase to as much as 30-40%, and in the earlier stages of advancement even more.

What should be improved to increase the survival rate?

Effective counseling to quit tobacco consumption must be put in place, and especially to fight for the youngest age groups. We lack coordinated, publicly funded educational programs. The next step would be to direct diagnostics to reach people from special risk groups. Paradoxically, patients with moderate risk factors are reported to study. It is important to have access to appropriate tests before we provide the patient with a rapid oncological diagnosis card, access to a specialist who will collect histopathological material from the tumor. It is about primary and secondary prophylaxis before starting the proper therapy. Later, quick access to treatment, although this stage is well organized for us, both in terms of surgical procedures or radiotherapy, as well as systemic treatment. Much of the treatment of lung cancer is included in drug programs. However, compared to Western Europe and the USA, we recognize patients in a more advanced condition, with much greater comorbidity, limiting the use of certain therapies.

So the patients come too late again?

I believe you cannot blame the patients. Professionals are always to blame for failures, an appropriate education, prophylaxis and diagnostics system is needed to support patients suffering from a serious disease such as lung cancer.

We encourage you to listen to the latest episode of the RESET podcast. This time we devote it to one of the ways to deal with stress – the TRE method. What is it about? How does it release us from stress and trauma? Who is it intended for and who should definitely not use it? About this in the latest episode of our podcast.