Lung cancer: Poland among the leaders in the number of cases and the number of deaths. Why?

Proven content

– In cigarettes, the most harmful thing is not the nicotine itself, but tobacco smoke. There are about 7 thousand. substances, many of which are harmful and carcinogenic. Ten “pack years” is the limit beyond which significant health consequences are likely. It is about smoking a pack a day for at least 10 years. Then the risk of chronic obstructive pulmonary disease and lung cancer increases significantly – says Prof. dr hab. n. med Robert Mróz, coordinator of the Center for Diagnostics and Treatment of Lung Cancer at the University Hospital in Białystok.

1. Poland ranks second in the EU in terms of lung cancer mortality, and we are also in the forefront in terms of incidence
2. Lung cancer is believed to be a disease of men. Meanwhile, more and more women are falling ill and dying of it
3. The main cause of lung cancer is cigarette smoking. Not through nicotine, but through smoke
4. When a patient cannot simply quit smoking, an alternative solution comes into play – tobacco warmers or e-cigarettes
5. More information can be found on the Onet homepage.

Agnieszka Mazur-Puchała, Medonet: Lung cancer is one of the most common causes of death among Poles. How do we compare with other countries in the European Union in this context? Is it as bad in other parts of Europe as it is here?

Prof dr hab. n. med Robert Mróz: Unfortunately, as a country we are among the leaders when it comes to lung cancer incidence and mortality. In the case of the maturity alone, only Hungary, Belgium and Denmark are ahead of us. In the case of mortality from this type of cancer, only Hungary is ahead of us. We have one of the worst situations in the entire European Union.

Why is it like that?

There is no clear answer to this question. Lung cancer develops with exposure to tobacco smoke and the vast majority of those affected are smokers. But not all lung cancers are dependent on cigarette smoke. Other factors that increase the risk of lung cancer incidence are also social factors, such as diet or physical activity. These include all the factors that influence immunity. Because we know that cancer is a disease not only of smokers, but also of those whose immunity is impaired.

We have a high incidence of cancer, but diagnosis is also a problem. Poles are in no hurry to conduct tests that could detect lung cancer …

In fact, we doctors have no influence on incidence, but we would like to have a greater influence on cancer detection. And it is not good with it, in my opinion, due to insufficient or too little awareness of the harmfulness of cigarette smoking, of what is associated with cigarette diseases, but also of symptoms.

Lung cancer symptoms are not specific. In the early stages, it will be a cough, a change in its nature, progressive exercise dyspnoea, and more frequent infections. Patients have symptoms that can be confused with an ordinary infection – they may appear cough with chest pain, fever. With such symptoms, they report to their primary care physician. In a pandemic, this usually only ends with teleportation. The patient is prescribed a more or less hit antibiotic, the symptoms of the infection disappear. And its root cause, lung cancer, continues to develop.

It is only a matter of time before the infection recurs with increased symptoms, another teleportation, another antibiotic. Record holders go through this cycle for as long as six or nine months before a diagnosis is made.

X-ray is a method of early detection of lung cancer. How often should it be done?

Chest X-ray is an affordable, cheap and really useful method. While pneumonia can be diagnosed by symptoms and physical examination, underlying lung cancer will not be ruled out other than by X-ray.

The smoker should perform such tests at least once a year. Even if he has no symptoms. The same applies to chronic diseases such as chronic obstructive pulmonary disease, for example. Today we have digital, low-dose cameras. For comparison, the radiation dose taken during chest computed tomography corresponds to approx. 400 x-rays of the lungs.

Lung cancer is a disease that is clearly associated with men. Statistics confirm this stereotype? In fact, women don’t have to worry about getting sick?

Until recently, we thought it was actually more of a “male” disease. It was like that a few years ago. Currently, however, we observe a decrease in the incidence and mortality of lung cancer among men. In turn, in women there is a completely opposite trend. Ladies are now dying more often from lung cancer than from breast cancer.

The main cause of lung cancer in both men and women is cigarette smoking. How does cigarette smoke affect the human body?

In cigarettes, the most harmful thing is not the nicotine itself, but tobacco smoke. There are about 7 thousand. substances, many of which are harmful and carcinogenic. The vast majority of these compounds are formed during the tobacco combustion process. This smoke can trigger chronic bronchitis, which is somewhat of a precancerous condition. This is also combined with long-term exposure to carcinogens such as benzopyrene or heavy metals. Ten “pack years” is the limit beyond which significant health consequences are likely. It is about smoking a pack a day for at least 10 years. Then the risk of chronic obstructive pulmonary disease and lung cancer increases significantly.

But I emphasize: this is not nicotine, but cigarette smoke.

Cigarette smoke that is not found in e-cigarettes or tobacco heaters. Are they a safer alternative? Is it absolutely not?

I am a strong supporter of such an alternative, i.e. the so-called reduced harmfulness. When I talk about it, I like to compare it to the late 90s when methadone was introduced in heavy drug addiction treatment. It then caused a great deal of terror among doctors who were to prescribe drug addicts, after all, a synthetic drug. However, this approach ultimately resulted in tremendous progress and significantly reduced exposure to diseases such as AIDS and many other blood-borne diseases that addicts passed on through contaminated syringes. The methadone was administered in tablets. Today no one among psychiatrists and addiction therapists questions this approach.

I have a similar approach to tested e-cigarettes or tobacco heaters, if other methods of supporting recovery from nicotine addiction fail. The same opinion is shared by the FDA [Food and Drug Administration of the United States – dop. ed.], who unequivocally recognized one of these heaters as a product with a reduced risk compared to smoking. Its findings show that it clearly reduces exposure to harmful and carcinogenic compounds in those smokers who will completely replace smoking by heating tobacco in this device. There is no such decision by the FDA for e-cigarettes yet, but it may be one day.

By introducing a substitute such as a tested tobacco heater in a smoker, we eliminate exposure to cigarette smoke. And that’s the key here. However, it should be clearly emphasized – which is what the FDA does – that any product containing nicotine is harmful to health, because nicotine is highly addictive.

An interesting study, commissioned by the Japanese Ministry of Health, was also carried out by the National Cancer Center in Tokyo. It was concerned with the comparison of the carcinogenic potential of smoking and heating tobacco. On the basis of toxicological data, it was estimated that the risk of cancer induction (risk of development) is 10 times lower in a smoker who uses a tobacco heater than in a smoker who continues to smoke. Researchers suggest that, thanks to substitute products and proper education of smokers, cigarette sales in the country have fallen by 38% in the last few years, and total tobacco sales by almost 20%.

And e-cigarettes?

There were a lot of reports on e-cigarettes that were basically fake news. It was about reports of deaths among a dozen or so young people inhaling liquids [liquids with nicotine – add. ed.] in the United States. Nobody bothered to say that these liquid tanks are open, so you can compose their composition. It is up to the user to decide what to pour into these trays. And these young people were adding vitamin E acetate, which is the foundation for marijuana, to the liquid. It is also a component that can cause complete pulmonary fibrosis leading to death within a few to several weeks in susceptible people. And that’s what happened in all these cases in the US.

Saying that an e-cigarette caused their deaths is the same as saying that driving a car could be the cause of death. Omitting the information that it is drunk driving or speeding.

What about young people for whom these alternatives are not substitutes but rather a form of first exposure to smoking?

This is a very dangerous phenomenon that we already observe among teenagers, high school students. They more and more often start the “adventure” with nicotine, although the vast majority of them from smoking. One of the reasons may be that the price of this drug is too low. The latest survey of PolNicoYouth NIZP-PZH shows that the e-cigarette was the first product with nicotine for every third (32,3%) teenager in Poland. According to the data of the National Institute of Hygiene, in the case of tobacco heating devices that are more expensive than cigarettes, the percentage of nicotine initiation among young people was 0,2%. This does not change the fact that we are completely against the use of any nicotine-containing product by non-smokers. Inhaling any substance other than clean air is potentially harmful. Especially for the young respiratory system. And inhaling chemicals, such as those found in e-cigarettes and tobacco heaters, which in addition lead to addiction, is absolutely worthy of criticism.

The safest alternative to smoking, however, is simply to recover from the addiction. This, unfortunately, often fails. Can the doctor in some way help the patient through this process?

There is a rule of five P, according to which we assess the degree of exposure, the severity of addiction, readiness to try to get out of addiction, plan this process, and follow up in which we evaluate the effects. The most important thing, however, is that you must not be discouraged by the fact that someone has already tried to quit smoking on their own, but failed to do so. If we have already tried tablets, patches or gums, it must be remembered that their effectiveness is only 20-25%. In the case of tablets, the problem is that in Poland they are not reimbursed. And these are, unfortunately, very expensive measures.

If nothing else has worked, the last resort is an e-cigarette or a heater. It is important that the smoker who uses them does not simultaneously smoke traditional cigarettes. For most people, it is really enough to just stand for five or seven days on such a substitute for “new” flavors and aromas to emerge. Then this ordinary cigarette just starts to smell off-putting. And when it comes to this stage, the complete abandonment of the classic cigarette is very real.

On the other hand, with e-cigarettes, we must bear in mind that most smokers develop chronic bronchitis. As a result, the first puffs of the e-cigarette may result in a suffocating cough. However, such symptoms pass within two or three days, unless we reach for a regular cigarette at the same time.

European health care institutions play an important role in optimizing the prevention of neoplastic diseases, in particular among patients who are addicted to tobacco and are resistant to pharmacotherapy of nicotine. They should conduct research on the optimal use of various forms of nicotine substitution, for example, as in Public Health England or the American Food and Drug Administration. This issue is still under discussion, but there are still no unambiguous European recommendations in this regard.

Does gender influence how we quit smoking? Who is doing better? Or maybe women use methods other than men?

Opinions on this matter are divided, although my observations show that it is a bit easier for women to quit. In fact, the key to success is motivation. When I start a discussion with a patient, I introduce them to the possibilities, dangers, and consequences of smoking that lie ahead of them. This is, for example, an increased likelihood of developing chronic obstructive pulmonary disease, cancers not only of the respiratory system, but also of the stomach, prostate, kidney, digestive tract and large intestine.

We need less than 20 percent to function smoothly without effort. spit. All the rest of their volume is a reserve for effort. Smokers often think that this reduced exercise capacity is related to age or lack of exercise. However, it is usually about progressive emphysema. When we come to the level of 20 percent. lungs, dyspnoea at rest appears. The slightest movement makes us unable to breathe. And unfortunately for those who did not follow the advice in a timely manner, when they get to that point, life turns into an absolute nightmare. Then everyone quits smoking. It’s only too late. I compare it to a situation where someone is taking their life. When someone dies while hanging on a rope, that moment of death lasts from a minute to three. In the case of advanced emphysema, and therefore lack of lungs, it is hanging on the rope for several months.

I have come across such an approach that radical quitting smoking in long-term addicts can have negative health effects. Should it actually be done more gradually?

Absolutely not. I am a supporter of just such a radical approach – it throws up here and now. Without postponing the decision until tomorrow, the first day of the month, January 1 or holidays. This is not a good approach and it shows that you are not fully motivated. A motivated person quits on the same day after talking to a specialist. I often say: ‘It doesn’t matter how much you smoked today. Those were the last cigarettes ».

Addiction to nicotine is severe because it is both physical and psychological. On the other hand, sudden withdrawal from nicotine has no negative effects on the body. There are only mental inconveniences. And they are only experienced when the asceticism is actually made. With alternatives such as tea lights or e-cigarettes, these symptoms are absent. Then we first give up psychological addiction – we realize that we may not smoke ordinary cigarettes. In turn, we put off farewell to nicotine for a later period. And it is very often the case that after a few months patients also quit nicotine substitutes. It is easier for them because they already realize that they can cope without cigarettes.

You are a professor and coordinator of the first Lung Cancer Unit in Poland, which was to contribute to the improvement of the situation of lung cancer patients in Poland. How does such a unit work and what does it give to patients?

The Lung Cancer Unit is a multidisciplinary unit that offers a wide approach. It brings together all the specialists needed for the diagnosis and treatment of lung cancer. The unit consists of pulmonologists, thoracic surgeons, oncologists, radiotherapists, pathomorphologists, radiologists, such specialists as a psychologist, nutritionist, and also a coordinator – which is very important. The fact that all these specialists are simultaneously focused on diagnostics and treatment causes, above all, the elimination of one-person decisions. They are undertaken jointly.

The operation of such a unit is based on the use of as many management algorithms as possible at the stage of diagnosis and treatment selection. Over 80 percent cases are standard patients for whom these algorithms can be applied automatically. Thanks to this, we have more time for 20 percent. non-standard cases, where multi-specialist decisions are of key importance at every stage of diagnosis and treatment of patients. The meetings of the councils are open, which is an opportunity to exchange experiences and an invaluable source of knowledge for young doctors.

Thanks to algorithms, we can apply personalized treatment, because today there are many possibilities of combined therapies. It is not only chemotherapy, but also chemoradiotherapy or immunochemotherapy. The surgical procedure that gives the best chance of recovery is possible only in the early stages of the disease.

The use of a multidisciplinary approach in the diagnosis of lung cancer allowed to shorten the diagnosis time to 5-10 days. It once seemed completely impossible. Today, in other centers, lung cancer is further diagnosed for several months.

Considering how high lung cancer mortality is among Poles, such units should be a standard. Why are there so few of them?

In Poland, these are only single units. I can only guess what it entails. When we were creating the unit, it seemed to us that the goal was to gather specialists in one place and time. But that is not the point. The key is to change your mindset from one-person to multi-person. I do not “know everything”, but just “do not know everything”. I need you and your expertise to make decisions at every diagnostic and treatment stage.

In my opinion, the closure of individual specialties, head of department, and insufficiently open approach to diagnostics and treatment are the reasons for the ineffective creation of Lung Cancer Units in Poland. One-man decisions are suboptimal by design. The entire civilized world has already departed from this thinking.

Also read:

1. This is what the lungs of a smoker with cancer look like, and so healthy. Scary? Understatement
2. This is the most common type of cancer in Poland. 2020 is the year of lung cancer
3. How not to get lung cancer?
4. Neoplastic changes in the respiratory system

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