The Spanish Lung Cancer Group (GECP)on the occasion of this World Day and its 11th Annual Symposium, it has presented an x-ray of the pathology situation in Spain based on data from 26,400 patients from the Thoracic Tumor Registry (RTT) from 89 hospital centers throughout Spain.
“This registry, the first of its kind in Spain, analyzes the socio-demographic, clinical, molecular, genetic and treatment outcome variables, so it makes it possible to offer a real x-ray of lung cancer,” he explained doctor Mariano Provencio, president of the GECPduring the presentation of the report in Barcelona.
In Spain, nearly 23,000 people die each year as a result of lung cancer, being the first cause of death from cancer. Specialists predict that 2022 will end with more than 30,948 new diagnoses
The profile of the lung cancer patient and the main cause, tobacco
This is a man, a smoker, with an average age of 60 years and with an advanced disease at the time of diagnosis.
73.6% of cases are men, but women are gaining ground and already represent 27% of cases due to their later incorporation into cigarette consumption.
And tobacco continues to be the main cause of lung cancer as reflected in the registry data: 42.3% of those affected are regular smokers while another 45.5% are ex-smokers. Only 12% of lung cancer patients admit to never having smoked.
“The danger of tobacco and its direct relationship with lung cancer must be taken into account more. There is primary prevention such as not smoking and it only depends on us”, stressed Dr. Provencio, also Head of Oncology at Puerta de Hierro Hospital in Madrid.
Younger and younger people, another lung cancer X-ray data
The age range between 60 and 70 already represents the highest percentage of patients included in the register, 35%, although people aged between 50 and 60 already represent 21%.
In addition, about 6% of lung cancer diagnoses already occur in people between 40 and 50 years of age.
“We want to dispel the myth that lung cancer is a disease of the elderly. Every time we are seeing diagnoses in consultation at earlier ages and the data from the register supports this’, explained for his part the doctor Bartomeu Massuti, secretary of the GEPC.
80% are diagnosed in an advanced state
80% of patients present the disease in an advanced stage at the time of diagnosis (more than 52% in a stage VI).
Cough, pain, dyspnea and sometimes weight loss are the main symptoms at diagnosis.
However, it should be noted that 30% of patients in advanced stages and almost 60% in early stages did not present any symptoms at the time of diagnosis, which highlights the difficulties in diagnosing this tumor.
The majority of cases are non-small cell lung cancer (83.2%) followed by small cell lung cancer (14.2%).
Access to precision medicine
In this lung cancer x-ray, according to registry data published in the BMC Cancer Journal, a total of 9,200 patients, nearly 85%, accessed molecular studies to determine whether the tumor had any mutations common in lung cancer (ALK, EGFR, PDL1, ROS1, among others).
“Access has progressively improved and the most recent analysis of RTT data shows that this information is obtained in more than 85% of cases,” explained Dr. Massuti.
The GECP emphasizes that the introduction of precision medicine has meant a significant improvement in the treatment of lung cancer. Biomarker determination and molecular diagnosis are currently necessary for personalized therapeutic decisions.
But he believes national strategies are urgently needed to implement next-generation sequencing (NGS) in an integrated and cost-effective manner in lung cancer.
“Planning and organization of resources for molecular diagnosis would be necessary. The GECP has launched the ATLAS project to facilitate the performance of molecular diagnostics (NGS) in a thousand cases with advanced lung cancer treated in centers without access to this technology”, explained the oncologist.
Regarding the time between diagnosis and start of treatmentaccording to registry data, in most cases, it is 1 to 3 months.
Regarding the treatment77.13% of patients with lung cancer were treated with chemotherapy, immunotherapy or targeted treatments, followed by radiotherapy (44.51%) and surgery (22.9%).
The demands of the GEPC
The data from this register make the GECP call for more efforts in primary prevention, to prevent the start of tobacco consumption, especially in the adolescent population, and greater agility in the arrival of innovation to patients, with special support to independent clinical research.
“Thanks to research, lung cancer is the cancer with the greatest global increase in survival worldwide. Currently, 20% of patients survive five years after diagnosis, with higher percentages depending on the subtype and stage. Thanks to the arrival of immunotherapy and new therapies, we are seeing survival rates unthinkable ten years ago”, explained the president of the GECP.
Despite this, according to Mariano Provencio, “survival figures are still far from high-incidence tumors such as breast or colon”.
To highlight the importance of lung cancer research, the GECP has launched the ‘May your efforts arrive’ campaign in which patients and researchers come together in a single image to highlight the need for innovation to reach the patient.
“Spain is one of the countries with the most research and participation in clinical trials in oncology. Last year alone, we launched more than 1,521 clinical trials. But it is necessary to work together to achieve an agile, transparent and participative process when applying advances in clinical practice. Without a doubt, the current formula does not work and we are losing opportunities and years of life for our patients”, he said.
The screening Project Cassandra will start in early 2023
On the other hand, the CASSANDRA lung cancer screening project will start, predictably in March 2023, sources from the medical societies involved informed EFEsalut.
And it will do so in more than 20 hospitals representing 14 autonomous communities (Catalonia, La Rioja, Madrid, Aragon, Valencian Community, Andalusia, Basque Country, Murcia, Castile and León, Extremadura, Canary Islands, Navarre and Castilla-La Mancha)
It is a pilot program led by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) which incorporates low-dose CT Computed Tomography as a screening tool, in combination with smoking cessation and collaboration with primary care.
The pilot project aims to provide evidence on the feasibility of lung cancer screening in our country, thus helping it to be implemented in the National Health System in the future.
CASSANDRA is supported again scientific societies: the Spanish Society of Thoracic Surgery (SECT), the Spanish Lung Cancer Group (GECP), the Spanish Society of Medical Oncology (SEOM), the Spanish Society of General and Family Physicians (SEMG), the Spanish Society of Radiotherapy Oncology (SEOR), the Spanish Society of Family and Community Medicine (SEMFYC), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of Medical Radiology (SERAM) and the Spanish Society of Pathological Anatomy ( SEPAP-IAP).
In addition to two patient associations: the Spanish Association against Cancer and the Spanish Association of Lung Cancer Sufferers (AEACaP); and two entities committed to the fight against lung cancer: Ricky Rubio Foundation and World of Johan Cruyff.
Dr Luis Miguel Seijo Maceiras, pulmonologist, coordinator of the Thoracic Oncology Area of SEPAR and co-director of CASSANDRA, says that implementing this screening program “must be a primary objective”.
Unlike breast, cervix or colon cancer, there is no established screening for lung cancer in public health and given that its symptoms are very imprecise, in the vast majority of cases it is diagnosed at an advanced stage, while that if detected in early stages it would have a better prognosis and impact on survival.
Patients request accelerated molecular diagnosis
On this World Lung Cancer Day, the Spanish Association of Lung Cancer Sufferers (AEACaP) asks the Ministry of Health to speed up the comprehensive implementation of lung cancer molecular diagnostic techniques and their equitable access throughout the national territory.
Currently, in our country, molecular diagnosis is not included in the portfolio of common services of the National Health System (SNS), nor is there a regulatory framework to implement and finance the tests. Therefore, “its use depends directly on the decision of the hospitals, according to the available resources, and generates great inequality not only between autonomous communities, but also between centers in the same territory”, he said Bernard Gaspar, president of AEACaP.
The Government has authorized the territorial distribution of funds to consolidate personalized precision medicine, with a first installment of 40 million euros that will be used to develop the plan known as 5P.
Data from the Spanish Society of Medical Oncology
It is estimated that 30,948 new lung cancers will be diagnosed in Spain in 2022, 65 per 100,000 people per year. Of these, 22,316 will be diagnosed in men – 96 cases per 100,000 men/year– and 8,632 in women – 36 cases per 100,000 women/year–.
Lung cancer accounts for 13.9% of all cancers in men, being the second most common, while in women it represents 7.2% of all cancers, being the third most common after breast cancers and colorectal, as reflected in the infographic on “Lung Cancer in Spain” produced, coinciding with World Lung Cancer Day, by the Spanish Network of Cancer Registries (REDECAN) and the Spanish Society of Medical Oncology (SEOM).