Less than 25% of lung cancer cases are detected at a stage that facilitates cure

Diagnosis in the localized phase continues to be one of the great challenges in the management of lung cancer, the tumor with the highest mortality.. “Diagnosing before, we could apply all the treatments at our disposal that seek a curative intention. We can currently do this in less than 25% of cases,” says Juan Carlos Trujillo, clinical chief of Thoracic Surgery at the Hospital de la Santa Creu i Sant Pau, in Barcelona, and coordinator of the Cassandra project for screening for lung cancer.

The remaining 75% of cases are diagnosed in an advanced or locally advanced stage.. As he points out, “the techniques have evolved a lot, but the treatment does not offer a guarantee of curing the disease, although it does increase survival. The highest mortality is probably linked to late diagnosis”. The reasons for this diagnostic delay are that this type of tumor does not cause symptoms until advanced stages of the disease.

According to his criteria, the ideal screening program is the one that diagnoses the largest number of patients in an initial phase of the disease with the lowest rate of false positives and negatives, “with sensitivity and specificity on par.”

About 85% of cases are linked to tobacco use. For this reason, Trujillo stresses that primary prevention, in addition to early diagnosis, must focus “on smoking cessation campaigns that work. We have two anti-tobacco laws that have not been successful.”. Regarding the 15% of diagnosed patients who do not smoke, he considers that they are “a therapeutic and diagnostic challenge: they have lung cancers with biomolecular characteristics that are different from other tumors.”

Both Trujillo and Fernando López-Ríos, head of the Molecular Pathology Section at the 12 de Octubre University Hospital in Madrid, have participated in the Visionaries project in lung cancer, an initiative whose objective is to act urgently for prevention and diagnosis early lung cancer. The report has had the collaboration of more than a dozen personalities from different fields whose recommendations are aimed at better understanding and detection of the disease.

For López-Ríos, biomarkers play a crucial role in this field. “We have to ensure that all patients with lung cancer who are operated on in earlier stages have an exhaustive notation of potentially predictive biomarkers,” he explains.

What is the role of mass sequencing?

In the opinion of López-Ríos, “the only way to achieve this is by doing massive sequencing, something that is not complicated, but that implies a paradigm shift: these tests should be done in all patients as they are diagnosed and in a reflex way, something that we currently do only in the most advanced patients. At this time, there is already scientific evidence that some of these biomarkers must be studied, such as EFGR -with PCR techniques or massive sequencing- and PDL1, by immunohistochemistry.. In the near future, it will be necessary to study more and more.”

“It can be argued whether these tests should be done even though the patient does not need this information. But it must be taken into account that a significant percentage of patients in the initial stages -which can reach 30% according to the series- ends up recurring.. That is why it is better to have that information, since it allows you to plan future options,” he says.

Another aspect that he considers relevant is the prognostic argument, “since we know that many of these alterations confer a worse prognosis. In addition, the more massive sequencing is done, the cheaper and faster it will be.. It may be paradoxical, but in some way, patients in early stages could be helping patients in advanced stages to get their results faster and more efficiently,” he summarizes.

How is the British model?

Regarding successful models in this field, López-Ríos highlights the cases of the United Kingdom, France, some regions of Germany and some large American centers. “In Spain, in some regions, it is also beginning to be a reality,” he recalls.

Trujillo agrees with the British model of early diagnosis as “the main mirror in which to look at ourselves”. Remember that the aforementioned country has started a campaign with a pilot study in which almost 80 million euros have been invested. “They are obtaining very important rates of adherence in the population at risk, with improved results in cancer survival.” It also considers the cases of Poland, Belgium, the Czech Republic and the Netherlands relevant.

“Each country must look for its screening program, because smoking rates are not homogeneous. And we must add the risk factors present in each autonomous community, such as radon or contact with asbestos. That is what we are trying to do with the Cassandra program, which we will present in April with 35 centers involved”, he concludes.