Lung cancer is recognized as the most deadly cancer in the world. Although it is not the most common cancer in most countries, as the most common cancers are usually prostate cancer (in men) and breast cancer (in women), several factors lead to the fact that lung cancer causes many more deaths.
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According to figures from the Global Cancer Observatory (Globocan), in 2020 alone, lung cancer caused 1.8 million deaths, out of the 9.9 million deaths caused by all types of cancer during that year. In other words, 18 percent of mortality was due to this type of cancer. Second on that list is colorectal cancer, which, however, barely reached just over 900,000 deaths, or 9.4 percent of the mortality recorded that year.
But recently, experts have become concerned that while strict anti-smoking policies around the world pushed the curve of lung cancer-related deaths downwards between the 1990s and 2000s, the curve now appears to be stagnating and rising. According to figures from the American Cancer Society, in the United States, between 1990 and 2020, the average death rate for men in the United States went from 80 deaths per 100,000 people to just 40. Meanwhile, the average for women went from 40 deaths per 100,000 to 30. However, the curve, instead of continuing to decline, now seems to indicate that it may increase.
According to Irina Zamora, interim medical director of AstraZeneca, one of the issues currently worrying the health sector is that there is an increasing trend in the number of cases of lung cancer, especially in women, linked to several factors such as tobacco and electronic cigarette consumption, as well as the impact of estrogens on lung health care.
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Irina Zamora, interim medical director of AstraZeneca.
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In an interview with EL TIEMPO, the expert highlights that one of the major problems of this disease is that it is usually detected very late, when symptoms are already present, which means that it is already in a very advanced state. Therefore, the recommendation is to go to regular check-ups with your doctor as soon as possible to identify the disease before it is already in an advanced stage.
You have warned that there is a trend towards an increase in lung cancer in women. What is the reason for this?
One of the reasons why there has been a significant increase in the trend of women with lung cancer over the last 20 years is precisely because of the increase in tobacco, which is actually one of the factors that has been most associated with lung cancer. And these changes in habits have significantly impacted lung health, not only increasing some lung pathologies, but also increasing the risk of lung cancer and cases of lung cancer in these patients.
Another thing that happens a lot in women is that they are diagnosed with lung cancer later. When we talk about lung cancer, there is a stigma that it is only the older male smoker who suffers from it and we sometimes do not necessarily think of women as the first target for this type of cancer.
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Increased tobacco consumption by women is increasing the trend of lung cancer cases in this gender.
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The other thing is that today we have identified that there is a potential role for estrogens in maintaining lung health and we have seen that with changes in estrogen levels, according to medical evidence, there is some even greater propensity for lung diseases, including lung cancer.
Today we also know that women tend to take better care of their health, so they tend to seek medical attention more proactively and in this way we can also find many more cases of lung cancer related to women versus men.
Men tend to apply medicine from a treatment perspective rather than from a prevention perspective, and women tend to use it more from a prevention perspective, proactively seeking to have tests done when they feel well. Men seek to have tests done when they already feel sick or have some symptom that forces them to go to the doctor. Women do seek to go for their check-up, to have their check-up, and in those tests, lesions can be found that may be related to an early diagnosis of lung cancer.
Why is lung cancer a cause for so much concern?
Lung cancer is a concern for us because what we diagnose is almost the same as what we die from during the year. This happens because it is diagnosed when it is already in a metastatic stage. So the number of cases that are diagnosed in the year is basically the number of cases of patients who die.
We must seek a reduction in the mortality of our patients and to seek this reduction in mortality we must then focus on increasing diagnosis in early stages, where through treatments and patient care we will lead them to have a survival of more than five years.
We should also be concerned because it is a cancer with a high prevalence, meaning that cases are increasing significantly. Today it is the third most common cancer in the world and the fifth in Colombia; it is the first in mortality worldwide and the second in Colombia after stomach cancer.
So today we should be concerned because we still have to work hard to develop better diagnostic platforms and, above all, better treatments that allow us to improve the prognosis of our patients, who today, unfortunately, have a mortality rate of 75% for most of them.
One of the points that you have raised at AstraZeneca is that you want to turn cancer into a chronic disease, what does that mean?
We want to make cancer chronic because we want patients not to die from the disease, but rather to have different treatment options that allow them, once the cancer does not respond to a certain therapy, to have other treatment options that can make it chronic or control the disease.
Our main focus as a company is really on: first strengthening early diagnosis to offer patients even the possibility of cure, and a lot of the development that we have today of medicines and diagnostic platforms is focused on increasing the probability of patients being diagnosed early.
Inevitably, a proportion of these patients will be identified in advanced stages and we must continue to offer these patients treatment options so that they do not have to face such harsh outcomes as death, but rather we can offer them alternative therapies once current therapies no longer work for them.
Undoubtedly, tobacco consumption is the greatest risk factor for developing this type of cancer.
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He told me that the company’s aspiration is to eliminate cancer as a cause of death. How is that?
Our aspiration as a company around the world is to eliminate cancer as a cause of death, and in the case of lung cancer in particular, this means reducing mortality. Our goal is to reduce lung cancer mortality by 50%, which currently has a rate of 75%; today our goal is to reduce it by half.
So in this effort, we are not only focused on improving our diagnostic platforms or improving treatments, but also working together with the different actors in the health system to remove the barriers that allow us to accelerate the management of our patients and be able to offer them better results and better prognoses in terms of a promising future for them and their families.
When should a patient consult their doctor to prevent lung cancer?
Well, first of all, it is very important to clarify that when the disease is already showing symptoms, we are probably facing an advanced stage of the disease. For this reason, we insist so much that early diagnosis and the identification of possible risk factors is a key and fundamental piece to identify which patients today need not only personalized medical support, but also complementary studies that allow us to identify this cancer in time.
So today when I have a recurrent cough, which is one of the most frequent symptoms, when I have coughing up blood, when I have chest pain, when I have dysphonia, when I have these types of symptoms, these symptoms are really evidence of extensive involvement of the tumor, not only at the lung level but also towards other organs.
So we want to mobilize other strategies so that patients are identified early. For example, so that they know their risk of developing lung cancer. Today, if I am a patient over 50 years old who smokes or is exposed to smokers, who lives in areas of high pollution and industrial exposure, if I have occupational factors such as exposure to asbestos or other toxic substances, a family history of cancer or a history of radiation therapy to the chest for these patients, these are factors that are already raising a flag for us, indicating that these patients need to be monitored in a personalized manner to identify what associated risk they have and may require additional studies.
For this reason, I believe it is very important that as patients and as normal people we know our health and also identify our life, family and personal dynamics, if we are potentially at-risk patients.
In many cities around the world, the air is unhealthy to breathe according to WHO standards. This is another risk factor. In fact, according to the Air Quality Life Index, Colombia is the sixth most polluted country in South America and almost no Colombian breathes air that is not polluted.
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As a multinational, you have a regional and global vision of this problem. How is Colombia doing in terms of the fight against cancer?
Cancer remains an important focus of collaborative work. One of our health priorities as a company is cancer. As pioneers in scientific development and innovation, we are empowered and feel that we have an active role in contributing to patients having a better outcome. At AstraZeneca we are open to collaboration with the different actors in the health system in order to guarantee not only the identification but also the appropriate management of the patient.
We see areas of opportunity in lung cancer: although Colombia has prioritized breast cancer and prostate cancer, we see that in lung cancer there is an opportunity to improve in many indicators, which is an area where we would like to be proactively working. Colombia has long made great progress in cancer issues in general in terms of plans and public health, but obviously the challenges are much greater than what we currently have.
Edwin Caicedo
Environment and Health Journalist
@CaicedoUcros
