Targetting the environmental risk factors of lung cancer
The European Commission addresses the environmental risk factors of lung cancer through an ambitious tobacco control policy comprising both robust laws regulating tobacco products and prohibiting the advertising and sponsorship of such products. Antoni Monsterrat Moliner, Senior Expert for Cancer and Rare Diseases, Directorate of Public Health, European Commission, elaborates on the the EU fight against lung cancer
Lung cancer causes 1.37 million deaths per year worldwide, which represents 18% of all cancer deaths. Within the European Union, lung cancer is the one of the most fatal cancers, leading to over 266,000 deaths yearly and accounting for 20.8% of all cancer deaths.
Lung cancer mortality in men from the European Union peaked in the late 1980s at an age-standardised (world standard population) rate over 53 per 100,000 and declined subsequently to reach 44 per 100,000 in the early 2000s and continued to fall over recent years, to reach a value of 41.1/100,000 in 2005-2009. The fall was similar at all-ages and in middle-aged men (less than 2% per year over most recent years), but was appreciably larger in young men (aged 20-44 years, over 5% per year).
A favourable trend is thus likely to be maintained in the foreseeable future, although the predicted overall EU rate in 2015 is still over 35 per 100,000, i.e., higher than the US rate in 2007 (33.7 per 100,000).
This favourable trend is essentially due to the widespread measures for smoking control and cessation. Smoking can contribute to around 85% of all lung cancer cases. (1) Anti- tobacco policies, especially in middle-aged European men, i.e., in the generations where smoking prevalence used to be high, would lead to appreciable reductions in male lung cancer mortality in the near future. This is particularly urgent in central and eastern European countries.
According to EUROCARE-5 Study (2), lung cancer had a European average survival of 13%. The European mean age-standardised 5-year survival for lung cancer is one of the poorest and it’s better for women than for men. Geographical differences were small, varying from 9% in the UK and Ireland to 14.8% in central Europe. Age was a strong determinant of survival, ranging from 24.3% for patients aged 15–44 years, to 7.9% for patients aged older than 75 years. However European 5-year survival increased significantly from 11.6% in 1999–2001 to 13.4% in 2005–07, with similar trends in each region.
For the European Commission, cancer prevention constitutes one of our highest priorities. The adoption of the new version of the European Code Against Cancer permits to have a key tool for general prevention of cancer with a particular emphasis in some recommendations that could be very efficient in prevention of lung cancer.
These recommendations are supported by an active policy of the EU. With one in three cancers being preventable, addressing the risk factors (or determinants) is at the forefront of the Commission’s strategy to reduce the burden of cancer. The Commission addresses all the key risk factors, e.g. through an ambitious tobacco control policy comprising both robust laws regulating tobacco products and prohibiting the advertising and sponsorship of such products; an award winning pan-EU campaign “Ex-smokers are unstoppable”; strategies and platforms for joint action on alcohol and nutrition & physical activity bringing together member states and a wide range of stakeholders including NGOs and industry.
The Commission further contributes to cancer prevention by addressing environmental factors such as exposure to carcinogenic and mutagenic substances both indoors (including in the workplace) and outdoors. It does so mainly by developing and implementing legislation on air, soil and water quality and on general chemical exposure (i.e. in water, waste and organic pollutants).
Lung cancer in women differs from lung cancer in men in many ways. Even though smoking is the number one cause of lung cancer, a higher percentage of women who develop lung cancer are life-long non-smokers. Some of the causes may include exposure to radon, second hand smoke, other environmental and occupational exposures, or a genetic predisposition. Recent studies suggest infection with the human papilloma virus may also play a role.
On 30 April 2015, the European Respiratory Society (ERS) and the European Society of Radiology (ESR) published a joint white paper on lung cancer screening (3) suggesting data supporting the survival benefit for screening of individuals at high risk for early detection of lung cancer using low dose computed tomography (LDCT) including minimum requirements and recommended refinements.
In the framework of the ongoing Joint Action (2014-2017) on Cancer Control, supported by the EU Health Programme, a specific work package will evaluate suggestions on possible new cancer screening programmes.
On the basis of the conclusions of this Joint Action and an opinion of the European Commission Expert Group on Cancer Control, the Commission would consider whether it would support the development of screening guidelines for lung cancer.
The Seventh Framework Programme for Research and Technological Development (FP7) has displayed a comprehensive approach to nurturing research and innovation on Chronic Respiratory Diseases (CRD), tuberculosis and cancer. During this programme, 194 relevant projects related to CRD from which 16% related to lung cancer. Lung cancer and infections with an impact on CRD have been funded for an amount of over €350 million. Horizon 2020, the Framework Programme for Research and Innovation (2014–2020; overall budget €80 billion), provides a wealth of opportunities to address unmet research and innovation needs in CRD within the theme “Health, demographic change and wellbeing” (budget €7.6 billion) and elsewhere in Horizon 2020.
The European Commission feels fully concerned by the tremendous impact of lung cancer. We will invest, as much as possible, to contribute to towards reducing cancer prevalence and offer a better prognosis for affected patients.
1. Dela Cruz, Charles S., Lynn T. Tanoue, and Richard A. Matthay. “Lung Cancer: Epidemiology, Etiology, and Prevention.” Clinics in chest medicine 32.4 (2011): 10.1016/j.ccm.2011.09.001. PMC. Web. 8 Nov. 2016.
2. Roberta De Angelis et al, “Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5—a population-based study.” Lancet Oncol. 2013
3. Hans-Ulrich Kauczor et al, “ESR/ERS white paper on lung cancer screening.” European Respiratory Journal. 2015