Policies to improve lung cancer prevention, treatment, and research in Europe
People diagnosed with lung cancer face many challenges that include stigma, delayed diagnosis, and access to optimal treatment. Lydia Makaroff, Director and Francesco Florindi, Policy Coordinator, European Cancer Patient Coalition, assess these challenges and offer urgent solutions to policy makers
Lung cancer is one of the most common causes of death from cancer, with over 300,000 deaths every year in Europe alone, accounting for approximately 28% of total cancer deaths (2). People diagnosed with lung cancer face many challenges that include stigma, delayed diagnosis, and access to optimal treatment.
While one risk factor for lung cancer is cigarette smoking, up to one third of people with lung cancer have never smoked (3). Risk factors for lung cancer also include exposure to second-hand smoke, consumption of cured meat, sedentary activity, air pollution, genetics, and occupational exposure to carcinogens (4).
Exposure to human lung carcinogens, such as crystalline silica and Chromium VI, can place people at increased risk of developing lung cancer (1). Crystalline silica is a basic component of soil, sand, and granite, and respirable crystalline silica exposure results from abrasive blasting. Over 5 million workers worldwide are potentially exposed to respirable crystalline silica, with most working in the construction sector (5). Chromium VI, also known as hexavalent chromium, is used in textile dyes, wood preservation and anti-corrosion products.
It has been associated with an increased lung cancer risk in non-smokers. European and national policies should ensure that strict binding occupational exposure limits exist for human lung carcinogens, including crystalline silica and Chromium VI, to ensure that workers are protected from the potentially carcinogenic effects of these compounds. Furthermore, any workers who are exposed to these carcinogens should have access to lifelong post-employment medical surveillance and cancer screening services.
Within Europe there are many disparities with regards to diagnosis and access to treatment. Radiotherapy plays a leading role in treating lung cancer, however, in many regions of Europe, the utilisation of radiation therapy is sub-optimal. The estimated age-standardised rate of lung cancer mortality in the European Union is 36.5 deaths per 100,000. Hungary, Serbia and Macedonia have above-average mortality rates of over 50 deaths per 100,000. Countries with below-average mortality rates include Malta, Portugal, and Cyprus, with rates below 24 deaths per 100,000 (2). Mortality rates can be improved by speeding up diagnosis and referral to specialists, and ensuring access to effective and personalised treatments.
Improved understanding of the molecular diversity of lung cancer has opened new possibilities for treatment. Personalised medicine based on biomarkers and immunotherapy has demonstrated benefits in the treatment of some kinds of lung cancer, and has been associated with longer survival as well as improved quality of life. Biomarker testing is now a critical part of the diagnostic process for lung cancer, as treatment is tailored to the molecular signature of the lung cancer (6). However, biomarker testing and personalised treatments can be expensive and may not be reimbursed by the health system. Furthermore, patients treated with such targeted therapies often experience unwanted side-effects, and the management of these reactions must also be incorporated into the treatment plan. In order to ensure sustainable use of innovative treatments, biomarker testing must be used to ensure that only patients with the correct type of cancer are given the treatments.
Currently there are over 636 ongoing lung cancer clinical trials on the EU clinical trials register. However, it is very difficult for patients to use the interface to find out what kind of clinical trial may be suitable for them. The EU clinical trials register database should be made more accessible for the development of patient-friendly portals with information on ongoing trials and top line results of completed trials.
Over the past decade, substantial improvements have been achieved in the prevention and treatment of lung cancer. However, continued efforts are required to ensure that workers are not unduly exposed to carcinogens, patients have timely and equitable access to personalised treatments, and that information about ongoing and completed clinical trials data is accessible to patients.
1. De Matteis, S., et al. 2012. Impact of occupational carcinogens on lung cancer risk in a general population. Int. J. Epidemiol. 41 (3): 711-721
2. Ferlay, J., et al. 2013. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. European Journal of Cancer, 49(6): 1374 – 1403
3. Jenks, S. 2016. Is Lung Cancer Incidence Increasing Among Never-Smokers? JNCI J Natl Cancer Inst. 108 (1): djv418
4. Molina, Julian R., et al. 2008. Non-small cell lung cancer: epidemiology, risk factors, treatment, and survivorship. In: Mayo Clinic Proceedings. Elsevier. 584-594
5. Sen, S. et al. 2016. Silicosis in Current Scenario: A Review of Literature. Current Respiratory Medicine Reviews, Volume 12, Number 1, March 2016, pp. 56-64(9) Bentham Science Publishers, USA
6. Vargas, AJ & Harris, CC. 2016. Biomarker development in the precision medicine era: lung cancer as a case study. Nature Reviews Cancer 16, 525–537