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Lung cancer: good news from the battle to topple the emperor of tumors


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The Conversation

Luis Montuenga

researcher senior of the Cima of the University of Navarra, member of the research center in network in Oncology (CIBERONC) and of high school of research Sanitaria de Navarra (IdiSNA); Dean of the School of Sciences, University of Navarra.

One of the great anniversaries of 2022 was the celebration in September of the 500th anniversary of the arrival of Juan Sebastián Elcano's expedition to Sanlúcar de Barrameda. The few survivors of that tragic three-year adventure had just completed the first circumnavigation in history, without having planned it at the time of their departure. "We have discovered and circumnavigated the round of the world," wrote the Basque sailor to Emperor Charles V upon arrival.

During these months, many values that Elcano and his companions developed during their voyage have been highlighted. Among them, undoubtedly, perseverance and courage.

Perseverance and courage are also essential in the mission statement to reduce the suffering and the unacceptable levels of incidence and mortality caused by lung cancer. We are all involved in this mission statement . On the one hand, through primary prevention: reducing and helping to reduce the levels of exhibition to tobacco and its derivatives in the population. And on the other hand, by supporting the work of those of us who are most directly involved in the battle against this disease: researchers, staff healthcare, institutional leaders, patients and their families.

Lung cancer is, in a way, another pandemic, prior to the one we are going through due to covid.

A relentless killer
In an excellent essay that won the award Pulitzer, Dr. Siddhartha Mukherjee describes cancer as The emperor of all diseases. Following his argument, it could be argued that lung cancer is the emperor of that subject of emperors.

Three data can help us to understand this definition. First, approximately one in five deaths due to cancer are lung tumors. Secondly, mortality from lung cancer is practically equivalent to the sum of deaths caused by colon, breast and prostate cancer combined.

Finally, the impressive growth in the level of female smoking in the last three decades has led to such a significant increase in lung cancer that, in some parts of the world, its mortality in women is already higher than that attributable to breast cancer.

The fruits of prevention and early detection
Despite these alarming data , the perseverance and courage of so many allows us to look to the future with hope. In fact, lung cancer incidence and mortality are already declining slightly in men. The effect of anti-smoking policies is beginning to be felt.

In addition, early detection programs for lung cancer using CT scans at leave doses are already offered at the population level in several developed countries. A few weeks ago, after several years of inexplicable silence, the European Commission recommended that member countries progressively introduce this screening into the public health portfolio. This new preventive tool , which detects lung cancer at very early stages, has been shown to be effective in several clinical trials over the last twenty years.

We are talking about asymptomatic tumors, which may grow for years in the patient's lung. If they are not detected in time, and these tumors already produce symptoms, it is a sign that they are very advanced, and that they will most probably not be susceptible to surgical intervention, so their prognosis is much worse.

Unfortunately, more than 70% of lung cancer cases are diagnosed today at inoperable stages. Hence the importance of developing and optimizing early detection. The EU scientific experts advising the Commission have underlined the interest of further research into other techniques such as blood-based markers, as these molecular technologies can improve the performance of image-based techniques.

New therapeutic weapons
In any case, the management of patients with advanced lung tumors has improved dramatically in recent decades. The molecular and cellular research has led to a much better understanding of the growth mechanisms and Achilles' heels of the various types of lung cancer.

The targeted therapies take advantage of the knowledge of the most relevant genetic alterations that determine the malignancy of some tumors. And immunotherapy has managed to control the molecular tricks that tumor cells deploy to hide or slow down the response of the patient's immune defense system.

In this field of advanced disease, research focuses on finding new molecular targets, improving immune therapy tools and, above all, solving the problems of resistance to new drugs, which are frequent after some time after administration.

Many achievements have been made, many patients have benefited from the programs of study carried out in academia, research centers or biotechnology or pharmaceutical companies. However, result is clearly insufficient and much remains to be discovered.

Juan Sebastian Elcano was received as a hero upon his arrival in Sanlucar de Barrameda and was decorated by Charles V, the emperor. From our emperor, the lung cancer, we do not expect any medal. The persevering and hopeful work of so many of us, involved in the battle against this disease, intends to put pressure on this emperor of emperors so that - as happened with Charles V himself - he retires to the inactivity of a silent place or disappears forever in the mists of history.

This article was originally published in The Conversation. Read the original.

The Conversation