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Back to 2019-09-16-Opinión-CIMA-Cáncer de pulmón
Rubén Pío, Director of the Solid Tumors Program of Cima University of Navarra
Lung cancer: reasons for optimism
These days we are celebrating the European Lung Cancer Week. A reminder that was created with the goal to raise awareness in society about the importance of preventing this terrible disease, with early detection and effective treatment.
According to the latest report of the SEOM (Spanish Society of Medical Oncology), lung cancer is one of the most frequently diagnosed cancers (almost 30,000 cases per year) and the cancer that causes the most deaths in Spain (22,000 deaths per year, which represents 20% of all cancer deaths). In other words, every 20 minutes a person dies in our country due to lung cancer, with the aggravating factor that it is a largely preventable disease.
On the framework of this European Week, from September 7 to 10, was held in Barcelona the congress World Lung Cancer, an event organized by the association International Association for the research in Lung Cancer (IASLC), which brought together more than 7,500 medical experts and researchers to share results, discuss ideas and plan new programs of study.
More than 100 different countries represented with a common goal : to reduce the harm that lung cancer causes worldwide.
Advances at research have enabled important changes in the treatment of lung cancer in recent years. Scientists often refer to cancer as a disease Genetics, meaning that it is a disease caused by irreparable damage to our genes.
Explained in another way, when a cell suffers damage to its genetic material (e.g., by the carcinogens in tobacco) changes in its behavior can occur that result in an uncontrolled multiplication capacity.
Over time, cells from the initially damaged cell may acquire new characteristics and eventually give rise to cancer, which may spread to other parts of the body.
The traditional therapy applied for advanced lung cancers has been chemotherapy, whose goal is to eliminate growing cells in a non-specific manner and is therefore associated with high toxic effects.
For years this was the only therapeutic option if the cancer had spread, but this changed at the beginning of the 21st century when specific genomic alterations were identified in some lung tumor types and more effective targeted therapies with fewer side effects were designed.
This ushered in the era of personalized or precision oncology, whereby each patient is assigned an individualized treatment based on the genetic characteristics of his or her tumor.
Oncologists already have several of these therapies at their disposal, but unfortunately they are not enough. At present, we are only able to identify treatable alterations in a small percentage of patients. Little by little we are improving. It is a slow process, but it is progressing. Today we are better than yesterday and surely worse than tomorrow.
The most recent breakthrough in lung cancer treatment has been immunotherapy. Last year's award Nobel Prize in Medicine was awarded to Drs. Allison and Honjo, for their programs of study on the treatment of cancer by re-activating the anti-tumor immune response.
Patients with various types of tumors are already benefiting from these treatments, lung cancer being one of the most prominent.
New developments in this field are often unveiled at the IASLC's congress . This year was no exception. The results of a clinical essay based on immunotherapy were presented for subject of lung cancer, called small cell lung cancer, for which no significant progress had been made for more than 20 years. As with any scientific advance, it should be viewed with caution, but at the very least, it offers opportunities for improvement and hope.
Another great challenge extensively discussed in the IASLC congress has been the implementation of screening programs for lung cancer, like those that already exist for breast, cervical or colon cancer.
In most cases, lung cancer is diagnosed when the disease is advanced and the chances of cure are very small.
However, there is clinical evidence from both American and European programs of study that screening high-risk individuals by means of a scanner of leave radiation dose increases the rate of early diagnosis and reduces lung cancer mortality.
In fact, in the United States lung cancer screening is already C by the healthcare system. In Spain, the Clínica Universidad de Navarra has pioneered the implementation of a lung cancer screening program. Now, many experts consider that the time has come for its application here in Europe at the population level.
The IASLC congress also presented the results of the largest clinical screening essay based on the use of molecular markers using a blood test. Very promising results that could help the implementation of lung cancer screening.
And I have left to the end the origin of the problem and what would be its best solution. This week serves above all to re-emphasize the main cause of lung cancer, smoking. It is estimated that at least 90% of lung cancer cases are associated with tobacco consumption.
A renowned oncologist recently explained it very graphically, "lung cancer has ten main causes and the first nine are tobacco". Therefore, one of the main challenges we face is to reduce tobacco consumption at all levels.
The IASLC has disseminated on its congress a manifesto calling for the implementation of measures to help the smoking patient achieve smoking cessation in order to increase his or her chances of cure.
As summary of meeting, and out of respect for the many people who suffer from this disease, I believe that the opportunities before us, be they targeted therapy, immunotherapy or screening, allow us to look to the future with moderate optimism.
In this way we will continue our research with enthusiasm and hope. Trusting also in receiving the necessary social and institutional support to advance towards our common goal .