November - Lung Cancer Awareness Month!

Abstract

Lung cancer is the most frequent cause of cancer deaths. It accounts for 28% of all cancer deaths and 1.3 million deaths globally. In the United States, 216,000 people are diagnosed with lung cancer every year and only 16% of the patients will survive more than 5 years. Unfortunately, only 15% of patients with lung cancer are diagnosed with “localized” disease compared to 60%, 80%, and 40% of patients with breast-, prostateand colorectal cancers, respectively. 1 While significant improvement in prognosis has occurred in many other solid tumors, little improvement has been seen – so far – in lung cancer. A question raised many times is why it there such a slow improvement in lung cancer compared to many other solid tumors. Lung carcinogenesis is a complicated process and lung cancer might be more biological heterogeneous than many other tumors. However, other factors play in. The difference in federal research money devoted to lung cancer compared to many other cancers seems disproportional to the magnitude of the health problem lung cancer is representing .The federal research funding (FY10) per death is for lung cancer $1,386 compared to $28,660 for breast and $13,697 for prostate cancer. 1 The NIH (including FY10 stimulus) funding for lung cancer is $203 mill. compared to $788 million for breast cancer and $345 million for prostate cancer. 2 For the lung cancer community, it is important that we get a multidisciplinary discussion on what are the obstacles for improvements. Recently, an international multidisciplinary (e.g., surgery, medical oncology, pathology, basic science) workshop was held, including representatives from the patients’ advocacy groups (sponsored by GlaxoSmithKline), with the goal of identifying barriers for improvements for early stage disease. 3 Several barriers were clearly identified, including perception of stigma and nihilism in the public, slow accrual to clinical trials, technical aspects, lack of strict guidelines for design of clinical trials, and lack of research findings. Lung cancer is seen as “self-inflicted” because of its association with tobacco. The general public holds negative and prejudicial attitudes toward lung cancer despite the fact that nearly 80% of the patients are former- or never smokers. 1 In contrast, patients with heart disease are rarely told their disease is self-inflicted because they are overweight, sedentary, and ate a poor diet. Patients who have never smoked (18%) are particularly impacted by “victim-blaming.” Even healthcare professionals often assume they are smokers or ex-smokers. The poor treatment outcomes with lung cancer have led to a climate of nihilism about the disease among health care professionals, the public and the media. There is little media interest in lung cancer because it is seen as depressing. For example, lung cancer kills more women than breast cancer, yet, in contrast to breast cancer, it is virtually ignored by the women’s media. The media want positive stories about cancer, and are interested in young, photogenic patients. Lung cancer cannot generally supply those stories, so despite its being the most common cancer, the media is not interested. One approach has been to emphasize women with lung cancer, to show it is not just a disease of men. We need to publicize the fact that anyone can get lung cancer. More multidisciplinary discussions needs to take place in order to identify the barriers for improvements in early- and late-stage disease as well as for successful screening of lung cancer. The “Tissue is the Issue” towards successful personalized medicine! The lung cancer doctors and particularly the patients need to be made aware of the importance of sufficient tissue acquisition and biomarker assessments for choice of therapy and for