Shocking truth about lung cancer – why you should get screened ASAP!

JULIA ROTOW: I’m Dr. Julia Rotow. I am a thoracic medical oncologist at the Dana-Farber Cancer Institute in Boston, Massachusetts. Therefore, EGFR-mutant lung cancer is a subset of lung cancer diagnoses that is more likely to affect younger people and people with little or no history of tobacco use.

And this occurs in about 15% to 20% of lung cancers in this country. Abroad, for example, in Asian countries, that rate can be as high as 50% or 60%. So it’s an important subset of lung cancer to identify a diagnosis.

JULIA ROTOW: There are many risk factors for lung cancer. And it is true that a history of tobacco use or current tobacco use is indeed a risk and increases the chances of lung cancer. That’s why lung cancer screening is so critical, particularly for those with this history.

But that’s not the only risk of lung cancer. And indeed, lung cancer can also affect those you wouldn’t expect, for example, those with no smoking history, younger patients. And this is really where the EGFR mutation data becomes critical.

We know that for young people or people who have never smoked with a diagnosis of lung cancer, your chance of having what’s called a driver mutation, a mutation in your cancer that has caused this cancer to form, can be quite high. . More than 50%, maybe even more than 75%, could have one. And these can be treated with targeted therapy pills in many circumstances.

EGFR is the most common of these driver mutations. And like I said before, it’s more common in young men, young women, and those of Asian descent.

JULIA ROTOW: The current lung cancer screening guidelines, and I’ll quote the US Preventive Services Task Force guidelines here, recommend lung cancer screening for people at high risk as defined by cumulative years. tobacco use and age. Therefore, the current guidelines, which were released in 2021, recommend screening for people age 50 and older, technically 50 to 80 years of age with at least a 20-pack-year history of tobacco use. And that means one pack of cigarettes a day for 20 years, two packs a day for 10 years, and so on.

And that’s considered high risk, and they recommend an annual low-dose screening CT scan. We know that by doing this screening, we can reduce the risk of death from lung cancer by finding lung cancer early when it is most treatable. This improves survival.

Unfortunately, in this country, the uptake of lung cancer screening has been very low. And in many studies, only 15-30% of people who are eligible for lung cancer screening actually get it. And that’s a real missed opportunity to catch lung cancers at an early stage, particularly with all these different advances that we’re seeing that improve outcomes for early-stage lung cancer.

JULIA ROTOW: The first step is to talk to your primary care doctor. This is a great opportunity to discuss whether lung cancer screening might be helpful to you as an individual. And our doctors really enjoy talking to their patients about this to help reduce their risk, just like you might talk about colonoscopies, mammograms, or prostate cancer screenings.

Now, our current lung cancer screening guidelines don’t include everyone who might be at high risk, and there are some abstracts and presentations at ASCO this year that are getting to that point. For example, we know that racial and ethnic disparities exist both in access to lung cancer screening and in eligibility for testing under current guidelines. And there are ongoing efforts to try to provide more risk adaptation scores or risk adaptation strategies to try to understand lung cancer risk.

I’d like to highlight a lung cancer screening study that was presented at this year’s ASCO and was led by Dr. Elaine Xu at NYU. And this study looks at the institution of lung cancer screening with three annual chest CT scans in young Asian women who never smoked. So, starting at age 40, even before our standard guidelines, and in people who never smoked or smoked very little, again, an unusual population for our broader national guidelines.

And this speaks to the high risk of mortality from lung cancer and Asian Americans. It is the leading cause of cancer death in this population. They have a higher rate of these actionable driver mutations, such as EGFR in their cancers.

And at this ASCO, Dr. Xu will present in a future session some preliminary results from the first 200 patients who enrolled in the study. And here they found a 1.5% rate of lung cancer in this population of young, non-smoking patients. And all of the lung cancers they identified had EGFR mutations and were able to go on to receive EGFR-targeted adjuvant therapy. So it speaks to the importance of not only thinking about our traditional high-risk patient population, who absolutely should get 100% detection if we could achieve it, but also these other, less common patient populations who can still benefit from possible detection strategies.

JULIA ROTOW: EGFR is a protein found inside tumor cells. It is called the epidermal growth factor. And when it’s active, it tells cells to grow and divide. In lung cancer cells, that can become abnormally active by having a mutation that causes it to turn on when it shouldn’t. And this, we know, helps drive the formation, growth and survival of lung cancer. And this is by targeting EGFR with EGFR inhibitors, which can shut down that protein and stop that survival signal, can improve outcomes for patients with this subtype of lung cancer.

So for people diagnosed with an early stage lung cancer, meaning a lung cancer that could be surgically removed with the intent to cure it, there are a number of different treatments that may be offered before or after surgery to treat to reduce the risk of relapse and improve survival.

These include what is called neoadjuvant therapy, that is, pre-surgical therapy, usually chemotherapy or immunotherapy, for example, immunostimulating drugs; or adjuvant therapy. And that is postoperative therapy, that is, therapy after recovery from surgery that is also intended to reduce the risk of relapse in the future.