American Review of Respiratory Medicine - Volumen 23, Número 2 - June 2023

Editorials

Should we change the diagnostic paradigm of lung cancer if we want to improve patients’ prognosis?

¿Debemos cambiar el paradigma de diagnóstico en el cáncer de pulmón si queremos mejorar el pronóstico de los pacientes?

Historically, lung cancer has been diagnosed late, with the well-known ominous consequences ^(1-2). Usually, lung cancer detection occurs in specialized hospital units with greater human and technologi­cal resources.

As described in the article “Analysis of Lung Cancer in a Reference Hospital in the City of Santa Fe with a Follow-Up of 20 years” and in many other publications, there have been epi­demiological changes in recent years. There has been a modification in the histology of the most common presentation (an increase in adenocarci­noma), a shift in prevalence between genders (an increase in women and a decrease in men), and a decrease in smoking incidence. However, at the time of diagnosis, non-surgical stages account for over 70%. There is already sufficient evidence that early detection programs using tomography improve survival rates and enable early diagnosis of cancer. However, there are many difficulties for people to access these programs ^(4-7). While there is acceptance among the majority of involved specialties ⁽⁸⁾ and consensus from scientific societ­ies ⁽⁹⁾, there may still be a lack of health policies aimed at changing this situation.

If we want to take measures that reach the entire population, we cannot expect to do so solely through large centers. In my opinion, primary care networks with increasing levels of complexity are the key to reaching asymptomatic patients. It is also important to have coordination with a higher complexity center for case discussions and the adoption of best practices. Early detec­tion healthcare providers should not only serve as referrals but also be an integral part of the project. Smoking cessation is an essential com­ponent of any program and could have a place in this level of care.

I think that we should form interdisciplinary working groups to implement the early detection program for lung cancer and ultimately improve the survival rates of this disease.

REFERENCES

1. Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2016;11:39-51. https://doi.org/10.1016/j.jtho.2015.09.009

2. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209-49. https://doi.org/10.3322/caac.21660

3. Vegetti L, Ballina A, Wustten S, et al. Implementation of a COPD Eradication Program Multidisciplinary Program for Prevention, Diagnosis, and Management of Pre-COPD Rev Am Med Resp 2023;23:89-104. https://doi.org/10.56538/ramr.NCNG2904

4. National Lung Screening Trial Research Team; Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5):395-409. https://doi.org/10.1056/NEJMoa1102873.

5. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020;382:503-13. https://doi.org/10.1056/NEJMoa1911793.

6. Pastorino U, Silva M, Sestini S, et al. Prolonged lung cancer screening reduced 10-year mortality in the MILD trial: new confirmation of lung cancer screening efficacy. Ann Oncol. 2019;30:1672. https://doi.org/10.1093/annonc/mdz169.

7. Santos RS, Franceschini JP, Chate RC, et al. Do Current Lung Cancer Screening Guidelines Apply for Populations With High Prevalence of Granulomatous Disease? Results From the First Brazilian Lung Cancer Screening Trial (BRELT1). Ann Thorac Surg. 2016;101:481-6. https://doi.org/10.1016/j.athoracsur.2015.07.013.

8. Lamot S, Viola L, Benitez S, et al. Current status of Lung Cancer Screening in Latin America. LALCA 2023. J Thorac Oncol. 2023;18: S29. https://doi.org/10.1016/j.jtho.2023.01.079

9. Boyeras I, Roberti J, Seijo M, et al. Argentine consensus recom­mendations for lung cancer screening programmes: a RAND/ UCLA-modified Delphi study. BMJ Open 2023;13:e068271. https://doi.org/10.1136/bmjopen-2022-068271