Lung cancer is no longer a death sentence. Why aren’t we saving more lives?
Lung cancer is lethal. It kills more people in Canada than breast cancer, colon cancer and prostate cancer combined; it is responsible for over 21,000 deaths per year. And yet, according to a new report by the Canadian Cancer Research Alliance (CCRA), lung cancer receives just six percent of the country’s total cancer research investment, while having among the highest projected incidence rate among Canadians, and the highest mortality of all types of cancer.
In Canada, research investment for specific types of cancer has resulted in advances in treatments and early detection methods, improving patient survival, and lessening the overall burden of the disease. The investment is often strongly linked to societal burden, with more common forms of cancer, such as breast and prostate, receiving more funding. But lung cancer, the most commonly diagnosed cancer in the country, does not enjoy corresponding levels of research funding. Why is this the case?
As someone who treats people with lung cancer, I believe there continues to be an unfair stigma and a certain nihilism attached to smoking-related illnesses. Smoking is one of the leading causes of lung cancer alongside other environmental factors such as radon exposure. Like obesity, another disease predominantly related to lifestyle choices, lung cancer may be viewed differently when organizations consider where to allocate research dollars.
Lung cancer, unlike other major cancers, has a challenging history in Canada. It continues to have a high mortality rate and for a long time, treatments were not very effective. This went against the trend of decreasing mortality and improving therapies for most major types of cancer over the past 20 years. While Canada ranks high in lung cancer survival compared to other countries, lung cancer may still be viewed by organizations as a lost cause and may be pushed aside in an atmosphere of supporting other more treatable cancers.
But Canadians need to know that times are changing for the better. Our efforts to address lung cancer in this country and investments in the disease need to follow suit.
Despite the relatively poor research funding to date, lung cancer is one of the most dynamically changing areas of oncology. In this era of personalized medicine, we now have novel targeted and immunotherapies that offer exciting treatments for advanced lung cancer. We also have focused radiation and new minimally invasive surgical techniques that allow more people with lung cancer to have curative surgery and recover faster.
Lung cancer is no longer a death sentence and outlooks for people with the disease today are more hopeful than ever before. It is time for our health care system to provide the programs and resources so these research findings can benefit patients.
In addition to emerging treatments, better screening has the potential to play a role in improving the state of lung cancer in Canada. Organized programs would provide routine screening, usually every two to three years, for high-risk individuals including long-term, daily smokers. As with all cancer screening programs, such programs have potential to catch lung cancer earlier. Early stages of lung cancer have a better prognosis than later stages.
Studies in the United States and Europe have shown that lung screening in individuals at high risk for the disease with computed tomography (CT) scans reduces mortality by over 20 percent. Despite this evidence, routine lung cancer screening does not exist in any province or territory.
Could we be saving more lives?
I would implore provincial and territorial governments, health authorities and organizations to start moving forward in addressing lung cancer and taking this disease, and the potential for people surviving it, more seriously.
This starts with increased investment in research to further build on effective treatments, followed by organized screening programs to help at-risk Canadians catch the disease earlier. Combining these efforts with tobacco cessation support for all newly diagnosed patients, which has proven to be effective in improving treatment outcomes, would offer better support and better outcomes to people with lung cancer.
I’m pleased to see that work has started. An organization I work with, the Canadian Partnership Against Cancer, is creating a framework to support any province or territory that wants to introduce organized lung cancer screening. The partnership is leading efforts to have organized lung screening available to all Canadians who can benefit, in all parts of the country, in the next decade.
I should be clear that smoking continues to be the leading cause of lung cancer. From a public health and prevention perspective, continued efforts on smoking cessation and harm reduction are needed. But for those who continue to smoke, we need to strive to move the bar on lung cancer treatment and screening to increase their chances of survival. We should not leave them behind.
There has never been more reason for optimism in the early detection and treatment of lung cancer. If we want to start saving more lives, we need to start putting money in areas where people are dying.
Dr. Christian Finley is an associate professor of thoracic surgery at McMaster University’s Department of Surgery and the University of Toronto’s Department of Surgery. He is also Expert Lead of Clinical Measures at the Canadian Partnership Against Cancer.