Lung cancer cases in people who never smoked grow

Lung cancer cases in people who never smoked grow

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Lung cancer cases in people who never smoked grow

In August 2019, seller Renato Astur discovered lung cancer at the age of 57. When he was bothered by a dry cough that refused to go away, he went in search of a diagnosis. After more than three months of going from office to office — and having his symptom wrongly associated with reflux — he was diagnosed with cancer after having a CT scan. The exam was only indicated by the pulmonologist out of “precaution”, since Astur was not part of the risk group: in addition to not smoking, he had a healthy diet and was adept at various physical activities, such as swimming in the sea, cycling and mountaineering.

“The professional who did the CT scan came out from behind that wall and glass and asked me: “Why did you come here?”. I replied that it was because my cough was not going away. doctor would talk to me. On the same day, the pulmonologist’s secretary called me saying that the doctor wanted to talk that afternoon. I went to the office. The doctor showed me the computer screen and everything was white, on both sides. I asked what that was and she I said it was probably cancer. Then my floor opened up. Because, until then, all you know about this type of disease is that you’re going to die fast”.

Faced with the challenge of treating the cancer that was already at an advanced stage and with metastasis, he decided to write the book “Eu não fumo” (I do not smoke) (published by Chiado), with copyright donated to Hospital do Graac, a reference in the treatment of childhood cancer.

Lung cancer is the second most common type of tumor in the country and affects about 30,000 Brazilians a year. Data from the National Cancer Institute (Inca) indicate that smoking is responsible for about 90% of diagnoses of this type of tumor. There is no doubt that the main risk factor for the disease is smoking. Therefore, the vast majority of cases are concentrated in smokers or ex-smokers. However, cases like the one in Astur have become more common around the world and the trend draws the attention of specialists.

A recent study in the United States of 12,103 lung cancer patients found that between 1990 and 1995, people who had never smoked accounted for 8% of all cases of the disease. Between 2011 and 2013, the participation of these people rose to 14.9%. The authors ruled out statistical problems and concluded that “the actual incidence of lung cancer in never-smokers is increasing.” Another study in the same year of 2,170 patients in the UK showed an even greater increase: the proportion of lung cancer patients who had never smoked increased from 13% in 2008 to 28% in 2014.

According to oncologist William Nassib William Júnior, director of Clinical Oncology and Hematology at BP – A Beneficência Portuguesa de São Paulo, a large part of this trend is due to the reduction in the number of smokers. As there are fewer smokers in the population, for every 100 patients with lung cancer, the number of these people will be smaller and, consequently, the number of non-smokers will increase.

On the other hand, there are indications that the absolute incidence of lung cancer in never-smokers is increasing. It is worth noting that this does not mean that someone who has never smoked has a greater chance of developing lung cancer today than in the past. One of the obstacles to better understanding this trend is the advance in diagnosis, which also contributes to more detection of the disease.

“We are getting better at diagnosing these tumors. CT scans have more modern techniques and this contributes to an increase in diagnoses”, explains the doctor.

The exam used to identify the disease is a chest tomography. There is still no national guideline for lung cancer screening in the population at risk. But international guidelines recommend that smokers or people who quit smoking less than 15 years ago, who have smoked at least one pack of cigarettes a day for 20 years, be tested. The orientation is to perform it every one or two years, from 50 to 55 years of age.

In Brazil, the lack of a guideline in this regard contributes to the fact that this test is still not widespread.

“Rarely, people go to a general practitioner and he is aware that the person is included in the criteria for this tomography”, warns William.

Lung cancer screening is not recommended for the general population because the costs are considered greater than the benefits. Still, the test can detect lung cancer in a significant number of people who have never smoked. According to William, in Asia, where this type of tumor is more common in non-smokers than in the rest of the world, studies are already being carried out to assess the cost-effectiveness of recommending screening for the entire population, starting at a certain age. The doctor points out, however, that even if the result of this study is positive, the recommendation should adapt to each country and population.

“Not everything that is done there can be applied directly here. For these tests to be useful, it is necessary to have a certain incidence of lung cancer because if it is very rare, the test will not identify. But this type of approach is already beginning to emerge “, says the oncologist.

One tool that is beginning to be developed are blood tests to detect early lung cancer. If it does happen, it will be a much simpler and more accessible way of tracking this type of tumor in the population. But the development is still quite preliminary.

It is still not very clear to medicine what are the causes of lung cancer in non-smokers. Some factors that are known to increase the risk of the disease, in addition to smoking, are: secondhand smoke, pollution, exposure to harmful substances such as radon, glass dust and asbestos, and family history. Chronic lung infections and lung diseases such as chronic obstructive pulmonary disease (COPD) also appear to increase the risk.

A study conducted by the US National Cancer Institute showed that lung cancer in non-smokers originates from genomic mutations. The work, published in the journal Nature Genetics, described, for the first time, three molecular subtypes of lung cancer in people who never smoked.

Data also show that women are at greater risk than men, for example. Women who have never smoked are twice as likely to develop lung cancer as men who have never had a cigarette in their mouths. It is still unclear why this is.

Improvement in treatment

Lung cancer is the leading cause of cancer-related death. The main explanation for this is late identification. Only 16% of cases are discovered in the early stage of the disease.

“In an early stage, lung cancer usually does not cause symptoms. When they appear, the tumor is already advanced”, points out William.

In addition to improving the identification of the disease, the development of new treatments can help to change this scenario and this has already started to happen. Data from the United States Annual Report on the Status of Cancer indicate that death rates for men and women with lung cancer are declining even faster than their incidence since 2011. the increase in diagnoses of the disease may partially explain this fact. But experts believe advances in treatment are primarily responsible for the trend.

In the last decade, more traditional therapies such as surgery, radiation and chemotherapy for non-small cell lung cancer, which accounts for the majority of this type of tumor, have improved and many new treatments have appeared. These include immunotherapies, which stimulate the patient’s own immune system to fight the tumor, and targeted therapies, which are indicated for specific genetic changes seen in some tumors.

The tumors of those who never smoked tend to have fewer mutations and to respond better to targeted therapy drugs. But indication of this type of treatment requires molecular tests.

The main way to prevent lung cancer is not to smoke. For those who smoke, quitting cigarettes also dramatically lowers the risk of the disease.

“Each year that a person stops smoking, the risk of developing lung cancer and various diseases, such as high blood pressure, cerebrovascular accident (CVA) decreases, in addition to an improvement in quality of life. Even cancer patients who stop smoking , respond better to treatment”, points out director of Clinical Oncology and Hematology at BP – A Beneficência Portuguesa de São Paulo.

Other indirect forms of prevention include eating healthy, exercising regularly and avoiding alcohol. Although the symptoms of lung cancer are more likely to appear later in the disease, it is important to be aware of when they appear. The most common are:

  • cough, usually dry and incessant
  • shortness of breathe
  • chest pain
  • spit blood
  • unexplained weight loss
  • loss of appetite
  • fatigue.

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