It is vital that society understands that getting checked increases the chance of early detection of lung cancer.
Lung Cancer Awareness Month (LCAM) is an important milestone for the lung cancer community providing a focal point for education and awareness-raising activities.
Dr. Barbara J. Gitlitz, practicing Oncologist and Senior Medical Director of Product Development Clinical Oncology from Roche, had the opportunity to speak to Ewelina Szmytke, Vice President of Lung Cancer Europe (LuCE) and lung cancer advocate for more than 15 years, about increasing rates of screening and the importance of biomarker testing to enable personalised healthcare.
Barbara Gitlitz (BG): LuCE’s Lung Cancer Awareness Month campaign this year is sending out a strong message to encourage people to take action and ‘Get Checked’ for lung cancer. Why have you decided to focus your attention on this issue?
Ewelina Szmytke (ES): Despite advances in treatment, lung cancer is responsible for the most cancer-related deaths in the world. It’s a significant healthcare burden, often diagnosed at a late, incurable stage. If more patients were diagnosed earlier it could lead to improved treatment outcomes and better quality of life, as well as improved survival rates.
Vice President of Lung Cancer Europe (LuCE)
BG: One way we’ve seen other cancers tackle earlier diagnosis is through screening programmes, which allow physicians to look for cancer in people at high risk, even before they have any symptoms. This approach can help find cancer earlier, when the goal of treatment may be cure. One of the major challenges with cancer, and specifically lung cancer, is that by the time symptoms appear, the cancer may have already spread. We’ve seen great outcomes across Europe from national screening programmes for other kinds of cancer, including breast, cervical and gastrointestinal cancers. However, despite the high unmet need in lung cancer, screening rates are a fraction of those for breast cancer.
ES: There are some pilot lung cancer screening programmes. For example, in Poland we had a pilot study and have now implemented a national low-dose CT screening programme for lung cancer that will continue until the end of 2022 or mid-2023 depending on the region. But when it comes to implementing national screening programmes for lung cancer there does seem to be hesitation from health services because there are several challenges and different factors at play. For example, the need to have enough CT scanners available and the right infrastructure in place can present barriers. I suspect that the cost effectiveness of such programmes is the main consideration for national authorities, so it’s vital that policymakers across Europe recognise that this is an urgent societal and political need.
BG: Yes, absolutely. We’ve seen the effectiveness of such screening programmes in studies such as NELSON - the largest trial in Europe of its kind - which found a positive effect of low-dose volume CT screening in reducing lung cancer mortality rates, echoing results from the US-based National Lung Screening Trial (NLST). In this study, mortality was reduced by 24% in men and 33% in women in the treatment group compared with the unscreened control group.
Dr. Barbara J. Gitlitz
Practicing Oncologist and Senior Medical Director, Product Development Clinical Oncology at Roche
Lung cancer is the leading cause of death from cancer worldwide and causes more deaths than breast, colorectal, and cervical cancers combined - cancers for which population-based screening programs exist. The reduction of breast and lung cancer-related mortality has been shown to be similar when early screening is implemented.
ES: There is another challenge though, in encouraging people to take up lung cancer screening if it’s made available to them. Stigma is a huge problem in lung cancer. Lung cancer is seen by many as a disease that is brought upon oneself, in a way not seen with some other cancers - for example skin cancer, where you don’t see people being blamed for not wearing sunscreen. This stigma means people are often reluctant to seek help for fear of being blamed or shamed for their illness. Education and information about early detection is so important - people need to know that so much more can be done to manage the disease if detected and treated early.
A typical treatment journey for people with early-stage non-small cell lung cancer
BG:LuCE’s ‘Get Checked’ campaign tells that message in a really clear and simple way. I know that you feel using the right language to talk to people is really important.
ES: It’s absolutely critical. For example, in the UK they use the term ‘your lung check’, not ‘lung cancer screening’. It encourages people to take positive action - to check their lungs to make sure they’re healthy. We need to do whatever we can to reduce the barriers that might prevent people from getting checked.
BG: Another important aspect of earlier diagnosis and treatment is the increasing role of biomarker and genomic testing, which if done at diagnosis can help physicians identify the right treatment for the individual patient. However, despite European guidelines recommending testing, a
ES: Raising awareness and education is vital here, as this is a significant problem. We need to improve physician awareness of the impact of biomarker testing through educational activities, as well as educate patients so that they can make an informed decision about their treatment. This is an area that also requires collaboration between both professional and political experts to make sure patients have access to these tests.
Lung cancer: the cancer of many guises
BG: LuCE does a huge amount of work to advocate for European policies that will hopefully lead to improvement in lung cancer diagnosis and treatment, as well as supporting and establishing lung cancer patient groups across Europe. Those partnerships must be something you’re really proud of. I know at Roche, we’re incredibly proud to partner with organisations like LuCE as well as other key stakeholders, such as healthcare professionals and professional societies. These cross-discipline collaborations are really important, aren’t they?
ES: I think they’re crucial. LuCE is the voice of people affected by lung cancer in Europe, advocating and networking to improve outcomes for patients. The collaborations are vital to enable us to identify and address the barriers relating to lung cancer care and treatment and we hope this will support the successful implementation of national screening programmes. Together with its partners, including Roche, LuCE has been developing a range of reports tackling relevant challenges for the lung cancer patient community. The reports include a set of actions that will be taken to the EU Parliament in an event held in November as part of Lung Cancer Awareness Month.
BG: The work you do is incredibly important. Let’s hope that this Lung Cancer Awareness Month, our combined efforts mean more people know how important it is to ‘Get Checked’.