IMPROVE the ability of primary care physicians to detect the early signs of lung cancer in non-smokers, and push them to consider lung cancer as a plausible diagnosis even in people who have never smoked. It is the goal of the campaign See Through The Symptoms just launched by three British associations, which in the project also involved 9 patients with lung cancer who have never had the habit of cigarettes. But cancer does. Like Faye, a woman of just 28 who has put her story at the service of the initiative.
See through the symptom, the English campaign on lung cancer in non-smokers
The UK initiative, aimed at family doctors, was launched by patient associations EGFR Positive UK, ALK Positive UK and the Ruth Strauss Foundation, and is supported by many scientific societies, including Cancer Research UK. (credits: lungcancerseethroughthesymptoms.uk. Photographs by Rankin)
Mind you, let’s talk about a disease, the seventh most common cause of cancer death in the world, which is closely linked to smoking. Suffice it to say that 85% of the people who suffer from it are or have been heavy smokers. But that 25% of cases among non-smokers remain. In Italy, for example, of the approximately 41,000 diagnoses a year, 8,000 concern people who have never smoked. In short, if those who smoke risk much more, those who do not smoke are not at zero risk.
Diagnosis arriving late
“Lung cancer in non-smokers can be difficult to diagnose, but the incidence of the disease in people who have never smoked is on the rise, and the fact that so many people are diagnosed when the disease is advanced indicates that the issue is it is underestimated by general practitioners, ”he told the British newspaper The Guardian, Jenny Abbott, president of EGFR Positive UK, one of the three associations involved in the project, together with ALK Positive UK e alla Ruth Strauss Foundation.
https://www.youtube.com/watch?v=z9-c_yJl2qA
I don’t smoke, don’t I get sick?
“In 2018 – added Abbott – I was diagnosed with advanced lung cancer, and it was a terrible shock, because as a non-smoker, I didn’t think I could get sick with this disease”. Here, those who do not smoke tend to exclude the possibility of getting sick, but the fact is that – at least across the Channel – even doctors tend to consider non-smokers as ‘unlikely’ patients. Many non-smokers with lung cancer – always reports the Guardian – do not access potentially life-saving treatment because despite meeting their family doctor several times, and during the visits they report symptoms such as persistent cough, difficulty breathing or recurrent chest infections, they are not directed to more in-depth investigations, x-rays or scans .
Same disease, for those who smoke and for not
Now, UK issues aside, news of a campaign targeting doctors on lung cancer for those who have never smoked is an opportunity to talk about a disease that is still perceived as the cancer of smokers by definition. “Nobody is free from lung cancer,” he says Silvia Novello, professor of Medical Oncology at the University of Turin and president of Walce, Women Against Lung Cancer in Europe, a patient association founded 15 years ago to raise awareness and inform women and doctors about a tumor that for decades was considered a disease of smoking men: “We are talking about a disease that also affects those who have never touched a cigarette in their life and more often, but not always, it is women and young people. In the population of European origin, therefore we, the percentage of cases in people who have never smoked is 15-20% with geographical variability “. But does lung cancer have different characteristics in smokers and non-smokers? “No, it is the same type of tumor – continues Novello – there is no specific tumor for non-smokers. Even among non-smokers, adenocarcinoma is the most common, just like among smokers. Almost absent, however, is the microcytoma or small cell lung cancer, historically and classically described as the ‘most smoking-related’ lung cancer. Provided that there are ‘less correlated’ ones ”.
More molecularly targeted therapies
Until a few years ago, lung cancer in non-smokers was said to be a more aggressive and poorly responsive disease. In reality, today we know that precisely in the tumors of non-smokers we find higher percentages of molecular alterations that can be treated with biological therapies. For at least 4 biomarkers, molecularly targeted therapies already exist and are reimbursed. And this happens more in those patients who develop the disease having never smoked. “EGFR and Alk, to give two examples, are found much more frequently in adenocarcinomas of people who have never smoked”, explains Novello: “If in Italy the average life expectancy of 5 years for a patient with lung cancer is of 19% for patients with a molecular alteration treatable with precision medicine, these rates can exceed 50% ”.
Risk factors when cigarettes are excluded
But once smoking is ruled out, what are the risk factors for lung cancer? “We know that there is a list of risk factors for this disease in addition to active smoking, but these are difficult to specifically associate with lung cancer in those who have never smoked. Passive smoking must certainly be remembered, which is often neglected but has a devastating effect on the health of children and young people, but not only. There is a family predisposition, although we do not speak of genetics in the strict sense. Then there is radon, an odorless and colorless gas, the product of the decay of uranium. Radon is one of the most studied risk factors and cited as the main risk factor for lung cancer in patients who have never smoked in the United States ».
Never let your guard down
In the past, lung cancer was perceived as a male, or especially male, disease. This ended up harming women who also got sick, but who were not always diagnosed in time, precisely because of a sort of prejudice against them: we do not go into the investigations as it is unlikely that it is cancer. Isn’t that a bit, with the necessary differences, what happens today for non-smokers? “In the past – replies the oncologist – an important awareness campaign had to be carried out to make it clear that lung cancer was not and is not a male disease only. And today, in the face of a decline, albeit slight, in the incidence rates among men, in Europe and in Italy the disease continues to increase among women. Never let your guard down for a disease that is still the leading cause of cancer death today: starting a campaign on the cancer of non-smokers is certainly a good idea ”.
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