Lung Cancer: Who Cares?
Principal and Founder, Digital Healthcom Group
The number of lives taken will be greater than the total death count of soldiers and civilians from all nations killed during World War II; will be more than 3x the death toll of all international wars of the last 60 years; more than 15 million casualties greater than the total deaths of the international AIDS crisis since its start in 1981; and will be equivalent to losing the combined populations of Beijing, Los Angeles, Cairo and Rome.
Should we care? I tend to think we should.
While the five-year survival rate is 54 percent for cases detected, that’s only when the disease is localized within the lungs. Only 15 percent of lung cancer cases are diagnosed at that early a stage. The five-year survival rate drops to just 4% once the primary lung cancer has spread to other organs.
$6.4 Trillion Economic Impact by 2050
The Smoking Gun?No news here that the greatest negative force involved in lung cancer incidence is smoking. The American Lung Association estimates that active smoking is responsible for close to 90% of lung cancer cases. Other interrelated risk factors include exposures to radon, outdoor air pollution, asbestos, uranium, and radiation treatment to the chest (for diseases like breast cancer or lymphoma).
As many as 20% of those who die of lung cancer annually never smoked or used tobacco. According to the American Cancer Society, “If lung cancer in non-smokers had its own separate category, it would rank among the top 10 fatal cancers in the United States.”
The Woman’s Cancer?
- Young women have started smoking at younger and younger ages.
- A women who smokes the same number of cigarettes as a man is twice as likely to develop lung cancer because men have a greater ability to detoxify toxins.
- Estrogen increases cancer incidence and growth.
A Silent Parade
With such an impact, why isn’t lung cancer getting the attention and funding it seems to deserve? Where are the huge fundraising walks, runs, nightly news stories, advocacy efforts, celebrity stories of hope and cause-related fundraising programs at every retail store counter?
2) About two out of three lung cancers are diagnosed in people over age 65, and the average age at diagnosis is 71. 6 So our small number of survivors are often too tired or in poor health, mentally and/or physically to lead the movement anyway. In comparison, 34% of all invasive breast cancer incidences occur in women under age 55, and 12% of those women are younger than age 45.
3) Lung cancer continues to have its usual stigma related to cigarette smoking. The “they got what was coming to them and should have known better” issue.
That’s 62% less funding each year for a killer we know about, and who we know will successfully kill 1.6 million people across the globe next year, and another 1.6 the year after that, and the year after that, and so on.
In more everyday context, the tobacco industry itself had a value of over $40 billion last year internationally. Our international lung cancer commitment in the same period was 2% of that.
Less deadly, coffee sales worldwide are more than $80 billion annually, and ice cream sales worldwide are over $74 billion. In context of dollars and cents only, lung cancer research got 1% as much money as either of those sales figures. While it’s an apples to bananas comparison, it does show economic perspective at simply a consumer spending level.
So Who Cares?
Awareness campaigns are still needed. Organizational or small- to mid-size collaborative research projects are inspiring and helpful. But however “promising” and hope-filled they seem, they are inadequate to make the major impact needed.
An unprecedented international collaboration and commitment of magnitude, resources and leadership is what is needed. The kind that wins not just battles, but wars.
Progress Being Made
- Catch lung cancer earlier while it is still treatable and either pre-cancerous or stage I.
- Create better, less toxic, less invasive treatments that have longer efficacy.
- Prevent lung cancer from happening in the first place.
The good news is that we are doing well at the first two.
Catching it Faster
Improved screening and its research movement began just several years ago. I was thankful to play a small part in one effort, the creation and funding of the Stacey Scott Lung Cancer Registry. The registry was one of the first international collections of biologic samples and corresponding scan and lifestyle data from high-risk patients at partner cancer centers in the United States, Canada, and Europe for research.
Low-dose computed tomography (LDCT) in high risk adults aged 55 to 80 years old is now recommended for individuals with a 30 pack-year smoking history and who currently smoke, or have quit within the past 15 years. This recommendation also took time to get wide adoption. In America alone, it is still endorsed by only 8 of 9 leading organizations in the field.
The one that did not is the American Academy of Family Practice (AAFP). AAFP’s reasons were because “favorable results, conducted in major medical centers with strict follow-up protocols for nodules, have not been replicated in a community settings. The long term harms of radiation exposure from necessary follow-up full dose CT scans are unknown.”
True. Community oncology diagnostics, care, treatment and follow-up for lung cancer (and most cancers) is typically of a different quality and consistency than that conducted in major medical centers and comprehensive cancer centers. In a perfect, collaborative environment, the solution would be easy: A generalist in the community would refer the high-risk case to the experts. Solved.
But we don’t live in that world. So that’s not about to happen.
Creating Better Treatments
But while laudable in their early current phases, the immunotherapy drugs offer just an extra 3 to 9 months of life beyond standard chemo for the majority of advanced lung cancer patients.
New and targeted gene sequencing tests also are hitting the market. These can quickly sequence an advanced lung cancer patient’s DNA to see exactly which known lung cancer genes have mutations on them in that individual. A “prescription” is then provided using the available, already approved drugs (mostly pills) for each of the gene mutations. It’s an advanced lung cancer treatment cocktail approach—more targeted, and less toxic, than ever before.
This is tremendous progress and is saving lives. But still, this is only part of the solution.
Vaccines for Lung Cancer
After some initial lessons from earlier vaccine NicVAX (by Nabi, and funded by the Dutch government), new vaccines and approaches are on the way it seems.
The most talked about is from researchers at The Scripps Research Institute and colleagues at Weill Cornell Medical College. It creates antibodies to “shut off” the brain’s reward system for nicotine. But it because nicotine is a small molecule, not seen by the immune system, the vaccine has to be joined to a larger molecule in order to get an anti-nicotine immune response. With help from Cornell, they announced in September that they have tied it to a purified protein delivery to increase the levels of anti-nicotine antibodies delivered to “shield the brain from nicotine.” Research continues.
Over at Massachusetts General Hospital in Boston, their peers are studying how to improve the clinical response rate to a nicotine vaccine using a laser-based, particulate vaccine and adjuvant-coated transdermal patch.
Like at Selecta Biosciences, in Watertown, New York. The company received $8.1 million from the National Institute on Drug Abuse (NIH) in June 2014 to continue development of a nicotine vaccine that uses nanoparticles to modulate the immune system. They previously secured $3 million from the same agency, “which paid for early research and an initial trial in 80 humans which found the drug (SEL-068) to be safe.”
This leads to the related discussion of creating an approved, international nicotine vaccine for children or even newborns. And that creates discourse and disagreement on ethical and moral grounds. I read one piece that even said teens might be more apt to smoke knowing they could not get addicted.
Yet if such a vaccine would allow no one to ever get addicted to cigarettes, we could prevent 30% of all cancers internationally, as well as millions of deaths from heart disease and other diseases each year. Financially we are talking about billions and trillions of dollars saved across the world.
And as we began this blog, we would save 160 million lives in the next century based only on current statistics.
I don’t buy the argument against it. But I seek your thoughts and expertise here. Thanks to LinkedIn, we have a dialogue opportunity with experts across the globe. Way smarter people than me for sure. And I want to learn the “why not” reasons so I can be better versed.
The nicotine vaccine approach also would have huge negative economic ramifications for those employed by the tobacco industry—from poor farmhands to middle class managers, and yes, extremely well paid VPs. Crime and criminal justice costs would likely eventually get sucked into the whole thing, too. We'd see criminal activity, worldwide violence, related deaths and other costs. Such international issues tend to face armies of opposition, with extremely deep pockets.
In the end, here’s the rub. Lung cancer is not an American problem. It is not a smoker’s problem. It is not a male problem or a female problem. And it is not the problem of the poor, rich or middle class. Lung cancer is everyone’s problem.
Taking it on for good requires deeper international collaboration, corporate collaboration, government funding collaboration, and moral and ethical discussion, debates and fights.The question is, are we really interested in going there?
Do we care about lung cancer, or don't we?