Early lung cancer detection improves survival rates
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The American Cancer Society estimated the numbers of new cancer cases and deaths in the United States, projecting nearly 2 million new cancer cases and more than 600,000 deaths in 2022.
In a recent report, researchers projected that lung cancer would be the leading cause of cancer death and found that the 3-year survival rate for lung cancer has improved.
Healio spoke with Rebecca L. Siegel, MPH, senior scientific direct of surveillance research at the American Cancer Society, to learn more about earlier detection of lung cancer and how it has helped patients increase their odds of survival and helped clinicians effectively treat their patients.
Healio: What are the key findings practicing clinicians should understand?
Siegel: After decades of poor prognosis, lung cancer is finally being diagnosed at an earlier stage and treated more effectively, bringing more hope to both patients and their doctors. Treatment advances have occurred across the board, from improved diagnostics and pathologic staging to targeted drugs and immunotherapies. As a result, the percentage of people alive 3 years after diagnosis rose from 19% in 2001 to 21% in 2004 and 31% in 2015-2017. Nevertheless, lung cancer is still responsible for more deaths than any cancer — more than breast, prostate and pancreatic cancers combined — so it is still important to talk to patients about not smoking and ensure cessation aids are available to those who do smoke.
Healio: What factors led to the observed increase in early diagnoses of lung cancer?
Siegel: The incidence of early-stage lung cancer increased by 4.5% per year from 2014 to 2018, while incidence of all other stages of disease decreased by 4% to 6% per year. The reasons are multifaceted but likely include increased access to health care because of the Affordable Care Act; the uptake of lung cancer screening with low-dose CT in certain individuals (those 50-80 years of age with a minimum 20-pack-year smoking history), which has been recommended by the American Cancer Society and U.S. Preventive Services Task Force since 2013; and incidental diagnosis because of imaging for other reasons.
Healio: How does early diagnosis of lung cancer improve patient outcomes?
Siegel: Earlier diagnosis has an enormous impact on survival because with less spread, treatment has a better chance to be effective — 5-year survival increases from 6% for patients diagnosed with metastatic disease to 33% for regional spread and 60% for localized disease. Earlier diagnosis also enables more treatment options.
Healio: What factors led to improved survival in patients with lung cancer?
Siegel: In addition to earlier diagnosis, staging and surgery are now more precise, especially with the advent of video-assisted thoracoscopic surgery. Additionally, drugs like epidermal growth factor receptor and aplastic lymphoma kinase tyrosine kinase inhibitors target specific oncogenes and have been a game changer for many patients with non-small cell lung cancer. We have yet to see the full effect of immunotherapies, which were only approved in 2015 for second-line treatment, but expect an additional boost there.
Healio: What work is needed to continue to improve survival in patients with lung cancer?
Siegel: As exciting as these advances are, we must remember that more than 80% of lung cancers are caused by smoking and stay vigilant to help people quit. Additionally, getting eligible people to screening has been challenging, so more work is needed to educate primary care physicians about eligibility criteria, train radiologists and improve patient navigation.
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