Younger patients with lung cancer more likely to have advanced disease at diagnosis
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Younger adults with lung cancer had a higher likelihood of having late-stage disease at diagnosis than older adults, according to study results.
The findings, presented during International Association for the Study of Lung Cancer World Conference on Lung Cancer, showed differences in tumor biology, delays in diagnosis and the absence of methods to facilitate early detection may contribute to the higher incidence of advanced disease among younger patients.
Rationale and methods
During the past decade, studies have shown significant improvements in early diagnosis and survival of older Americans diagnosed with lung cancer. However, these studies have not evaluated trends in early lung cancer diagnosis and survival among young adults, Alexandra Potter, co-founder and executive director of the American Lung Cancer Screening Initiative, said during a presentation.
“Previous studies have shown that young adults have distinct tumor characteristics and survival compared with older adults,” she said. “It is unknown whether recent improvements in early diagnosis and survival among older adults diagnosed with lung cancer are also observed among young adults.”
For this reason, Potter and colleagues gathered data from the U.S. Cancer Statistics Database and National Cancer Database between 2010 and 2018 to assess incidence and changes in the stage of non-small cell lung cancer by age group among patients aged 20 to 79 years. They additionally assessed 5-year OS and changes in median OS among the different age groups.
Key findings
Researchers identified 1,328 lung cancer cases among those aged 20 to 29 years, 5,682 cases among those aged 30 to 39 years and 39,323 cases among those aged 40 to 49 years.
More than 75% of individuals aged 20 to 29 years had a diagnosis of stage IV disease compared with 40% of those aged 70 to 79 years.
Researchers additionally observed a significant decrease during the study period in the percentage of patients aged older than 50 years diagnosed with stage IV lung cancers, whereas the percentage did not change significantly among those aged 20 to 29 years and 30 to 39 years and increased among those aged 40 to 49 years (P = .002).
The percentage of stage IV lung cancers diagnosed among those aged between 20 and 49 years increased from 60% in 2010 to 64% in 2018. Conversely, the percentage of stage IV lung cancers diagnosed among those aged between 50 and 79 years did not significantly change between 2010 and 2013 — prior to the U.S. Preventive Services Task Force guidance that called for low-dose CT screening starting at age 55 years for those with at least a 30 pack-year smoking history — but decreased by 3% between 2013 and 2018, from 46% to 43%.
“The difference in the rate of stage IV disease identified between the younger and older cohorts increased from 13% in 2010 to 21% in 2018,” Potter said. “We also performed a multivariable adjusted analysis of changes in the likelihood of being diagnosed with earlier stages of disease from 2010 to 2018. Among patients aged between 20 and 29 years, 30 and 39 years, and 40 and 49 years, the multivariable-adjusted odds of being diagnosed with earlier stages of disease from 2010 to 2018 did not significantly change. In contrast, patients aged older than 50 years had a significantly greater odds of being diagnosed with earlier stages of disease in more recent years.”
The researchers reported a 5-year OS rate of 20% among all patients aged between 20 and 29 years. Among those diagnosed with stage IV disease, they reported 5-year OS rates of 11% among patients aged 20 to 29 years, 15% among those aged 30 to 39 years and 10% among those aged 40 to 49 years.
“We then evaluated changes in median OS among patients aged 20 to 49 years diagnosed with stage III to stage IV disease,” Potter said. “There were similar increases in median OS among this subset of patients with late-stage disease, which likely drove the improvements in OS observed among the overall cohort of young patients. Notably, these improvements in median OS appear to align with the NCCN’s recommendation for genetic testing for EGFR and ALK mutations in 2012, as well as the FDA’s approval of immunotherapies in 2015.”
Implications
Potter reported several study limitations, including the absence of data on whether lung cancer was screen-detected and the lack of data regarding tumor biomarkers and receipt of targeted therapies among patients in the cohort.
“These improvements in median survival observed among young adults diagnosed with lung cancer are encouraging,” she said. “However, the lack of progress with regard to increasing early diagnosis among this population illustrates the need for strategies to increase the early detection of lung cancer among younger patients who are currently ineligible for lung cancer screening.”
For more information:
Alexandra Potter can be reached on Twitter @alexandra_p_24.
Perspective
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Houssein A. Sater, MD
Statistics show that stage IV disease is predominant in all age brackets affected by lung cancer. As more patients present with this disease at a younger age, it becomes necessary to better understand and tackle lung cancer earlier.The study by Potter and colleagues raised some really interesting flags, highlighting a higher percentage of stage IV disease among younger patients than older patients. Although this finding might not be surprising to oncologists who treat and follow lung cancer statistics, it certainly focuses the light toward an untouched area of highest importance.
Incidence of lung cancer increases with age bracket as patients carry more risk as they age. The 3% decrease in incidence of stage IV disease among older patients can be attributed partially to screening, but the significant increase among those aged 40 to 49 years has no clear explanation. U.S. Preventive Services Task Force screening recommendations increased the spectrum to between ages 50 and 80 years, and lowered the smoking threshold to 20 pack-years. Although this change is commended to save a higher number of patients, it still doesn’t address the younger adult age group (those aged younger than 50 years). The high percentage of stage IV disease with no major shift over time among those aged 20 to 40 years indicates that a distinct underlying biology, host factors and medical practices may exist among younger and older populations. In practice, the study perhaps suggests that earlier symptoms or signs of lung cancer among younger individuals should not be taken lightly.
Improved survival rates in the younger population reflects advanced personalized medicine and encourages more research in this area. In addition, more research is needed to address differences in access to care and community based medical practices for these patients.
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Potter A, et al. Abstract OA05. Presented at: International Association for the Study of Lung Cancer World Conference on Lung Cancer (hybrid meeting); Aug. 6-9, 2022; Vienna.
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