Disparities facing the world of lung cancer mortality

Research results presented at the annual meeting show that despite the declining incidence of lung cancer across the country, there are various disparities, so the significant difference in disease incidence and outcome remains at the state level. increase.

In the presentation, Dr. Raymond U. Osarogiabon, an oncologist at the Baptist Cancer Center in Memphis, Tennessee, discussed the geographical disparity in lung cancer mortality across the United States.

“We know that (lung cancer) is an oncological challenge of our age. From a human life perspective, it is the largest of men and women in the United States and many countries around the world. The good news in the United States is that it’s declining over time, “Osarogiagbon explained in an interview with CURE®. “But the bad news is in the United States. If you dig a little deeper, you’ll find a completely different situation. At the state level, breaking down lung cancer as a cause of death makes a big difference between states … Southern and Midwestern United States. Is the cluster with the highest per capita risk of death. “

According to Osarogiagbon, the states with the lowest lung cancer mortality rates are Kentucky, Mississippi, Arkansas, Tennessee, West Virginia, Alabama, North Carolina and South Carolina, and Louisiana.

“At the county level, the gap is even worse,” he said, with some of the deaths from lung cancer increasing, such as the Appalachian and Delta authorities, but flattening. He said that some have become.

The disparities involved include women at high risk of lung cancer and racial minorities, despite low levels of tobacco exposure.

Dr. Kim Lori Sandler, associate professor of radiology and radiology at Vanderbilt University School of Medicine in Nashville, Tennessee, and co-director of the Vanderbilt Lung Screening Program, can cause inequality beyond smoking. He emphasized that there is sexual exposure. “We know that smoking is the number one cause of lung cancer, but there are other causes as well. We know that radon exposure and other types of exposure can cause lung cancer. Certain populations continue to be exposed to smoking and other high-risk exposures, “she told CURE®.

Sandler, who was not involved in the study presented at the conference, said the importance of lung screening emerges here. “The population highlighted in the presentation is common in this southeastern region, where we maintain very high smoking rates,” she said. “Unfortunately, the percentage of lung cancer screenings (in that region) remains lower than in other parts of the country, such as the northeast. Looking at the map of the availability of lung cancer screening programs, a variety of programs are available. You can see that they are very localized in the center of these northeastern areas. Going to the southeastern part, they spread further and patients need to move further to be able to enroll in these programs. . “

Importance of lung screening

According to Osarogiagbon’s presentation, keeping up with the annual lung cancer screening, which is usually covered by insurance, can reduce the risk of dying from the disease by 20%.

“From the time of onset, whether (lung cancer) is detected early, whether it is optimally treated, whether it is properly monitored after diagnosis and treatment … there are very preventable differences. ,” He said. “It’s the people who live in parts of the world, or parts of the country, who have resources organized in a particular way, not others, but who are doing well. Than racial minorities. It’s also whites who are doing well. When we talk about the intervention itself and access to them, it’s often common, it’s men who do better.
Than a woman. And these are all you need. It significantly undermines the full benefits of the innovations discovered. “

Lack of screening practiced in states with high illness deaths can also lead to late diagnosis. In this situation, it means that many patients with lung cancer cannot be cured by surgery. For example, 50% of lung cancer patients in Wyoming can be cured by surgery, but 90% in states such as New Jersey, Massachusetts, and Utah.

“If you dig deeper and go to the county level, it’s even uglier. There are counties as low as 12% of patients with early-stage lung cancer that can be cured by surgery,” added Osarogiagbon.

Notably, the 5-year survival rate for early lung cancer diagnosis is 90%. However, when the disease enters the late stage, the 5-year survival rate drops to less than 10%. “Ideally, when we detect lung cancer, we want to find it at the earliest stage in which patients can be treated with minimally invasive surgery without the need for chemotherapy or radiation therapy,” Sandler explains. bottom. “It’s unusual for our screening program to say that finding cancer is a win, but if we can find it early and really offer patients treatment options, it’s a big win for us. . “

Close the gap

According to Osarogiagbon, these disparities must face a multifaceted approach.

“We begin to focus (if necessary) on preventing, narrowing (and) closing inequality. We need to understand that solutions come from multiple levels. The least effective are It is a level that directly abuses and (and) blames the victims of inequality. (Patient) Do not agree with the idea of ​​doing something to hurt yourself. Poor (patient) lung cancer does not rise in the morning “Ippy, I’m going to make sure I’m getting the wrong treatment today. I don’t mind dying.” “When we talk about inequality, we see our enemies away from the traditional narrow lens of who these people are or why they have such terrible consequences. It’s very important to recognize that it’s us. “

Sandler agreed with this outlook, emphasizing the need to dispel the stigma of smoking and lung cancer, especially if other factors may be involved.

For this reason, Sandler believes that further research into screening eligibility and expansion of eligibility to at-risk populations will impact, in addition to further involvement with the community to enhance outreach and education. I am.

She said there were some progress. “As for inequality, the guidelines were just updated earlier this year, reducing ages from 55 and 30 to 50 (and pack-year smoking history), respectively,” she said. “And the recommendations from the United States Preventive Services Task Force (US Preventive Services Task Force) specifically say that it is to address the gap between the African-American community and women, because these are what we actually do. Because of the population we see in the population. Increased eligibility. Not perfect. It’s the first step. But with that conversation, different organizations are ready to embrace the new guidelines and continue to work on them. I think it’s a really, really positive step to confirm. “

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