06/12/2024
Lung cancer diagnosis and treatment requires both early screening and genetic testing
As the aging process of China's population gradually accelerates, the incidence of cancer in China is still on the rise, seriously threatening the health of Chinese residents. Among them, lung cancer ranks first in the number of new cancer cases and cancer deaths each year. According to the latest data from the China Cancer Burden Report released by the National Cancer Center, in 2022, there will be about 1.0606 million new cases of lung cancer in China and about 733,300 new deaths from lung cancer. According to data calculations, one in five new cancer patients is a lung cancer patient, and one in four cancer patients who die is due to lung cancer.
It is understood that lung cancer can be divided into non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), of which NSCLC accounts for about 80%-85% of all lung cancers. However, due to its hidden early symptoms, about 75% of patients are already in the middle and late stages when they are discovered, and the overall 5-year survival rate of lung cancer patients is less than 20%. However, Zhang Yong, secretary of the Party Committee of the National Cancer Center, said at a press conference held by the National Health Commission that the formation of cancer is a chronic process of long-term accumulation of multiple risk factors, which can be prevented and controlled. According to data from the World Health Organization, one-third of cancers can be intervened in advance through early detection, significantly reducing mortality and prolonging survival. So, how to improve the 5-year survival rate of lung cancer patients? What is the important significance of the development and application of early screening and standardized precision diagnosis and treatment for the diagnosis and treatment of lung cancer? What is the important role of genetic testing in patients receiving targeted treatment? During the National People's Congress and the Chinese People's Political Consultative Conference, Professor Zhang Hua, member of the Standing Committee of the Hebei Province Lung Nodule Diagnosis and Treatment Center of the China Lung Cancer Prevention and Control Alliance, member of the Political Consultative Conference of Xinhua District, Shijiazhuang City, Hebei Province, and deputy chief physician of the Second Department of Thoracic Surgery of Hebei Provincial People's Hospital, said in an interview with a reporter from 21st Century Business Herald that at this stage, the public's awareness of early screening, early diagnosis and early treatment of lung cancer is still insufficient, resulting in many patients being diagnosed in the late stage. At the same time, the public and patients have cognitive misunderstandings about the characteristics and treatment methods of lung cancer, and pay less attention to genetic testing, resulting in ineffective treatment, delayed disease, and increased difficulty in lung cancer treatment.
"It is urgent to improve the public and patients' correct understanding of lung cancer treatment methods and accurate diagnosis. At present, a standardized diagnosis and treatment system for lung cancer should be established, with both early screening and genetic testing to improve the 5-year survival rate of lung cancer patients, and to reduce the economic burden of lung cancer patients to the greatest extent in terms of affordability." Professor Zhang Hua said.
Pushing the prevention and control threshold forward
"At present, there is no clear main cause of lung cancer, but the clinic will discuss high-risk groups." Professor Zhang Hua gave an example, for example, people over 45 years old need to pay more attention to their lungs, and the incidence rate of both men and women is very high; smokers and people with a history of environmental or high-risk occupational exposure will have a higher incidence of lung cancer; people with a family history of tumors, especially those with a family history of lung cancer, have a much higher incidence of lung cancer than normal people.
Because lung cancer is relatively hidden, even if the patient has a three or four centimeter tumor, he may not have any symptoms. He often only seeks medical treatment after coughing, sputum, hemoptysis and other characteristic clinical manifestations of lung cancer. At this time, the treatment is already in the middle and late stages, and the prognosis is not ideal.
In this regard, Professor Zhang Hua emphasized that high-risk groups need to pay special attention to early screening. "People over 45 years old should undergo lung cancer screening as early as possible, and people at high risk of lung cancer should undergo low-dose spiral CT early screening regularly once a year. This is the most helpful and meaningful way to detect cancer early. Today, the 5-year survival rate of stage I lung cancer can reach 80% through treatment, and the 10-year survival rate can reach 70%. From the perspective of the 5-year survival rate, it is actually cured, and this is mainly due to early screening and early diagnosis."
Currently, low-dose spiral CT is the only internationally recognized effective lung cancer screening method. Its advantages mainly lie in low radiation, high clarity, low harm to public health, and the ability to detect tiny tumors with a diameter of less than 1 cm, playing an important role in early lung cancer screening. Relevant data show that low-dose spiral CT screening can reduce the mortality rate of lung cancer patients by 20%.
However, the early screening rate of lung cancer in China is not high at present. The main reason is that the public generally lacks awareness of early screening and it is difficult to take the initiative to screen. "For the public, they lack professional knowledge. This information asymmetry leads to the public's low awareness of early screening and diagnosis of lung cancer, which requires professionals to constantly popularize science to them." Professor Zhang Hua said that if early tumor screening is included in the basic public health service project, it will greatly increase the participation of high-risk groups in screening and promote the advancement of lung cancer prevention and control.
It can be seen that early screening, early detection, and early treatment are at a relatively early stage when patients seek medical treatment. On the one hand, it is of great help to the diagnosis and treatment of lung cancer; on the other hand, for patients, the cost of early treatment is much lower than that of late treatment, and the family's economic burden will not be too heavy, and they will not become poor or return to poverty due to illness.
It is recommended to include genetic testing in medical insurance
In recent years, China has vigorously promoted cancer prevention and control, and established the "Cancer Prevention and Control Action" among the 15 special actions of the "Healthy China Action (2019-2030)". At the end of October 2023, multiple national departments jointly issued the "Healthy China Action-Cancer Prevention and Control Action Implementation Plan (2023-2030)", which will enhance cancer screening and early diagnosis and treatment capabilities, standardize diagnosis and treatment levels, and control patients' disease burden as the main goals.
Driven by a series of policies, lung cancer has a very clear treatment standard. Usually, in the early stage of tumor discovery, radical cure is the primary goal, surgical treatment is the first choice, and there will also be auxiliary treatments such as chemotherapy and radiotherapy. If it is in the late stage, there are many ways such as targeted drug therapy, immunotherapy, and comprehensive treatment. However, the premise of using targeted drugs is to do genetic testing, which is also because about 40%-80% of lung cancer patients will have gene mutations and need to use corresponding targeted drugs for treatment. Genetic testing is an important step in the entire treatment cycle for patients, and it is very helpful for "prescribing the right medicine for the right disease".
According to Professor Zhang Hua, genetic testing is currently mainly used in two types of situations in clinical practice. The first type is to recommend genetic testing for patients with middle and late stage lung cancer to determine whether they can match relevant targeted drugs. It mainly detects genes related to lung cancer such as EGFR, ALK, and ROS-1. The second category is applied to postoperative patients, because postoperative patients may experience recurrence and metastasis, and genetic testing can also help determine the adjuvant therapy drugs in such cases.
It is worth mentioning that the most common driver gene mutation in lung cancer patients is EGFR mutation. According to statistics, 40%-60% of Chinese lung cancer patients have EGFR mutations. Based on China's large population, the number of lung cancer patients with EGFR mutations is relatively large. The "Clinical Practice Guidelines for Molecular Pathology Detection of Non-Small Cell Lung Cancer (2021 Edition)" lists EGFR as a must-test gene for NSCLC (Grade I recommendation), and believes that patients receiving EGFR-TKI targeted therapy need to undergo target molecular gene testing for mutation sites in exons 18-21 of the EGFR gene before treatment.
However, lung cancer gene testing is a self-funded project with high testing costs. Taking non-small cell lung cancer as an example, the cost of a single mutation test is about 2,000-3,000 yuan. The targeted drugs needed after genetic testing have entered the national negotiation or medical insurance, but the premise is that there must be a formal genetic test report to match it. If there is no test report, the patient will have to use it at his own expense. Many lung cancer patients cannot afford the cost of genetic testing and can only try drugs blindly.
"Targeted drugs provide patients with an important clinical treatment 'weapon', but targeted therapy must choose the right 'target' to be effective. Genetic testing is the core prerequisite for detecting the right target. Only when the mutation type is clearly known can targeted anticancer drugs play a role." Professor Zhang Hua said that clinical results show that the average effective rate of using targeted drugs without screening is only 30%-40%. Blindly using targeted drugs will not only delay the treatment of patients, but also cause huge waste of medical resources and irrational use of medical insurance funds.
Professor Zhang Hua said: "For patients, the treatment itself has already cost a lot of money. If there are many self-funded projects, they may choose to give up, and therefore may lose the right to survive. If genetic testing can be included in medical insurance, it will help provide patients with precise treatment plans, reduce the burden of long-term medication for patients, promote the standardization of lung cancer diagnosis and treatment, benefit more patients, and promote the development of precise diagnosis and treatment."
Reprinted from: 21st Century Business Herald Author: Ji Yuanyuan
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