Lung Cancer Now Affecting More Women, Non-Smokers In Asia

Over 85% of female lung cancer patients in Asia never smoked, compared to 15% in the West. Genetic mutations are far higher in Asia. Initial cost-benefit analysis suggests Asian countries may gain US$40 million by screening the high-risk for lung cancer.

SINGAPORE, Dec 28 – Lung cancer, one of the deadliest forms of cancer worldwide, is showing a different trend in Asia as it affects more women and non-smokers, experts say. 

Data from the World Health Organization’s Global Cancer Observatory (Globocan) for 2020 revealed that 60 per cent (1,315,136) of new lung cancer cases occurred in Asia, while 62 per cent (1,112,517) of all lung cancer-related deaths took place in the region.

AstraZeneca vice president and global franchise head for lung cancer Mika Sovak said that current lung cancer treatment guidelines are primarily rooted in Western data. In the West, the majority of lung cancer patients are often smokers, though not all.

“In Asia, a lot of women are diagnosed with lung cancer and actually over 85 per cent of women who are diagnosed with lung cancer in Asia, never smoked. In the West, it’s only 15 per cent. So that is a very big difference – 85 per cent in Asia, and 15 per cent in the West. 

“That tells us that this disease is very different in Asia than it is in the West,” Sovak said during a panel discussion on “Redefining the future of lung cancer care: An Asia-specific approach” held on the sidelines of the International Association for the Study of Lung Cancer (IASLC) World Conference on Lung Cancer 2023 on September 12.

Another key point is that lung cancer patients in Asia are often diagnosed at a younger age.

Globally, lung cancer stands as a leading cause of death, accounting for nearly 20 per cent of all cancer-related deaths. It is the second most common cancer worldwide, second only to breast cancer by a small margin.

Unlike breast cancer, where patients are often diagnosed at very early stages of the disease, the majority of lung cancer patients are diagnosed after the cancer has already metastasized, meaning it has spread to other parts of their body. Unfortunately, once metastasis occurs, a cure becomes a challenging prospect.

As a result, the five-year survival rates for lung cancer hover at around 10 to 15 per cent.

What Sets Lung Cancer In Asia Apart From The West

The role of driver mutations, which are specific genetic alterations responsible for the initiation and progression of cancer, is pivotal in understanding this discrepancy. 

Among these driver mutations is the epidermal growth factor receptor (EGFR), a protein change that plays a pivotal role in the development of lung cancer.

In Asia, about 40 to 55 per cent of lung cancer patients exhibit this mutation, a far higher rate than the 15 to 20 per cent seen in the West. These varying molecular characteristics of lung cancer are a significant driver of the different experiences patients have in Asia and the West.

Another contributing factor is the higher incidence of tuberculosis in Asia, a known risk factor for lung cancer. 

Additionally, environmental exposures, such as asbestos and biomass, are more common in Asia than in the West, further elevating the lung cancer risk in the region.

“If we understand what is causing the cancer, we can develop drugs that specifically help treat the cancer in that particular patient. And that’s really the power of understanding the science behind it and the molecular drivers behind cancer,” Sovak said.

Biomarker Testing For Personalised Treatment

In recent years, there has been a substantial shift in the approach to lung cancer treatment. Biomarker testing, which identifies specific protein changes in cancer cells, is facilitating a more personalised approach to treatment. 

This breakthrough means that patients receive drugs tailored to their unique cancer profile, improving the efficacy of the treatment, reducing side effects, and enhancing their quality of life.

“That is our goal, and the outcome is that the individual patient has a better response to the treatment and we are not exposing them to drugs that perhaps won’t work for their particular cancer. 

“In addition to improving patient outcomes, what comes along with that is the economical benefits in terms of shorter hospital space and better quality of life. These are all things that we really look at and try to make sure that we’re improving how patients are being diagnosed and treated,” Sovak said.

Research Hints At $40 Million Gain From Lung Cancer Screenings In Asian Countries

AstraZeneca vice president and global franchise head for lung cancer Mika Sovak and health economist Chris Hardesty speaking at a panel discussion on “Redefining the future of lung cancer care: An Asia-specific approach” held on the sidelines of the International Association for the Study of Lung Cancer (IASLC) World Conference on Lung Cancer 2023 on September 12, 2023.

Health economist Chris Hardesty shared preliminary findings from his research on the cost-effectiveness of lung cancer screenings, indicating that Asian countries could potentially benefit by an average of US$40 million (RM190.5 million) by screening the current high-risk population for lung cancer.

“After all the investments, the net benefit is going to be around US$40 million, plus or minus, depending on population size and health spending. I hope that is a bit of a wake call for governments to say this is a return on investment. 

“I would also tell you that these are extremely conservative numbers. We’ve kept the risk threshold quite low for the potential target population. We’re really only talking about the direct implication of lung cancer, but there are a lot of indirect implications in terms of caregiver costs or lost workdays so these models can become very complex.

“But also, importantly, in Asia, we lack a lot of data that can actually factor into the model and I believe as we capture more data, the size of the problem, but also the opportunity, will be even larger. But again, I share with you some preliminary findings that we are working on,” Hardesty said.

Hardesty highlighted that, despite the benefits and significance of lung cancer screening, governments often grapple with a “screening paradox” when discussing the necessity of health screening.

“You might be asking, ‘If lung cancer screening is so important and obviously, there are benefits, why aren’t we doing more?’

“I want to introduce you to a very key concept here, a health economic concept, which is called the ‘screening paradox’ and often what happens when you talk to governments about the need for screening is, they’re thinking, in the short term. that the more people I screen, the more cases I’m going to find, and therefore, the more burden I’m actually going to have to deal with, right?

“This is a very true reality when you talk to governments because they are trying to prioritise a lot of things. So, this is what is called the screening paradox.

“And there’s a lot of input into the screening paradox. If you aren’t using the latest screening technologies, then oftentimes you make miss cases. So governments might think, well, this isn’t really a useful investment.

“Or if you’re, let’s say, having a biomarker screening and identifying certain mutations, then you might overdiagnose, right? 

“But either way, you end up in this vicious cycle, which is that governments think that the resource that they are putting behind the screening is ultimately not really generating an outcome – and that is really the screening paradox.

“And there’s a lot of output too. We face inequities in the region as it pertains to screening versus the west and even amongst other cancer diseases. This also leads to a slow adoption of technology both screening as well as intervention.

“And so, ultimately here, what we are hoping to achieve is more of a virtuous cycle, which is resources that are correctly allocated and we’re able to achieve this kind of precision, personalised health care,” Hardesty said.

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