Better lung cancer treatment lowers overall cancer death rate–yet stigma persists

STAT News published an article today titled “U.S. cancer death rate drops by largest annual margin ever, report says.” An excerpt says:

The overall cancer death rate has been falling about 1.5% a year since 1991. It fell 2.2% from 2016 to 2017, according to the new American Cancer Society report. That’s the largest drop ever seen in national cancer statistics going back to 1930, said Rebecca Siegel, the lead author.  ‘It’s absolutely driven by lung cancer,’ which accounts for about a quarter of all cancer deaths, she said. Take lung cancer out of the mix, and the 2017 rate drop is 1.4%, she added.

Experts mainly credit advances in treatment. Topping the list are refinements in surgery, better diagnostic scanning, and more precise use of radiation.

They also celebrate the impact of newer drugs. Genetic testing can now identify specific cancer cell mutations, which allow more targeted therapy using newer pharmaceuticals that are a step beyond traditional chemotherapy.

This news reinforces National Cancer Institute (NCI) data published in 2019 that the lung cancer 5-year survival rate rose to 19.4% for all types of lung cancer.  When I was diagnosed with lung cancer in 2011, the 5-year survival rate for lung cancer was only 16%, and the majority of lung cancer patients survived less than one year. As the STAT article says, it has a LOT do with newer lung cancer diagnosis and treatment options. A major contributor is genomic testing of tumors, and the targeted therapies that can inhibit cancer cells driven by altered genes.  Patients on some targeted therapies have a median survival of over five years! About 30% of non-small cell lung cancer patients are currently eligible to take some form of targeted therapy, and that number may soon rise to 50%.

The benefits of targeted therapies have just begun to affect the NCI’s five-year survival stats. The first successful lung cancer targeted therapy clinical trial (crizotinib for ALK-positive non-small cell lung cancer) began in 2007, and the drug was approved in 2011. The NCI’s 2019 stats are based on data collected between 2009 and 2015. The survival rate will continue to go up due to approval of more targeted therapies, as well as the advent of immunotherapy (first approved in 2014), more precise radiation treatments, better surgical techniques, and early detection with lung cancer screening. When lung cancer is caught in early stages, 80% of patients are CURABLE.

However, despite obtaining their information from same source (the Associated Press), some media outlets have emphasized different angles of this story. An National Public Radio (NPR) article states, “What’s behind the decline [in cancer deaths]? In part, smoking rates have fallen steadily, which means the biggest risk factor for lung cancer has fallen appreciably. New cancer treatments are also playing a role, Siegel says.” (That’s ALL NPR’s article says about the contribution of better lung cancer treatment to the reduction of cancer deaths).

I wish the media would stop emphasizing smoking cessation as the cure for lung cancer death, instead of the significant advancements lung cancer treatment. Anyone with lungs can get lung cancer. An increasing number of lung cancer cases (currently around 20%) occur in never smokers. While overall lung cancer deaths have been dropping slightly, the death rate in young women who have never smoked is actually RISING. The World Health Organization has acknolwedged that air pollution is a risk factor for lung cancer, as is exposure to radon gas and other environmental exposures.

Crediting smoking cessation as the primary reason for reduction in lung cancer deaths perpetuates stigma, which contributes to worse lung cancer outcomes through physician nihilism, patient anxiety depression, and reduced funding for lung cancer research. Once a person has been diagnosed with a serious disease, they should receive the same compassion and treatment regardless of their personal characteristics. Blaming the patient and telling them to stop smoking never cured anyone.  But it may prevent the patient from experiencing the best possible outcome for their disease. Why won’t the media emphasize very real contribution–and the hope–offered by better lung cancer treatments ?

So, when you see news about the reduction in cancer deaths (and lung cancer in particular), please look past the errant “due primarily to smoking reduction” emphasis.  Focus instead on the hope offered by cancer research and the increasing number of new lung cancer therapies.  We don’t have a lung cancer cure for everyone, but researchers are working on it. Those touched by lung cancer need that hope.

We’re getting better at killing lung cancer.  Stigma is SO much harder to kill.