"In twenty years, we could see new types of lung cancer due to vaping."

BarcelonaUntil the 80s, receiving a diagnosis of lung cancer was a death sentence; you had six months to live. With the arrival of chemotherapy, the prognosis for patients improved slightly, with patients living for over a year thanks to treatment. But ten years ago, there was a real revolution with the emergence of immunotherapies, which stimulate the patient's defenses to attack malignant cells and have achieved survival rates of five, six, or even more years after diagnosis. However, they are not perfect. Tumors eventually develop resistance to treatment, and lung cancer remains the most lethal: it is the leading cause of death from cancer worldwide.

Here, one of the major pending tasks is to reduce the incidence of tobacco, which is behind more than 80% of cases, and experts are wary of new forms of smoking, such as vaping and electronic cigarettes, which are most popular among the new generations and the extent of the impact they can have on the health of consumers is still unknown. "It could be that within twenty years we will have new types of lung cancer due to vaping. We know it's an addictive habit that inflames the lungs and puts them at risk, but we still don't know all the negative consequences it can have for those who smoke," warns the oncologist from Reguar A No, a "conchologist" at Hospital Clínic.

The expert is also one of the presidents of the World Conference on Lung Cancer organized this weekend by the International Association for the Study of Lung Cancer in Barcelona. The Catalan capital will be the global epicenter of this disease between Saturday and Monday, with nearly 8,000 professionals from around the world who will review the main challenges facing thoracic tumors today and share the latest advances in the treatment of these diseases. Reducing the number of smokers, eliminating tumor resistance to treatment, and developing screening programs to detect cases in early stages are some of the priorities for experts.

Another focus of oncologists is the increase in cases among women, while the incidence is declining among men. This is explained by the fact that women started smoking later, and diagnoses have been increasing in recent years. According to an analysis by the Spanish Society of Medical Oncology (SEOM), deaths from lung cancer are now almost comparable to those from breast cancer in Spain. Like Reguart, they also emphasize the need to implement more public policies to tighten the siege against smoking. Specifically, they advocate that smoking should be banned on bar and restaurant terraces, on beaches, in parks, and at public transport stops. "Tobacco should be avoided in all public places," argues the oncologist.

Knowing the Surnames of Cancer

Apart from reducing the number of smokers, which In Catalonia it has been stagnant since 2017Experts point out other aspects to consider in the fight against lung cancer. Santiago Viteri, director of the oncology service at Clínicas Mi (UOMI) and one of the speakers at the conference, warns that diagnoses are also increasing among non-smokers and calls for more funding to allow for in-depth research into why this is happening. The main hypothesis is that they are increasing due to environmental pollution, but there is still not enough evidence to definitively determine which pollutants are causing cases to rise and how.

Viteri maintains that patients' lives have changed radically in recent years thanks to the efforts made to better understand the disease. Now, when a patient comes to the clinic with a lung tumor, a molecular study is performed to determine their "last names"—that is, to find out what subtype of lung cancer they have, because each one is different, and the treatment they should receive. Currently, there are up to nine different lung cancer mutations, each treatable with its own specific therapy, a milestone achieved by thoroughly studying the biology of this cancer.

Detection and resistance

This knowledge has made it possible to develop immunotherapies and targeted therapies specific to each lung tumor. The former stimulate our immune system to recognize and attack the tumor, while the latter are drugs capable of identifying the tumor's specific mutation and attacking it directly, without harming healthy cells. However, there is still a long way to go in the fight against this disease, with outstanding work to be done in prevention, early detection, and treatment resistance, explains Jordi Remon, oncologist at the Gustave Roussy Institute in France.

"Cancers are very intelligent and end up becoming resistant to immunotherapy. We need to understand why this happens in order to avoid or delay this resistance," says Remon, who also believes that accessibility to treatments must be improved and new therapeutic strategies found, so that the prognosis for patients "will be better." In this regard, Viteri argues that it is necessary to implement an early detection program in Spain to identify lung cancer cases at a stage when the disease has not yet progressed and is easier to treat.

"80% of the lung cancers we detect now are in an advanced stage, and only 20% are candidates for curative treatment such as surgery," warns Viteri, who proposes regularly testing at-risk individuals (people who have been smoking for more than 30 years) in case signs of . In fact, Reguart details that initiatives are currently underway in Spain to evaluate the cost of implementing a program of this nature and asserts that it has been proven that efforts in early detection lead to a decrease in mortality. "Testing smokers would prevent one-fifth of deaths from lung cancer," she concludes.