“Lung cancer is certainly one of the most challenging cancers,” says Gudrun Absenger and she should know it. As an oncologist at MedUni Graz, she specializes in lung cancer and is confronted every day with the sad certainty that another affected person was diagnosed too late and a cure is no longer possible. “Only when the tumor in the lung is very large or has already spread to other organs do patients notice symptoms,” says Absenger. This is also the reason why only around 25 percent of lung cancer cases are discovered in an easily treatable early stage. Once the cancer has formed metastases, i.e. secondary tumors, therapy can still give valuable life time, but in most cases a cure is no longer possible.
Quitting smoking is worthwhile at any age
Lung cancer is caused by smoking in up to 90 percent of cases – and even though Austria has improved its smoking bans, around 14,000 people in Austria still die every year as a result of tobacco consumption. A study that analyzed data from a total of 1.48 million people shows how much life smokers lose to cigarettes: Smoking shortened life expectancy in the 40 to 79 age group by twelve years for women and by 13 years for men. If you looked at the typical causes of death for smokers (cancer, cardiovascular diseases, respiratory problems), life expectancy was reduced by 24 years for women and by 26 years for men.
Absenger’s Gudrun, Oncology
© Sissi Furgler Photography
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But the same study also showed that quitting smoking is worthwhile at any age, especially if you quit before your 40th birthday. Quitting smoking before the age of 40 brought the mortality rate of ex-smokers back to that of non-smokers within three years. “There is hardly any other lifestyle change that contributes as much to extending life as stopping smoking,” says Bernd Lamprecht, President of the Austrian Society for Pulmonology.
Screening for lung cancer required
In order to detect lung cancer earlier, experts have been advocating lung screening for early cancer detection for years. What could this look like? The screening would be aimed at people with clearly defined risk factors: long-term active and former smokers between the ages of 50 and 75, but also people who have been exposed to dust, gases or vapors for years, for example due to their job. These groups of people should be routinely examined using low-radiation computer tomography (medical: low-dose CT) in order to detect and treat possible lung cancer at an early stage. “We know from the international data that we can save many lives through a program like this,” emphasizes pulmonologist Lamprecht. Austria’s pulmonologists show that such screening could also detect other respiratory diseases at an early stage, such as pulmonary fibrosis or COPD.
Oncologist Absenger would also urgently like to see such early detection for the lungs, as is also the case for breast or colon cancer in Austria – but she also sees the hurdles: “For this we would need clearly defined care paths, because: The CT image alone does not say whether a lesion is really cancer.”
If there is suspicion after imaging, a tissue sample would have to be taken – an intervention in the body that is associated with risks. And: These examinations must be able to take place within the limited resources of the health system. At the same time, such early detection would have to be linked to smoking cessation, emphasizes Absenger. Despite these hurdles, the expert is confident that Austria will manage to establish lung cancer screening.
Immunotherapy brought a breakthrough
In the meantime, medical research has also caught up and thanks to new therapies it is now possible to treat lung cancer much better: “Immunotherapy has provided a real breakthrough,” explains Absenger. Lung cancer is one of the cancer types that respond particularly well to immunotherapy – which is why most patients are now treated with a combination of chemotherapy and immunotherapy. This can achieve very good results for many patients: The five-year survival rates have increased from around 12 percent in 2015 to around 24 percent in 2022. “Unfortunately, the therapy does not work for everyone affected,” adds Absenger. Targeted therapies are also an option for some patients with lung cancer and specific mutations in the tumor.
What the cancer specialist also observes with great concern: “So many young people use vaping products or e-cigarettes, which can be the start of a lifelong addiction.” In addition, there is currently no data on what long-term effects these products have. “Every pollutant that gets into the lungs irritates the tissue and actually has no place there,” says Absenger. When it comes to these vaping products, she fears, “There could be an unpleasant awakening.”
