Lung cancer diagnoses in patients with no history of tobacco smoking present unique and diverse challenges. Furthermore, limited access to genomic profiling of lung cancer in some parts of the world may leave patients with no smoking history without access to lung cancer screenings. This concern was noted by Lucia Viola, MD, during the 2024 Latin America Conference on Lung Cancer (LALCA) Highlights Webinar, which covered key topics and presentations from the meeting.
“We know that this is a heterogeneous disease, and access to genomic profiling for lung cancer in Latin America is a big concern,” she said. “There are also concerns about the quality of the tissue needed to implement these kinds of diagnostic tools.”
During the presentation, Dr. Viola, an interventional pulmonologist at the Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center and Colombian Pulmonology Foundation, Bogotá, Colombia, discussed the landscape of lung cancer screening and diagnosis in Latin America. Some of the key takeaways included the heterogeneity of lung cancer in the region and its impact on the presentation of the disease in patients.
Dr. Viola presented findings from a study that aimed to understand the genomic and clinical profiles of patients in Latin America with non-small cell lung cancer (NSCLC) diagnoses. The study revealed a significant prevalence of EGFR mutations in lung cancer cases in Latin America, along with an association between wood smoke exposure (WSE) and the presence of these mutations.
The findings also indicated an inverse relationship between PD-L1 expression and the WSE index. Additionally, the study identified TP53 mutations associated with WSE.
“We know that in Latin America we have a high proportion of EGFR-mutated lung cancer cases. As researchers used this diagnostic tool to characterize this population, they found a concurrence with TP53 within these patients,” Dr. Viola said. “This is not [commonly found] because the panels we use in Latin America are not this wide [comprehensive] and we don’t have access to this kind of information, which is relevant and important for the future of research in lung cancer.”
Dr. Viola also discussed a pilot study on lung cancer screening in Latin America, which used low-dose CT screening for a high-risk patient population. The study involved nearly 2,000 participants between ages 50 to 75 who were at elevated risk for lung cancer because of tobacco exposure.
In addition to CT screening, researchers had access to a medical records database. Among the 1,953 patients screened, 14 cases of lung cancer were detected, resulting in a need to screen 140 patients to identify a single case. The proportion of early-stage diagnoses was 71.4% among patients screened as part of the pilot study compared with 5.2% of cases detected through incidental findings or clinical symptoms.
“Here in Latin America, we need to continue implementing lung cancer screening using the information we have from major clinical trials, as well as from the regional clinical trials,” Dr. Viola said.
Implementing lung cancer screening programs could reduce healthcare costs while maintaining effective screening outcomes, particularly in low-income countries. Although these findings are promising, any lung cancer screening strategy must be integrated into a national policy framework.
“In Latin America, having access to lung cancer screenings and selecting the high-risk population based on tobacco exposure isn’t feasible in every region,” Dr. Viola said, “We need to go further and try to gather information about the patients who don’t smoke and the trials that could be available in Latin America.”
