ABSTRACT

Lung cancer according to the World Health Organization is the leading cause of of
cancer-related deaths worldwide, accounting for the highest mortality rates among
both men and women. (REF1)
Screening is not universally applied worldwide and this presents an ethical and
public health conundrum. Lung cancer is estimated to be related to tobacco
consumption (smoking) in 85% of the cases and when diagnosed it is often
diagnosed at advanced stages. (REF1)
Prevention plays a key role in reducing the percentage of health quality indicators
such as morbidity and mortality rates. Part of also positively impacting these
indicators is early diagnosis plays a crucial role where the early diagnosis of the
disease optimises health outcomes for patients with lung cancer. (REF2)
The implementation of strategic planning combined with public health facilities and
policies is needed. Thus this investigation focussed on current lung cancer health
quality indicators and policies in Portugal.

KEYWORDS

Screening; Lung cancer; Diagnosis; Public health; Policies; Smokers;

INTRODUÇÃO

Lung cancer or also known as bronchogenic carcinoma refers to cell growths

originating in the lung parenchyma or within the bronchi. (REF3) if undiagnosed or
diagnosed in advanced stages leads to poor health outcomes. (REF3)(REF1)
Lung cancer used to be a rare disease however with the adoption of risk factors
which are embedded into cultural and social settings the disproportionate increase in
incidence was seen as more elements of the population started smoking tobacco.
(REF2)
It is estimated that 90% of lung cancer cases are attributable to smoking. The risk of
lung cancer secondary to passive smoking increases by 20 to 30%. Other factors include
 radia on for non-lung cancer treatment, especially non-Hodgkins lymphoma and breast
cancer. Exposure to metals such as chromium, nickel, arsenic, and polycyclic aroma c
hydrocarbons is also associated with lung cancer. Lung diseases like idiopathic pulmonary
brosis increase the risk of lung cancer independent of smoking. (REF4)

The most common types of lung cancer are non-small cell carcinoma (NSCLC)
(85%) and small cell carcinoma (SCLC). NSCLC is more common and shows a
slower development rate whilst SCLC is less common but often has a faster growth
rate. (REF1)(REF2)
Lung cancer is a signi cant public health concern, causing a considerable number of
deaths globally. GLOBOCAN 2020 estimates of cancer incidence and mortality
produced by the International Agency for Research on Cancer (IARC) show that lung
cancer remains the leading cause of cancer death, with an estimated 1.8 million
deaths (18%) in 2020. (REF1)
Lung cancer is the most commonly diagnosed cancer worldwide, accoun ng for
approximately 12.4% of all cancers diagnosed worldwide, and is the leading cause of cancer-
related deaths. (REF2)
Diagnosis is often diagnosed at advanced stages when treatment options are limited.
(REF1)
Diagnostic methods for lung cancer include physical examination, X-rays and CT
(computerised tomography) and PET (positron emission tomography) scans,
examination of the inside of the lung using a bronchoscopy, taking a sample of tissue
(biopsy) for histopathology, and molecular testing to identify speci c genetic
mutations or biomarkers to guide the best treatment option. (REF1) (REF2)
To note, that some programs have been tried out in Europe such as the NELSON
program which showed very positive outcomes when it came to the bene ts of
screening patients, and allowed the development of clinical pathway work ows and
follow-ups. It was also observed that the number of CTs required was lower in
comparison to populations who had not followed this preventative program.
Currently, only 26% and 8% of cancers are diagnosed at stages I and II, respec vely,
whereas 28% and 38% are diagnosed at stages III and IV respec vely. Therefore, cura ve
surgery is an op on for only a minority of pa ents. (REF2)
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 In Portugal, the government has yet to establish national guidelines for the screening
of lung cancer. Per year, there are at least 4000 deaths related to lung cancer.
(REF5)
In 2015, the ERS (European Respiratory Society) published a statement where it
highlighted initial and early steps that can be taken locally by comprehensive
multidisciplinary centres for screening of lung cancer. In this statement, there is
already a concern with public health and health quality indicators when it comes to
lung disease. An excerpt is seen below: “Further re nements are recommended to
increase quality, outcome and cost-e ec veness of lung cancer screening: inclusion of risk
models, reduc on of e ec ve radia on dose, computer-assisted volumetric measurements
and assessment of comorbidi es (chronic obstruc ve pulmonary disease and vascular
calci ca on).” (REF6)
Such measures, lead to posi ve outcomes and an improvement in morbidity and mortality
rates such as seen with the Na onal Lung Screening trial, where there was an overall
decrease in mortality by 6.7% with screening. (REF2)

Health quality Indicators in Lung Cancer Disease

REF1 - https://www.who.int/news-room/fact-sheets/detail/lung-cancer
REF2 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336169/
REF3 - https://pubmed.ncbi.nlm.nih.gov/29493979/
REF4 - https://pubmed.ncbi.nlm.nih.gov/12527563/
REF5 - https://www.sppneumologia.pt/uploads/subcanais_conteudos_ cheiros/ci-
rastreio-do-cancro-do-pulmao.pdf
REF6 - https://erj.ersjournals.com/content/erj/46/1/28.full.pdf
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