“We should promote legislative measures so that tobacco is not part of the economic role that it has”

..Drafting.
Dr. Javier Castrodeza is a professor in Preventive Medicine and Public Health with a position at the Valladolid Clinic. He has been general director of Professional Regulation of the Ministry of Health, general director of Public Health and Secretary of Health. And, currently, he is a member of the Executive Committee of Lung Ambition Alliance (LAA) an alliance promoted by AstraZeneca and made up of 14 scientific entities, both scientific societies, patient associations and social foundations, whose objective is to accelerate advances in lung cancer survival and improve patient outcomes. This makes him an authorized voice to analyze the current situation of this pathology, who explains it in this interview to iSanidad.

Is Spanish society aware of lung cancer?
I think she is aware of it, but the heads of the health administrations and the health professionals of the scientific societies and professional associations should send a message that it is a very important disease. The battle against certain unfavorable lifestyles for this disease is not won. We must insist and turn around the early diagnosis. We have to move decisively so that the disease is known as soon as possible.

Lung cancer is diagnosed late many times, when it is already very advanced

This is what the professionals say: it is diagnosed late many times, when the disease is already very advanced. Thus, it is forced to include it in a very relevant position with other cancers that are also important such as colon or breast cancer. Because unfortunately it has very strong, very strong mortality rates. Therefore, I do believe that it is necessary to put it in the first positions.

What role does this pathology play for health authorities?
It should occupy a more important role than it is today. If one reviews the casuistry, for example, we see that of the cases that occur, one in four affects women (2). And this is an important issue because there has been a certain increase. It is a pathology that is associated with smoking, without a doubt, and smoking, although it has decreased in recent years, seems to be tending to stabilize. And there is a group between 30 and 44 years old in Spain where the smoking habit is more present.

It is a disease with a long natural history. But if the smoking habit does not end up reducing, unfortunately, we will have more cases and it will mean an ever greater increase.

Treated lung cancer has a cost of 17,000 euros per patient and 34,000 if it is metastatic

How much could the SNS save if it opted for an adequate prevention and screening system? Is it important to insist on the prevention of this disease?
I totally agree, it is very important. What happens with tumors or cancers is that, sometimes, when you do not have a clearly evident element of early diagnosis, as happens for example with cancer of the cervix, colon or if you also hurry me with breast cancer that It has its limitations, it seems that the authorities do not place the problem in the first positions.

I believe that it is necessary to be aware of the importance of leading healthy lifestyles (no smoking, physical exercise, diet, etc.). We know that they can be responsible for more than 40% within cancers. Reducing the consumption of tobacco I believe would substantially reduce its sequence. That from the start. This has important consequences, so you have to consider it.

In addition, not only the lifestyles, but the economic cost. There is a study published by a consulting firm that talks about the financial impact of lung cancer. There is talk of an average cost per patient treated for lung cancer of almost € 17,000 per year; metastatic, € 34,000 per year. (2)

These are figures that may seem irrelevant to us, but already skipping what the long-term cost of all cases diagnosed in a year could entail, that is, taking a cohort of diagnosed in years, for example 2018-2019, and following them Until the end, that cohort would bring us almost 2,100 million euros for the National Health System. This is a cohort, each year another cohort can be generated, and another cohort, and another.

I believe that the economic cost is relevant beyond the life expectancy that is shortened, beyond the early death that occurs, beyond all the family consequences, etc. They result in cancer, which has a moderate average life expectancy. If it is microcytic even worse. I do believe that we should promote strategic actions to reduce the impact of this problem in our country.

We should promote legislative measures so that tobacco is not part of the economic role that it has

Is lung cancer a major public health challenge?
Obviously, because it is clearly linked to harmful health habits. What has been launched in our country are very positive regulatory programs: 2005, 2010 … Other interventions that have been made by modifying aspects related to tobacco, but I think we have stagnated. I believe that smoking cessation should continue to be reinforced through training measures in different groups, groups in the educational environment.

We should make efforts to quit smoking by promoting access to smoking cessation treatments. I believe that in some way we should strengthen legislative measures so that tobacco is not part of the economic role that it has.

It is true that there are also countries that make a living from tobacco production, but I think we have become a bit stuck in formative education. The fear of tobacco has been lost, we went from some interesting measures from there to 2005, to the year 2010 and it gives me the impression that even those measures of recommendation not to smoke in certain places we have relaxed a bit. I believe that in public health we must insist that tobacco lifestyles are an absolutely determining factor in people’s health and lung cancer is the main factor.

In addition, quitting smoking at any time in life is a very timely and necessary measure. It may happen that there are people who say “well, I’ve already been smoking I don’t know how long, what difference does it make now”. No, at any time you have to stop smoking, it is an important message.

Early detection has been shown to improve life expectancy

What role should health authorities play to change the approach around the early diagnosis of lung cancer?
I believe that all actions aimed at better understanding and assessing early symptoms should be promoted. I mean that blood in the sputum for many days or those persistent bronchitis. Also if there is a factor of difficulty when breathing or chest pain, weight loss … I think it would be necessary, in some way, to educate the population that they are not pathognomonic signs of early diagnosis. Yes, it is worth going to the medical consultation to be evaluated.

And once they go to the doctor’s office, of course, primary care doctors play an important role because they are the first to enter the system. Through the use of more or less complicated or escalated diagnostic tests, this detection can be advanced as soon as possible. The sooner it is detected, the life expectancy will be better and much longer in time. This is proven.

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