Lung cancer in Brazil

Araujo, Luiz Henrique; Baldotto, Clarissa; Castro Jr, Gilberto de; Katz, Artur; Ferreira, Carlos Gil; Mathias, Clarissa; Mascarenhas, Eldsamira; Lopes, Gilberto de Lima; Carvalho, Heloisa; Tabacof, Jaques; Martínez-Mesa, Jeovany; Viana, Luciano de Souza; Cruz, Marcelo de Souza; Zukin, Mauro; Marchi, Pedro De; Terra, Ricardo Mingarini; Ribeiro, Ronaldo Albuquerque; Lima, Vladmir Cláudio Cordeiro de; Werutsky, Gustavo; Barrios, Carlos Henrique; ,

doi:10.1590/S1806-37562017000000135

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REVIEW ARTICLE • J. bras. pneumol. 44 (01) • Jan-Feb 2018 • https://doi.org/10.1590/S1806-37562017000000135 linkcopy

Lung cancer in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Lung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.

Keywords:
Lung neoplasms/epidemiology; Lung neoplasms/therapy; Lung neoplasms/diagnosis; Biomarkers; Brazil

Author	N	Type of facility	NSCLC, %	SCC/Ad ratio	III-IV, %
Ismael et al.⁽¹⁸⁾	1,887	Public	89	0.93	71
Younes et al.⁽¹⁹⁾	737	Public	100^a	1.20	74
Westphal et al.⁽²⁰⁾	352	Public	91	2.54	66
Barros et al.⁽²¹⁾	263	Public	87	1.96	94
Novaes et al.⁽²²⁾	240	Public	80	1.25	72
Araujo et al.⁽²³⁾	566	Private	100^a	0.33	80
Caires-Lima et al.⁽²⁶⁾	232	Public	92	0.48	93
Mascarenhas et al.⁽²⁴⁾	338	Private	83	0.38	78
Freitas et al.⁽²⁵⁾	93	Private	100^a	0.33	88

Author	N	EGFR mutation, %	NS, %	Female, %	non-SCC, %	Setting
Pontes et al.⁽⁴⁰⁾	3,371	25	NR	58	100	Clinical
Yen et al.⁽⁴⁵⁾	417	25	34	57	100	Clinical
Saito et al.⁽⁴⁶⁾	395	26	27	51	91	Clinical
Domingues et al.⁽⁴³⁾	288	27	26	56	95	Clinical
Bacchi et al.⁽⁴¹⁾	207	30	54	58	82	Clinical
Gomes et al.⁽⁴⁸⁾	162	33	32	48	100	Clinical
Melo et al.⁽⁴²⁾	157	22	15	47	68	Research
De Sa et al.⁽⁴⁴⁾	100	28	NR	NR	100	Clinical

Author	Design	N	Study period	PS ≥ 2, %	Type of facility	mOS, months
Chemotherapy
Younes et al.⁽⁶⁸⁾	Re	2,673	1990-2008	49^a	Private	8.0
Naime et al.⁽⁶⁹⁾	Re	564	1990-2003	47	Private	8.3
Araujo et al.⁽²³⁾	Re	339	1998-2010	11	Private	12.2
Leite et al.⁽⁷⁵⁾	Re	163	2006-2013	NA	Public	NA
Zukin et al.⁽⁷⁰⁾	Pro	205	2008-2011	100	Public	5.3/9.3^b
Pereira et al.⁽⁷⁶⁾	Re	82	2007-2011	NA	Private	26.4/16.4^c
Jardim et al.⁽⁷⁷⁾	Re	56	2006-2011	7.2	Private	14.8
Pereira et al.⁽⁷¹⁾	Pro	44	1996-1998	50^a	Public	7.5^d
EGFR TKI
Caires-Lima et al.⁽⁷²⁾	Re	49	2010-2013	NA	Public	NR^e
Domingues et al.⁽⁴³⁾	Re	32	2011-2014	NA	Public	62.9
Freitas et al.⁽⁷³⁾	Re	61	2010-2014	NA	Private	36.3/NR^f

Current scenario

Action

Lung cancer is a leading cause of cancer death in Brazil.
Smoking-related lung cancer remains a major health burden.
Data on lung cancer diagnosis, staging, therapy, and outcomes are scarce.
There is a deficiency in radiation therapy machines to provide full treatment coverage in the country.
There is a significant delay in the approval of systemic therapies by local regulatory agencies.
Inequities in the access to diagnosis, therapy, and molecular testing between public and private health care systems are remarkable.
A lengthy clinical research approval process limits access to clinical trial opportunities.

Reinforce the role of tobacco control, and stimulate programs directed to the entire population, particularly teenagers.
Collect high-quality data on epidemiology and health economy aiming at describing diagnosis, staging, access to therapy, and outcomes.
Strengthen, bring together, and stimulate productive dialogue among medical societies, advocacy groups, government, pharmaceutical companies, and regulatory agencies.
Propose and implement programs to positively impact on prevention, diagnosis, and access to therapy.
Increase local funding for lung cancer prevention, diagnosis, and treatment research.
Stimulate the development of research units and participation in clinical trials.
Stimulate and implement international collaborations.

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Sociedade Brasileira de Pneumologia e Tisiologia SCS Quadra 1, Bl. K salas 203/204, 70398-900 - Brasília - DF - Brasil, Fone/Fax: 0800 61 6218 ramal 211, (55 61)3245-1030/6218 ramal 211 - São Paulo - SP - Brazil
E-mail: jbp@sbpt.org.br

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[TFN1] NSCLC: non-small cell lung cancer cases; SCC: squamous cell carcinoma cases; Ad: adenocarcinoma cases; and III-IV: patients in stages III or IV. ^aStudies including only NSCLC cases.