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quantify this which is a good start to figuring this out. Other researchers are looking at biomarkers that might allow us to estimate lifetime or long-term radon exposure. As these tools are validated, they could be incorporated into risk prediction models and lung cancer screening criteria. Ultimately, the solution to radon exposure is likely a building code and engineering one rather than a screening one.
Breast screening continues to evolve and the definition of who qualifies for screening is widening faster than for lung cancer. How does the stigma of lung cancer and smoking play
a role in that?
The stigma around lung cancer and the marginalization of high-risk groups for this disease play a big factor in the slow pace of implementation of lung cancer screening. We've known for a long time that lung cancer research gets a tiny fraction of the dollars dedicated to other cancers such as breast and prostate. Even with clear evidence it is taking many years to convince funders (governments) to get behind this. One of the issues has been the lack of advocacy which also relates to the stigma associated with this disease. People with lung cancer, especially smokers, tend to blame themselves and do not speak out, or demand better care or research dollars. At the end of the day, governments respond to what the population demands of them. Researchers and clinicians can ask for funding all day long but until people ask their healthcare systems and governments to fund this, politicians and administrators can easily ignore the requests.
What should our screening programs look like and how can we get there?
The first and most urgent step is to start lung cancer screening on a wide scale across the country in an organized fashion. Once we're doing that, we need to continue improving the process and broadening the reach of screening. Of course, we can't forget about primary prevention – we should focus on the elimination of tobacco and other forms of smoking
from our society and the mitigation of other risk factors such as radon exposure.
What will the impact of the radon clinical trial be on the screening landscape?
The radon work will allow us to better identify people at risk for lung cancer related to this exposure and perhaps allow us to screen such individuals.
We do need to keep pressuring our governments to improve building codes
in construction standards so that this becomes a nonissue in the first place.
The last word:
Lung cancer screening represents a breakthrough in our approach to lung cancer with a 20 to 25 percent reduction in mortality rates after a few years of screening which is likely to reach closer to a 75 percent reduction in mortality if people get screened over the entire age of their eligibility. It is not a perfect intervention and will not detect all lung cancers in our society, but we need to recall that currently almost no screening is going on and this disease remains the number one cause of cancer death in Canada. Even reaching 50% of individuals at risk would dramatically shift the landscape of this disease. The time to start broad-scale lung cancer screening in Canada is now.
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