ASCO Connection

July 2017

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Gilberto de Lima Lopes Jr., MD, MBA, FAMS Sylvester Comprehensive Cancer Center and University of Miami @GlopesMD Excerpt From The State of Lung Cancer in Latin America …By 2030, the number of deaths due to lung cancer is expected to almost double for Latin American women and to increase by 50% for men. Despite strong action against tobacco, through legislation restricting sales and advertising, increasing taxation, establishing smoke-free indoors public policies, educational cam- paigns, public control programs to prevent teenage and young adult smoking, and therapeutic programs to increase quitting, the epidemiologic impact of lung can- cer is still high and rising. There is particular concern in low-income populations in which smoking is still highly prevalent and more commonly so, as well as associated with a heavy economic burden. Cigarettes can repre- sent between 25% and 40% of all expenditures of low- income families and individuals in the region. In Latin America and low- and middle-income coun- tries around the world, most governments and health systems have evolved to address infectious diseases and maternal-child health, for a long time ignoring the demographic transition and the significant increase in the incidence of chronic non-communicable diseases, including lung cancer. Early detection programs are usually absent, and when available, are often ineffec- tive and restricted to the private sector and wealthier segments of the population. Cancers are therefore commonly diagnosed at later stages with correspond- ingly high mortality and suffering. Treatment for late- stage cancers most commonly takes place in public hospitals that have limited resources due to a combina- tion of poor funding and oversized demand for servic- es. As a result, often health care institutions can only provide a bare minimum of activities that cannot keep up with an overwhelming load, compromising results. Many countries also lack basic cancer planning tools such as population-based cancer registries, up-to-date clinical guidelines, and consistent coverage and provi- sion of care. Older chemotherapy agents available as generics, such as cis- and carboplatin, gemcitabine, and taxanes, are commonly used, but there is limited access to molecu- lar testing, modern staging procedures, and targeted agents and immunotherapy. Around 25% of patients in Latin America and Hispanic patients in the United States have EGFR-activating mutations, a higher prevalence than in white patients in North America and Europe, making the lack of availability of targeted agents an even bigger failure. …As Steve Forbes wrote in 2016, mention Panama and the first thing to come to mind might be "papers" and money laundering, but the country's sustained GDP growth in the last decade makes this the unsung suc- cess story in a region that has been plagued by set- backs in recent years. Through efforts in transparency (the Organization for Economic Co-Operation and Devel- opment, OECD, recently removed Panama from its list of tax havens), and business-friendly policies such as a low tax environment, decreased bureaucracy, and welcom- ing foreigners and their investments, the country is well poised to continue growing and to become a model for many in Latin America. This brings hope that with con- tinued development, the region will be able to double down on its efforts against lung cancer…. Find full post and references online at istent coverage a d The State of Lung Cancer …By 2030, the number of deaths due to lung cancer is expected to almost double for Latin American women 16 I 07.2017 Connected continued

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