He is one of the specialty’s leading experts in lung cancer and living history. Consultant of the Thoracic Surgery Service of the Hospital Clínic of Barcelona, Dr. Laureano Molins also chairs the Organizing Committee of the European Congress of Thoracic Surgery that begins today in Barcelona.
What news will be presented at the congress?
It is a congress of thoracic surgery specialists, which means that we focus above all on the surgical treatment of diseases that affect the chest, the organs in it and the rib cage itself, except the heart. 80% of the pathology we intervene in is lung cancer, although there are others, such as mediastinal tumors, thymomas or pleural pathology, which is called pleural mesothelioma. Also tumors of the airway, trachea, bronchi. And finally, what is the chest wall, trauma to it, such as congenital or acquired defects, such as pectus excavatum or tumors.
This is the society’s 32nd congress. What changes would you highlight in the specialty in these three decades?
One of the big changes is the split of the Society of Cardiothoracic Surgery, in 1993. Much importance was given to cardiac surgery. In fact, cardiac surgeons also operated on the lung. But the fact of separating the two societies made the dedication of the surgeons increasingly exclusive. And second, the collaboration with the Medical Oncology teams and the multidisciplinary tumor committees. This is another great advance. Patients are brought to these committees in which there are oncologists, radiation therapists, radiologists, pulmonologists, thoracic surgeons, nuclear medicine and pathological anatomy, and this is where decisions are made and protocols are adapted, because there has been a great change in their approach. .
“It is the tumor with the highest mortality rate because 80% of cases are detected in advanced stages”
One of the great demands of the specialty is the implementation of lung cancer screening.
It continues to be the tumor with the highest mortality rate due to its frequency and high mortality, because the diagnosis is made in advanced stages in 80% of cases. So, the challenge is how we can reduce this mortality. There are two ways. The first is an early diagnosis. All the tumors that have improved their survival have been because they have been diagnosed early, especially through screening such as those of the breast, colon or cervix. But we didn’t have it in lungs. Until, thanks to several international studies with more than 50,000 volunteers, it has been determined that performing low-dose chest CT on people at risk (which we would summarize as those between 50 and 75 years old who smoke or who have smoked less than 15 years ago). quit smoking). We must not forget that 85% of lung tumors are due to tobacco. At the congress, experiences from countries in which population screening of people at risk of developing lung cancer has already been established, such as Poland, Croatia or England, will be presented. And in Spain we are starting a pilot program called Cassandra.
How is its implementation going?
The Cassandra project was born from the Spanish Society of Pulmonology and Thoracic Surgery, Separ, but more than 12 scientific societies related to this cancer, patient associations and an entity called the Lung Ambition Alliance have joined it, of which also I am national coordinator. 42 hospitals in Spain have joined the project along with their primary care unit. The objective is to determine that through the Ministry and the autonomies they become aware that this is the way in which we can absolutely change the map of lung cancer because in this way 80% of patients would be diagnosed in early stages. At the Hospital Clínic we started a month ago and it has already started in five hospitals in Spain. Its duration is five years and the idea is to introduce as many volunteers as possible to be able to demonstrate not only what has already been proven, which is that we are going to detect lung tumors in 80% of cases in early stages, but also that It is cost-effective. Furthermore, it is the way to be able to decide how to carry it out in the future within public health.
“With population screening we would diagnose 80% of patients in early stages”
In recent years there have been very relevant therapeutic advances, also led by Spanish doctors, that have changed the paradigm of approaching this tumor. How have they affected?
Yes, in the studies in advanced patients, who are the ones we will continue to diagnose for many years to come, unfortunately, there have also been advances that will be considered at this congress. Today we have multiple studies in which, by associating immunotherapy with classic chemotherapy, the response to the treatment is greater and in the patients who subsequently undergo surgery there will be a better prognosis. Furthermore, in some cases, in patients who cannot undergo surgery, prior treatment with chemotherapy plus immunotherapy can convert these non-resectable tumors into resectable ones, so we can apply surgical treatment, which has the greatest healing capacity. to more patients. 20-15 years ago those in advanced stages had a half-life of eight months and now 35. We have improved a lot. But the really big leap for survival to improve is early diagnosis.
Despite this, public financing has cost a bit for some in Spain…
Yes, we really need to take the advances of these studies that show increased survival. We are talking about increasing it from 50% to 60%, and that small 10% is a lot for a tumor that has such a high mortality rate. We must demand that the Administration finance them.
From time to time, controversy arises regarding the possibility of limiting smoking in spaces such as terraces. What is your opinion of these measures?
What is clear is that smoking must be eradicated. We have been trying to reduce it for many years and if 40 years ago 45% of the population smoked, now 25% continue to do so, which is a lot and especially young people. Already with the first law there was concern among restaurants that if they did not allow smoking inside they would lose many customers, and that did not happen. And the same is going to happen now with the terraces. In them, whoever is next to a smoker is exposed to the tobacco, smoke and carcinogens of the person who is smoking next to them, so they must be protected and extended to the terraces. And nothing is going to happen, because people are adapting.
“We must protect non-smokers and extend the tobacco law to terraces”
Despite tobacco bans, alternative forms such as vapes are making their way, especially among young people, who think that these devices are less harmful than cigarettes. Are you seeing any consequences related to this change in habits?
It is also essential to fight against new forms of tobacco, because now the tobacco companies play nice by saying, well, yes, tobacco really gives you cancer and such, but now we have some great new forms that taste very good, everything which is vaping and electronic cigarettes. And the youth buy it. And what this strategy does is encourage them to continue having the habit of putting something in their mouth because then they will get tired of the electronics and the mint and strawberry flavor beforehand and they will return to normal. It is a very well done strategy on the part of the companies and we must go for it in this regard. Because it is not only lung cancer, but also bladder cancer, larynx cancer, COPD, coronary artery disease, peripheral vascular disease, emphysema… there are many pathologies.
In recent years there has been an increase in cases of lung cancer in women. Is there any specificity in them, as happens in other pathologies such as heart attacks?
The good news for women is that lung cancer in them has a better prognosis than in men. And it is true that it also occurs more in non-smokers.
“It is essential to also fight against new forms of tobacco that especially affect young people”
Why this better prognosis?
We started seeing it 20 years ago in women of Asian origin who had lung cancer without being smokers. A few years ago there were many women in this case who lived with the smoker in the office or at home, so she is still a passive or secondary smoking woman. Hence also the number of non-smoking women with cancer is a little higher than that of men. But they were much lighter tumors, most of them very early and in which the prognosis is better, the vast majority of them could be operated on and obtain good results.
Living history of the specialty
►Dr. Molins was one of the 32 founding members of the European Society of Thoracic Surgery back in 1993, of which he was also its president in 2008 and 2009. «I had the honor of being one of the two Spaniards who participated in its foundation. The fact that in 93, when it was created, we were 30 surgeons, which soon expanded to 100, 150, 200 and currently there are more than 2,000 thoracic surgeons in this society, has endorsed it with absolute dedication to what I have defined as non-cardiac thoracic pathology. The figures prove him right: this year 800 abstracts have been sent and more than 1,800 participants are expected, the largest participation to date.