Smart Doctor: Dr. Santos, how have perceptions of lung cancer changed over the past few decades?
Dr. Edgardo S. Santos: Over the last two decades, we have witnessed significant progress in our understanding of lung cancer. One of the key shifts I want to highlight is the importance of moving beyond the stigma that lung cancer is solely a “smoker’s disease.” This perception is not only outdated—it’s harmful. About 25% of patients with non–small cell lung cancer have never smoked in their lives. That means environmental factors or genetic predispositions can also play a critical role in disease development.
While a history of smoking remains a major risk factor, we now recognize that lung cancer is more complex. Advances in legislation and public health efforts have contributed to reducing smoking rates and promoting cessation, but we must also address how we approach the disease clinically and socially.
SD: What impact has public health had on changing this narrative?
Dr. Santos: Public health initiatives have played a crucial role, particularly in tobacco control policies and promoting smoking cessation programs. These efforts are essential, but they must be paired with an increased focus on early detection. Lung cancer screening is a key area where we still need to make substantial improvements.
Despite the clear benefits shown in two large phase 3 clinical trials such as the NELSON trial and the National Lung Screening Trial, we still have low screening rates in the USA. That’s concerning because both trials demonstrated a reduction in mortality with early detection using low-dose CT scans.
SD: What can physicians do to improve lung cancer screening rates?
Dr. Santos: The first step is taking a thorough patient history. Primary care physicians and internists play a critical role here. Any patient with a 25-year smoking history, especially those who meet the updated age-based screening guidelines, should be referred for lung cancer screening using a low-dose CT scan.
This simple step can significantly alter the disease course by identifying lung cancer at earlier, more treatable stages. It’s an actionable way to change the current paradigm and improve survival outcomes.
SD: Beyond screening, what other advancements have influenced lung cancer care in recent years?
Dr. Santos: One of the most transformative changes has been the move toward precision medicine. Genomic studies have given us powerful insights into tumour biology, allowing us to identify specific drivers and pathways responsible for cancer progression.
This has enabled the development of targeted therapies, which are far more effective than the one-size-fits-all approach we relied on in the past. Personalized treatment not only improves clinical outcomes and quality of life for patients but it also makes our healthcare system more cost-effective. When we understand what we are targeting, we can deliver the right therapy at the right time, avoiding ineffective treatments and unnecessary costs.
SD: How would you summarize the current landscape of lung cancer care?
Dr. Santos: In many ways, we are in a new era. The integration of early detection strategies, the de-stigmatization of lung cancer, and the rise of precision medicine have all contributed to a more hopeful outlook for patients.
But there is still a lot of work to do. We must continue to educate both the public and healthcare professionals about the evolving nature of lung cancer. We also need to ensure access to screening and genomic testing, and encourage participation in clinical trials so we can keep moving forward.
