E3. Lung cancer in Latin America: A perspective

E3. Lung cancer in Latin America: A perspective Rodrlgo Arnagada Karollnska Unlversltv Hospital Solna, Stockholm, Sweden Latin America consists of the entire continent of South America m addition to Mexico. Central America and the island of the Caribbean whose inhabitants speak a Romance language I m total 23 countries) The total population is 55q~ million in 2q.~4 and the projection for 2q~5q~ is 767 million The peoples of this large area shared the experience of conquest and colonlsatlon bv the Spaniards and Portuguese from the late 15th through the 18th centurv as well as movements of independence from Spare and Portugal m the earlv 19th centurv However. there are large differences between them The geography and climate of these countries varv lmmenselv as well as the social and cultural characteristics across the pre-Columblan, colonial and independence periods After the dlscoverv of America. Europeans adopted the tobacco that was usuallv cultured in the tropical and subtropical countries Thus. the lung cancer pandemic had its origin m Latin ICentrall America To describe the lung cancer situation in this continent. we organlsed a pool among s o m e specialists In the Latin America countries Up to date. answers of countries accotmtlng for more than 7qO.. of the total population h a ~ been received and some information is included here Tobacco: The tobacco consumption in the continent is currentlv quite heterogeneous varying from 25 to 55°.. m males, and from 5 to 35°.. in females Most countries h a ~ an anti-tobacco law. but onlv h a l f of the specialists feel that the tobacco consumption has decreased after the law application In h a l f of the countries, the official policy has been to increase the tobacco price and most participants consider that this constitutes a good practice Registries: Internatlonallv recognlsed national (systematic and exhaustive) cancer registries exist onlv m a few countries Some other countries have only regional registries. but almost all h a ~ information of cancer death rate Diagnosis: The diagnosis is considered to be done generally late in the evolution of the disease Major causes for delayed diagnosis are difficulties to have access to a medical centre, delav m the performance of complementary examinations and also cultural reasons (patient delaying medical consultation) The proportion of disease according to clinical stage is quite variable but oscillate around 2q O.. for operable. 3qO.. for locallv advanced and 5qO.. for metastatic disease The diagnosis is suspected or done bv the general or chest physician The possibility to h a ~ access to a multldlSclpllnary opinion exists in all countries, but the

proportion of benefited patients IS quite variable About 4qO.. of specialists consider that the current situation is unacceptable and thev propose different possibilities of improvement that w i l l be d e ~ l o p e d at the presentation T r e a t m e n t : In all countries, all patients with Stage I nonsmall cell lung cancer and 9qO.. of Stage II are treated bv primary surgery (lqO.. r e c e l ~ preoperative chemotherapy). and 66°. of patients w i t h Stage IIIA receive p r e o p e r a t l ~ chemotherapy Postoperative radiotherapy is not indicated in Stage I. is done in only 2q~°.. of Stage II and is given for all in Stage IIIA Adjuvant postoperative chemotherapy is indicated m the following proportions 250.. of Stage I. 4qO.. of Stage II. and 95°.. of Stage I l I A Chemotherapy consists of platm-based regimen, in 750.. w i t h clsplatm Patients with locallv advanced lung cancer receive a concurrent radio-chemotherapy approach m all cases In metastatic disease, a majority of selected patients receive a palliative chemotherapy In hmlted small cell lung cancer, surgery is rarelv indicated i f the tumour is resectable, all patients r e c e l ~ chemotherapy and thoracic radiotherapy, and almost all a prophylactic cranial irradiation Education: Most specialists consider that education should be improved at different levels general public. medical school, general physicians and specialists Different possibilities of improvement were proposed Research: A l l consider that research is clearlv insufficient in epldemlologlcal, basic and cllracal areas The most common noted reasons are poor economy, overworked specialists, lack of structure Idata managing, monitors) and lack of specialist formation m the area of research Some specialists feel that the current research is m a m l v pharmaceutical-industry driven A few national groups of research w e r e identified, but regional groups generally exist The participation of Latin America in an international academic chemotherapy trial IIALTI represented less than 6% of the total number of inclusions In contrast, the participation in an international academic tamoxlfen trial in breast cancer (ATLAS. C)xfordl represented 2 8 % of the worldwide inclusions Thus. the participation in this kind of trials m a v be relevant but tumour site dependent Provided propositions of improvement w i l l be developed The pool will be extended up to M a v 2q.~5 to include a larger number of countries and opinions H o w e ~ r . it is plausible that the results will not represent the general situation in Latin America. as all consulted specialists

work in hospitals and centres of large cities It is highly probable that the situation in the rural areas is significantly different However, it was largely established that the need

for developing effecti~ anti-tobacco laws and high-standard education, and independent research, at least in leading centres, is felt as a priority to be dealt with in the next vears