2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

LUNG CANCER IN BRAZIL
Fig. 1. Relative distribution of causes of death in Brazil, 2010. 31
Abbreviation: CNS, central nervous system.
mortality can be reduced by annual screening with low-dose
CT, especially in high-risk populations. However, this strategy
can be associated with possible harm. 7 Currently, there
is still no formal recommendation for the routine use of
screening CT as standard clinical practice in Brazil.
KEY POINTS
● Cancer is now a public health problem in Brazil, with
more than 500,000 new cases expected for the year
2012.
● Lung cancer will be responsible for 17,210 new cases
in men and 10,110 new cases in women.
● Brazil reduced the percentage of smokers from
around 32% in the 1970s to 17% in 2010s, and a
further annual decrease of about 0.3% is projected by
government health authorities.
● Diagnosis, staging, and treatment guidelines for patients
with lung cancer follow the recommendations
of the Brazilian Society of Clinical Oncology and the
Brazilian Cancer Society, which are consistent with
the National Comprehensive Cancer Network and
European Society for Medical Oncology guidelines.
● As a developing country with large cultural and
socioeconomic contrasts and an estimated population
of over 190 million inhabitants for the year 2012,
disparities in patient access to proper medical care
are still a major challenge for cancer control in Brazil.
Classification and Prognostic Factors
Lung cancer is grouped as NSCLC and small-cell lung
cancer (SCLC). NSCLC accounts for more than 85% of all
cases and is classified as squamous (SCC) and nonsquamous
cell carcinoma (NSCC). NSCC includes adenocarcinomas,
large-cell carcinomas, and other subtypes. In a retrospective
analysis of 240 consecutive patients treated at an academic
hospital in Sao Paulo, Brazil, between 2000 and 2006, the
most common NSCLC subtype was SCC. 8 Similar results
were reported in a study performed in Manaus, Brazil,
between 1995 and 2002. 9 In contrast, in a recent series of
patients with NSCLC from the Brazilian National Cancer
Institute in Rio de Janeiro, Brazil, the most common histologic
subtype was adenocarcinoma. 10 This pattern is being
also observed in an NSCLC series from developed countries.
11 As a rule, most patients with NSCLC (80%) present
with locally advanced or advanced disease (stages III and
IV), while a minority (20%) of patients have early disease
(stages I and II) at presentation. 8,10
Favorable prognostic factors for survival in patients with
NSCLC include early stage, good performance status, no
weight loss, and female gender. In contrast, p53 mutations
and KRAS activation may predict a less favorable prognosis.
12 In another study, 114 patients with NSCLC from Porto
Alegre, Brazil, underwent tumor resection for stage I disease.
The 5-year survival rate was 85.5% and 46.4% for
women and men, respectively (p � 0.0001). 13
Pathology
Tumor specimens can be obtained from fine-needle aspiration,
core needle, endobronchial or transbronchial biopsy,
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