Issue 11 | November 2017

November is Lung Cancer Awareness Month

Welcome to this new look edition of myStrand! We hope you like it and will continue to read our articles focused on cancer genetics and genetic counselling. November is lung cancer awareness month, so this issue summarizes some of the most pertinent facts as well as symptoms of lung cancer. Also in this issue, we also have a guest article on the various guises of hereditary breast cancer from one of Strand’s genetic counsellors!

The myStrand Team

10 Facts about Lung Cancer

November is Lung Cancer Awareness Month and needless to say, it is another killer that people are not aware of enough. It is important to highlight here that India’s struggle with lung cancer is somewhat different from other countries, as the range of causes (besides the obvious one of tobacco smoking or chewing) is slightly more diverse. To shed some light on the healthcare situation surrounding lung cancer, we have collected 10 of the most pertinent facts about lung cancer globally and in India.

  1. Lung Cancer is the most common cancer in the world.
  2. In India, at least 70,000 new cases are diagnosed each year (according to the GLOBOCAN 2012 report), however estimates based population based cancer registry data from the Indian Cancer Society from Maharashtra (in the year 2011) assume the actual number is closer to 150,000 new cases every year. Fortis Chennai puts the number even higher at 250,000-300,000 cases detected every year.
  3. It is the most common cause of cancer death for men and the seventh most common for women, after breast, cervical, colorectal, ovarian, stomach, and lip/oral cavity cancer. However, in western countries women and men are almost equally affected, which is commonly attributed to varying smoking habits of men and women between the two geographies.
  4. If you smoke 25 cigarettes a day you are 25 times more likely to get lung cancer than if you never smoked. Importantly, an individual’s smoking habit also adversely affects non-smoking family members, especially young children.
  5. It is never too late to stop smoking. Quitting at any age reduces your risk of getting lung cancer. However, your best chances at avoiding lung cancer are if you don’t smoke at all as, according to Fortis Chennai, 60% of lung cancer cases still occur in former smokers. 20% of cases occur in current smokers and the other 20% in non-smokers.
  6. Other risk factors prevalent in India, like air pollution (outdoor and indoor), the exposure to fumes from burning biomass fuel, poor diets, or possibly even the prevalence of infectious pathogens like Mycobacterium tuberculosis are speculated to contribute to India’s lung cancer burden. However, science still has a limited understanding of the exact impact these risk factors have on lung cancer incidence.
  7. Contact with substances found in the workplace or environment, such as asbestos and diesel exhaust fumes will increase the risk of lung cancer.
  8. Despite scientific and clinical advances in diagnosing and treating lung cancer over the years, only little progress has been made in improving survival rates. Since the primary risk factor for lung cancer is known to be tobacco smoking and chewing (inferring 80-90% of total risk), both habits that can be overcome with or without assistance from healthcare providers, the overall focus to improve lung cancer related issues should be on prevention!
  9. symptoms of lung cancerLung cancer treatment can be managed effectively using Liquid Biopsy assays. Liquid biopsies are simple blood samples taken from patients at the beginning of and through the duration of cancer therapy. These blood samples are put through sophisticated analyses and can provide an accurate picture of how your tissues are responding to the given treatment.
  10. Symptoms to look out for include:
    • A cough that won’t go away
    • Feeling breathless for no reason
    • Unexplained tiredness and lack of energy
    • Chest infection(s)
    • Chest or shoulder pains
    • Weight loss that you can’t understand
    • Blood in your spit
    • Coughing up blood
    • Hoarseness in your voice
    • A cough that you always have that changes or gets worse

Being aware of these symptoms and seeking medical help early on are key to saving your own life or that of a loved one as early diagnosis significantly improves the chances of survival.

Disclaimer: The information provided in this article is in no way intended to replace expert medical advice. Always discuss any concerns with your doctor.

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cancer survival rates by time of diagnosis

Early diagnosis is key!

In a recent feature on cancer in The Economist magazine, this graphic struck a cord. It shows how five-year relative survival rates drastically deteriorate depending on in which stage the cancer is diagnosed (based on US data from the year 2016). For example, prostate cancer when diagnosed at an early stage, when the cancer is still localized, had a 100% survival rate. Contrast this with lung cancer, where even an early diagnosis is associated with a less than 60% survival rate.

Hereditary Breast Cancer – One Cancer Many Syndromes

Ms. Payal Manek
Strand Life Sciences

Breast cancer is now the most common cancer in most cities in India. Many personal and environmental factors like gender, age, ethnic background, previous diagnosis of breast cancer and hormonal and reproductive factors contribute to a person’s risk of developing breast cancer.

In some families, clusters of individuals with breast cancers are seen across and through one or two generations. Such cancers are called hereditary cancers and known to be associated with inherited gene mutations. Hereditary breast cancers tend to develop earlier in life and are more likely to affect both breasts.

In general, individuals with hereditary breast cancer syndromes are at an increased risk of being affected with multiple cancers, not just breast cancer. Also, the unaffected/healthy members of these families can carry mutations in their genes that greatly increase their lifetime risk to many cancers. Affected members of these families, given their high risk of developing cancer, should be under lifelong surveillance and need to be offered preventive management options.

 

Cancer risks vary by syndrome

 

A very high risk to breast cancer is caused due to inherited mutations in BRCA1 and BRCA2 genes. They cause Hereditary Breast and Ovarian Cancer syndrome that are also associated with increased cancer risk in ovaries, male breast cancer, pancreatic and prostate cancer.

A significantly increased risk of breast cancer is also a feature of several rare genetic syndromes. These include Cowden syndrome, which is most often caused by mutations in the PTEN gene; hereditary diffuse gastric cancer, which results from mutations in the CDH1 gene; Li-Fraumeni syndrome, which is caused by mutations in the TP53 gene; and Peutz-Jeghers syndrome, which typically results from mutations in the STK11 gene.

Elevated risk to breast cancer is caused by mutations in some genes including ATM, CHEK2, NBN, NF1, PALB2.

 

Genetic test outcomes have real benefits for patients and their families

 

It is good to understand that some genes, when they malfunction, can cause cancers. How is this knowledge going to help common people, you ask? Genetic tests are designed to identify gene mutations which put an individual at a higher risk of developing a cancer. A negative test result can provide a sense of relief and reduce the anxiety of the individual or family members. It can reduce the need for, or at least the intensity of, check-ups, screening and preventive therapy. A positive test result is also a win-win situation! It can help in therapy and current disease management, earlier disease detection, and more targeted surveillance. Importantly, it can also serve as an effective prevention strategy by motivating a person to make behavioural changes that lower their chances of getting cancer.

The list of genes that are associated with hereditary breast cancers include ATM, BRCA1, BRCA2, BRIP1, CDH1, CHEK2, EPCAM, MLH1, MSH2, MSH6, NBN, NF1, PALB2, PMS2, PTEN, RAD51C, RAD51D, STK11*, TP53 – all covered in the Strand® Hereditary Cancer Test. Yet, scientific researchers continue to investigate and identify more genes, which is why this list is constantly updated.

The most common breast cancer syndromes along with their causative genes and lifetime breast cancer risks (compared to the population average risk of 12%) are summarized in this table.

Syndrome Genes Increased breast cancer risk
Hereditary Breast and Ovarian Cancer (HBOC) BRCA1 46-87%
BRCA2 38-84%
Cowden Syndrome PTEN 85%
Peutz-Jeghers Syndrome STK11 45-50%
Hereditary Diffuse Gastric Syndrome (HDGS) CDH1 39-52%
Li Fraumeni Syndrome TP53 27%

Have questions, or would you like to get more information on this topic? Please do not hesitate to get in touch through our StayAheadOfCancer portal (www.strandls.com/stayaheadofcancer) to make an appointment with a genetic counsellor to discuss your concerns.

Disclaimer: The information provided in this article is in no way intended to replace expert medical advice. Always discuss the best possible course of action for your situation with your doctor.

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Advanced genomic analysis for answers not found before

No wedding, no funeral

Family of 25 opt for genetic testing to know cancer risk

25 family members come together to identify cancer risk in Pune (featured in The Indian Express on 15 November 2017, photo by Express Photo/Sandip Daundkar). They are using Strand’s Hereditary Cancer Test to identify family members carrying the genetic mutation that has been causing breast and other cancers in several of them. Read more

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