Diseases & Longevity · File 21

Lung cancer. 1st global cancer death cause — and LDCT screening changed the history.

Lung cancer kills more than any other cancer in the world — approximately 1.8 million annual deaths. Smoking is the main causal factor, but ~20% of cases occur in never-smokers (biomass smoke, radon, occupational, pollution). Annual screening with low-dose CT (LDCT) in high-risk patients reduces mortality 20-24% (NLST 2011, NELSON 2020) — and that is the real longevity window.

Why LDCT screening redefined the intervention window

For decades, lung cancer was diagnosed in advanced stages with grim prognosis — 5-year survival globally <20%. The reason was simple: symptoms (cough, dyspnea, hemoptysis, weight loss) appear when the tumor is already locally advanced or metastatic. Previous screening efforts with chest X-ray or sputum cytology did not demonstrate mortality reduction.

That changed with two trials: NLST 2011 (NEJM) — n=53,454 — and NELSON 2020 (NEJM) — n=15,789. Both demonstrated that annual LDCT screening in high-risk patients (smokers and ex-smokers with significant accumulated burden) reduces lung cancer mortality by 20-24%. USPSTF 2021 updated indication: annual LDCT screening in adults 50-80 with ≥20 pack-years of active smoking or cessation <15 years. That is a real and modifiable longevity window.

LDCT screening is not optional in high risk — it is the only population intervention with demonstrated lung cancer mortality reduction.
Annual deaths · global

The global weight, in numbers

Quantitative lung cancer data come from GBD, GLOBOCAN, NLST, NELSON, and USPSTF/NCCN guidelines. They confirm the early intervention opportunity.

  • Global burden

    #1 muerte oncológica

    Lung cancer is the 1st cancer death cause worldwide — ~1.8 million annual deaths. It's the 2nd in cancer incidence, after breast cancer.
    — GLOBOCAN 2022; GBD 2019

  • Smoking as cause

    ~85% hombres / 70% mujeres

    Smoking causes ~85% of cases in men and ~70% in women. Cessation significantly reduces risk — effect is seen 5-10 years after quitting, and approaches that of never-smokers after 15+ years.
    — USPSTF 2021

  • LDCT screening (NLST)

    ↓20% mortalidad

    NLST 2011 (NEJM): n=53,454 high-risk adults. Annual LDCT screening reduced lung cancer mortality 20% vs chest X-ray. 5-year survival in LDCT-detected cancers exceeds 80% (vs <20% symptomatic diagnosis).
    — NLST Research Team, NEJM 2011

  • NELSON 2020 confirmation

    ↓24% mortalidad (hombres)

    NELSON (NEJM 2020): n=15,789 Europeans. Confirmed 24% mortality reduction in men and 33% in women with LDCT screening vs control. Established European generalization of NLST evidence.
    — de Koning et al., NEJM 2020

Chap. 03 · Never-smokers · LATAM

Impact on trajectory, quality of life, and other factors

Lung cancer is not just a smoker's problem — ~20% occurs in never-smokers. The modern conversation must include environmental factors and quality-of-life perspective.

  • Cancer in never-smokers

    ~20% de los casos

    Approximately 20% of global lung cancer cases occur in never-smokers — particularly Asian women, indoor biomass smoke exposure, and radon. EGFR and ALK mutations are more frequent in this subgroup.
    — Sun et al., Nat Rev Cancer 2007; IARC 2017

  • Biomass smoke in LATAM

    Subdiagnosticado

    In rural areas of Latin America, chronic exposure to indoor wood and coal smoke is a significant risk factor — frequently underestimated and underdiagnosed in healthcare systems oriented to classical smoking.
    — Kurmi et al., Thorax 2012

  • Immunotherapy and survival

    Cambió el pronóstico

    Checkpoint inhibitors (anti-PD-1/PD-L1: pembrolizumab, nivolumab) and targeted therapies (EGFR, ALK, KRAS-G12C, others) have significantly changed survival in advanced lung cancer. Oncology decision.
    — Reck et al., NEJM 2016

  • Post-diagnosis quality of life

    Impacto sostenido

    Lung cancer patients report significant and sustained quality-of-life reductions — dyspnea, fatigue, anxiety, and depression are common symptoms. Integrated support (early palliative care when indicated) improves outcomes.
    — Temel et al., NEJM 2010

What we don't offer — and what we do

Wellness Care does not diagnose or treat established lung cancer. Biopsy, staging, decision of surgery, radiotherapy, chemotherapy, immunotherapy, and targeted therapies are the exclusive responsibility of thoracic oncologist, interventional pulmonologist, and thoracic surgeon. What we do is high-risk screening, smoking cessation support, and evaluation of environmental and longevity factors.

We evaluate patients with: active smoking or ex-smokers with ≥20 pack-years burden, biomass smoke exposure, sustained occupational exposure (asbestos, silica, radon), family history of early lung cancer, or patients with lung cancer in remission wanting to optimize secondary prevention and longevity trajectory. LDCT indication is evaluated per USPSTF / NCCN criteria. Coordination with pulmonology / oncology when indicated.

Accompanied smoking cessation and LDCT screening in high risk are the two real pulmonary longevity interventions — not antioxidant pseudo-therapies.
How we measure it

How risk is evaluated
at Wellness Care

LDCT screening in high risk + accompanied smoking cessation + evaluation of environmental and systemic comorbidity factors. In coordination with pulmonology and oncology when indicated.

Advanced biomarkers

21 specialized panels across 8 clinical categories — biological age, inflammaging, metabolic profile, functional hormonal, microbiota. The quantitative layer.

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Functional medicine

Shared root causes — mitochondrial dysfunction, inflammaging, neuroendocrine dysregulation — before organ pathology.

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Bioregulatory medicine

Autonomic regulation, HRV, stress response. The functional trajectory that precedes clinical diagnosis.

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The Longevity Program

How this assessment integrates into the full program — from initial valuation to individualized protocol design under medical judgment.

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Featured evidence

Key evidence supporting this approach

Four publications structuring the modern lung cancer conversation — NLST, NELSON, USPSTF, and cancer in never-smokers.

«El cribado anual con LDCT en pacientes de alto riesgo reduce la mortalidad por cáncer de pulmón un 20% versus radiografía de tórax.»
NEJM · 2011
NLST Research Team, NEJM 2011
Establecimiento de LDCT
«NELSON confirmó la reducción de mortalidad por cáncer de pulmón en cohortes europeas — 24% en hombres y 33% en mujeres con cribado LDCT.»
NEJM · 2020
de Koning et al., NEJM 2020
Confirmación europea
«La USPSTF 2021 ampliró la indicación de cribado LDCT a adultos de 50-80 años con ≥20 paquetes/año de tabaquismo activo o cesación <15 años.»
JAMA · 2021
USPSTF, JAMA 2021
Actualización de criterios

Frequently asked questions about lung cancer

The most recurrent questions about lung cancer — LDCT screening criteria, cessation, environmental factors, and why longevity medicine operates in primary prevention.

01

Who is a candidate for LDCT screening?

USPSTF 2021 recommends annual LDCT screening in adults 50-80 with:

· Active smoking or cessation <15 years
· ≥20 pack-years accumulated burden

NCCN has somewhat broader criteria that may include:

· Occupational exposure
· Family history of lung cancer

Decision is individualized — considers comorbidities, life expectancy, and preferences.

02

Does smoking cessation really change the risk?

Yes, significantly — but risk is not eliminated immediately.

Trajectory:

· 5 years of cessation → risk falls approximately by half vs active smoker
· 10-15 years → approaches that of never-smoker

That's why LDCT screening remains indicated in ex-smokers up to 15 years post-cessation.

Structured accompanied cessation (counseling + pharmacotherapy: varenicline, bupropion, NRT) has significantly higher success rates than isolated attempt.

03

Why is there lung cancer in people who never smoked?

Multiple factors:

· Indoor biomass smoke (wood, coal) — particularly in rural LATAM
· Radon exposure in some regions
· Occupational exposure — asbestos, silica, chromium, nickel, arsenic
· Air pollution with fine particles (PM2.5)
· Environmental tobacco smoke (passive smoker)
· Family history
· Genetic factors — EGFR, ALK mutations more frequent in Asian never-smoking women

Screening all never-smokers is not standard — but there are high-risk groups deserving evaluation.

04

Do antioxidant supplements prevent lung cancer?

No.

And worse: two classical clinical trials showed that beta-carotene and high-dose vitamin A paradoxically increase risk of lung cancer in smokers:

· ATBC 1994
· CARET 1996

Evidence is solid: mega-dose antioxidant supplements do not prevent lung cancer — and can be harmful in high risk.

The only prevention interventions with evidence:

· Smoking cessation
· LDCT screening
· Reduction of environmental exposure

05

When should I consult?

A structured assessment is worthwhile if:

· You're a smoker or ex-smoker with ≥20 pack-year burden
· You have sustained exposure to biomass smoke (indoor wood, coal)
· Occupational exposure to pulmonary toxins (asbestos, silica, radon)
· Family history of early lung cancer
· Persistent cough / hemoptysis / dyspnea without identified cause
· Unexplained weight loss

The assessment orients screening and cessation — final diagnosis belongs to pulmonology / oncology.

Screen what really saves lives

Accompanied smoking cessation and LDCT screening in high risk are the two real interventions of pulmonary longevity.

Identify high risk, accompany smoking cessation with pharmacotherapy when applicable, indicate LDCT per USPSTF/NCCN criteria, and coordinate with pulmonology and oncology — that changes real outcomes.

Smoker, ex-smoker, or biomass smoke exposure?

Book a lung cancer risk assessment

We evaluate exposure history (smoking pack-years, biomass, occupational), inflammatory profile, pulmonary biomarkers, LDCT indication per USPSTF/NCCN criteria, smoking cessation support, and comorbidities. The assessment does not replace pulmonology / oncology — it complements them.

Book pulmonary assessment