Without these tests, modern oncology would be meaningless. The National Health Fund (NFZ) only covers a portion of them.
- Poland is among the countries with a high incidence of lung cancer.
- The most common cancer in the lung is malignant non-small cell lung cancer
- Without conducting full molecular diagnostics and assessing the expression of the PD-L1 protein, optimal treatment planning for patients with this form of cancer is impossible.
The global population experiences up to 2.5 million new lung cancer cases and 1.9 million deaths each year. Poland is among the countries with a high lung cancer incidence, which is similar to other European countries – although this trend is slowly slowing down.
"In most countries, including Poland, mortality among men is declining. In Poland, lung cancer accounts for 14% of all cancer cases among men and 9% among women. The proportion changes when we look at deaths. Lung cancer accounts for a quarter of cancer deaths among men and a fifth among women. Despite the decreasing incidence, this cancer still takes a deadly toll," points out Prof. Joanna Didkowska, head of the Department of Cancer Epidemiology and Primary Prevention and the National Cancer Registry at the Maria Skłodowska-Curie National Institute of Oncology – National Research Institute (NIO-PIB) in Warsaw.
The main factor responsible for the high risk of lung cancer remains cigarette smoking, especially among women. Data confirm that the percentage of women who smoke remains unchanged, while men are smoking less and less.
"Unfortunately, as many as 16% of data reported to the National Cancer Registry lacks a stage of cancer progression. The percentage of patients with low-stage disease remains stable, and we haven't seen significant improvement. Stage of disease is crucial for a patient's chances of survival," added Professor Didkowska.
In June 2024, the Polish Lung Cancer Group, along with 13 scientific societies and patient organizations working to support lung cancer patients, established the "Lung Cancer Mission 2024-2034." Its goal is to reduce the lung cancer death rate from 24% to 15% and increase the five-year survival rate from 14% to at least 20%.
"The most common lung cancer is malignant non-small cell carcinoma. Only less than 20% of patients can undergo radical surgery. Based on publicly available data and European and global standards of care, we know that for surgery to lead to a complete cure, perioperative treatment is essential. This involves modern therapy both before and after surgery. It includes modern molecularly targeted drugs and immunological agents," noted Prof. Rodryg Ramlau, president of the Polish Lung Cancer Group.
The Polish Lung Cancer Group presented recommendations regarding the molecular diagnostic pathway and biomarker assessment in non-small cell lung cancer.
"Histological diagnosis is still the primary diagnosis, but it has been insufficient for many years. Without a complete molecular diagnosis and assessment of PD-L1 protein expression, optimal treatment planning, including the use of new perioperative therapy options, will be impossible. Therefore, completely new algorithms for lung cancer treatment are needed, encompassing analysis of test results, pathological assessment, imaging, molecular, immunological, and immunohistochemical tests. Without these tests, modern oncology has no rationale," emphasized Prof. Ramlau.
That's why the community has been calling for the creation of a network of lung cancer competence centers for many years. "Policymakers have made promises several times, but so far, they've been ineffective," the expert said.
Currently, the National Health Fund reimburses single-gene PCR tests and complex molecular tests, as well as "small panels" of NGS, so-called hot spots, from tissue material.
"We still lack the ability to perform liquid biopsy and use it in both hospital and outpatient settings. We also lack the ability to test fresh material and perform comprehensive genomic profiling, which is the most promising method," added Prof. Ramlau.
Moreover, many laboratories in Poland perform NGS research, but few have clinical certification, allowing the results to be used to qualify patients for reimbursed treatment. Certificates are issued by foreign entities, and the process of obtaining them is lengthy and expensive. Poland lacks a national reference system and laboratory certification.
It's estimated that lung cancer diagnosis in Poland can take up to six months. For many patients, it may simply be too late—70% of them are diagnosed in an advanced stage of the disease.
"Many centers in Poland do not have pathology and molecular diagnostics departments. Therefore, material for histopathology is often collected at one center, then sent to another center, and then finally sent to yet another center, which performs molecular testing. This is why the waiting time for the final histopathology test result is often 180 days ," noted Professor Renata Langfort, head of the Department of Pathology at the Institute of Tuberculosis and Lung Diseases in Warsaw.
According to experts, the creation of Lung Cancer Units would have the potential to shorten and streamline this process.
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