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N. Pilnik

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    ED12 - Regional Tobacco Control Policies: Advances & Challenges (ID 281)

    • Event: WCLC 2016
    • Type: Education Session
    • Track: Epidemiology/Tobacco Control and Cessation/Prevention
    • Presentations: 1
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      ED12.06 - Tobacco Control Policies in Latin America (ID 6494)

      11:00 - 12:30  |  Author(s): N. Pilnik

      • Abstract
      • Presentation
      • Slides

      Introduction Smoking is the single most important cancer risk factor and accounts for 26% of all cancer deaths and 84% of lung cancer deaths in Latin America[1]. Lung cancer is one of the most preventable cancer types; and doctors of all expertise are essential to impart to patients and their families the idea of smoking prevention, thereby contributing to the reduction of mortality from lung cancer. There are around 145 million smokers age 15 years or older in Latin American. Adult smoking prevalence varies from 35% in Chile and 30% in Bolivia to 11% in Panama and 11∙7% in El Salvador[2, 3]. The continuing popularity of smoking among adolescents is particularly worrisome as smoking rates among teens and young adults predict future lung cancer rates. Smoking rates among young people aged 13–15 years are now higher than in adults in many Latin American countries. Prevalence among female adolescents has surpassed their male counterparts in Argentina, Brazil, Chile, Mexico, and Uruguay. Unless these high rates of smoking are curtailed, cancer mortality rates will continue to rise[3]. We have assessed the impact on smoking rates of anti-tobacco policies adopted by five Latin American countries, in compliance to the WHO’s Framework Convention on Tobacco Control (FCTC). Argentina, Brazil, Mexico, Peru, and Uruguay were used as case studies to illustrate the challenges and ways in which governments and civil society organizations can effectively work together to reduce lung cancer deaths and other tobacco-related diseases. Since the endeavor for approving anti-tobacco policies was met with a strong lobby against it in these countries, different degrees of compliance with the FCTC terms were reached. We analyzed reports issued by local governments and epidemiologic surveys found in the literature. Tobacco farming in Latin-America has increased in recent years, representing almost 16% of the global production. Argentina and Brazil are among the ten largest world producers and the cultivated area in Latin America reaches 13.55% of the global land dedicated to tobacco farming worldwide. The prices paid by the tobacco industry to farmers are also increasing since 2007, and the sector employs 650,000 people. Tobacco farming is also present in Colombia, Dominican Republic, Honduras, Ecuador, Guatemala, Mexico, Nicaragua and Paraguay[4]. Therefore, tobacco control policies must necessarily include solutions to help tobacco growers to escape from the influence of the tobacco industry without loss of income and jobs. Results We have found a differential decrease (and increase) in smoking among the population of the studied countries in the last decades: Argentina: (from 29% in 2007 to 22.1% in 2014); Brazil (from 34.8% in 1989 to 14.7% in 2013); Mexico (21.7% in 2008-2011 to 23.6% in 2014); Peru (from 44.5% in 1998 to 21.1% in 2010 and 13.3% in 2013); Uruguay (from 34% in 1998 to 23.5% in 2011)[5 – 11]. Discussion According to the 2014 FCTC Progress Report[12], the implementation degree of the articles among the countries varied from <20% to more than >75% in most cases. One-third of all FCTC signing countries have not enacted anti-tobacco legislation or reached the full implementation of at least two important time-bound articles: tobacco advertising ban and health warnings on cigarette packages and at the selling points. Our data also showed uneven degrees of implementation among the studied countries. One of the underlying causes for slow implementation in some countries, like Mexico and Argentina, is the strong political lobby by the tobacco industry. In our study, Argentina has come in third in smoking prevalence, with a 22.1% smoking rate among adults, due to the strong pressure upon legislators by the tobacco industry that so far has prevented the FCTC ratification by the Congress. Nevertheless, the Argentinean political environment was more sensitive than the Mexican, to the persistent anti-smoking advocacy by the medical associations and organizations of the civil society. Therefore, some of the FCTC tobacco control policies were enacted by legislators in 2011 and implemented in 2013. Mexico, however, was the one with the poorest implementation of tobacco control policies and the highest in smoking prevalence among adults (23,60%), seconded by Uruguay (23.5%), where the past administration has neither enforced the already existing tobacco-control policies, nor promoted new ones, such as heavy taxes upon tobacco products. One of the important measures recommended by the FCTC - which has proved to be effective in smoking prevention among children and teenagers - is high taxation (over 75%) of tobacco products[12]. Conclusion The degree of compliance with the terms of the Convention seems to have a direct impact on the reduction of smoking rates in the countries studied. Other solutions should contemplate tobacco farmers, whose fear of shifting to new unfamiliar cultures is exploited by the tobacco industry to prevent FCTC ratification in many countries. But farmers should not stop growing tobacco plants, but just shift to transgenic tobacco farming[13]. Transgenic tobacco is being successfully tested for expression of for more than fifteen human therapeutic proteins, including antibodies, antigens for vaccines, and autoimmune inhibitor factors. [(14-17)]. Pharmaceutical companies could benefit from the existing agricultural tradition of tobacco farming in Brazil, Argentina, and elsewhere by fostering the commercial production of those molecules. Transgenic tobacco is improper for smoking and could also have the nicotine gene knocked out to discourage misuse. Therefore, the pharma industry could open new roads to smoking eradication while preserving the economic activity and profitability of traditional tobacco farmers. Effective tobacco control requires a close cooperation between health institutions, medical societies, NGOs, and the press - and the regular funding of surveillance programs and educational campaigns. Smoking prevention programs must be part of the educational curricula from the pre-school onwards.

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    P1.02 - Poster Session with Presenters Present (ID 454)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Biology/Pathology
    • Presentations: 1
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      P1.02-085 - Molecular Profile in NSCLC Biopsy Samples: A Multicenter Local Study (ID 6213)

      14:30 - 15:45  |  Author(s): N. Pilnik

      • Abstract

      During the last time substantial progress have been made in the characterization of the molecular abnormalities of NSCLC tumors such as activations of oncogenes by mutations, translocations and amplifications, which are being used as molecular targets and predictive biomarkers. Currently these molecular analysis is mandatory for therapy selection.

      92 small biopsies and resection specimens of patients with NSCLC (AC) in different institutions of Cordoba were studied during a period (2014 2016). We determined the frequency of molecular alterations in EGFR and gene fusion ALK in our Caucasian and Hispanic populations to decide the adequate treatment . Histopathology Type,immunohistochemistry (IHC) characteristics as well as molecular profile and several clinical variables were studied. To detect alterations of EGFR and fusion gene EML4-ALK expression, different tests were used with the aim to identify our own profile and decide the adequate therapeutical option. EGFR mutation was studied by therascreen kit, PCR, in order to detect genetic alterations in exons 18, 19, 20 and 21. ALK translocations were analyzed by FISH (Vysis- Break Apart, Abbott) and IHC (clon D5F3, ventana, Roche). The molecular profiles were correlated with different clinical variables (age, gender, and tobacco habits). The statistical method used was the multiple regression logistic model.

      58 men and 34 women out of 92 samples were tested for EGFR expression. Eight men and ten women expressed EGFR positive. Sixteen men and two women were smokers. Activating kinase-domain mutations in EGFR were identified in 21 pts (22,82 %): exon 19 deletion = 11, L858R = 7, exon 20 insertion = 1, other = 2. EGFR alterations were related with gender , women showed more alterations of the genes. Age and smoking habit of patients did not show significant association . We used the multiple regression logistic model to correlate EGFR expression to age, gender, tobacco habits. We identified 4 pts (5%) with fusion gene EML4-ALK. ALK alterations were not related to gender, age and smoking habit .

      Our results showed a comparable frequency in EGFR mutations and gene fusion ALK in relation to the data published in western population and our data presented in LALCA meeting 2016. These results permit an adequate diagnosis to provide these pts with the most benefitial therapy.