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Lung Cancer Can Stay Hidden for Over 20 Years, Scientists Say

Array of genetic defects thwart targeted treatments
Investigators at Cancer Research U.K. have discovered that lung cancers can lie dormant for more than 20 years before suddenly turning into an aggressive form of the disease, according to a study published October 9 in Science.

The team analyzed lung cancers from seven patients — including smokers, ex-smokers, and never smokers. They found that after the first genetic mistakes that cause the cancer, it can exist undetected for many years until new, additional faults trigger rapid growth of the disease.

During this expansion, a surge of different genetic defects appears in separate areas of the tumor. Each distinct section evolves down different paths — meaning that every part of the tumor is genetically unique.

The new research highlights the need for better ways to detect cancer earlier. Two-thirds of patients are diagnosed with advanced forms of the disease, when treatments are less likely to be successful.

By revealing that lung cancers can lie dormant for many years, the researchers hope their study will help improve early detection of the disease.

Lead author Professor Charles Swanton said: “Survival from lung cancer remains devastatingly low, with many new targeted treatments making a limited impact on the disease. By understanding how it develops, we’ve opened up the disease’s evolutionary ‘rule book’ in the hope that we can start to predict its next steps.”

The study also highlighted the role of smoking in the development of lung cancer. Many of the early genetic faults were caused by smoking. But as the disease evolved, these became less important, with most of the faults now caused by a new process that generates mutations within the tumor controlled by a protein called APOBEC.

The wide variety of faults found within lung cancers explains why targeted treatments have had limited success. Attacking a particular genetic defect identified by a biopsy in lung cancer tissue will be effective only against parts of the tumor with that fault, leaving other areas to thrive and take over, the study showed.

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