Norwegian Lung Cancer Registry
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The number of lung cancers stands at well over 3,000 new cases annually. As a result of better treatment, the proportion living with a diagnosis of lung cancer today is three times as large as it was 20 years ago.
Summary from the annual report 2024
This annual report from the Norwegian Lung Cancer Registry is based on data collected by the Cancer Registry of Norway (CRN). Data sources include individual reports from clinicians and pathologists as well as data from other national registries.
Patients diagnosed with, treated for, or who deceased from lung cancer up to 31.12.2024 are included. CRN has been estimated to include 98.6% of all Norwegian cancer patients. The number of patients diagnosed with lung cancer in 2024 was 3396, a slight reduction from the all-time high of 3466 cases in 2022. This is probably coincidental but may also be a hint of the anticipated decline in incidence to come.
There is no significant gender difference with 1686 and 1710 new cases in men and women respectively. As shown in figure 2.3, panel A there has been a significant increase in annual cases, especially among women in the last 20 years. In the same time period, the median age at diagnosis has increased from 70 to 74 years. This is due to a declining incidence rate in persons below the age of 70 (figure 2.2). For patients over 70 years, the incidence rate is still high, slightly higher among men than women. Among the older individuals there has been a small annual decrease in incidence rates among men in contrast to an increase for women albeit with a trend for plateauing these last years.
The apparent discrepancy between the increase in total numbers and the declining incidence rates is due both to an increase in citizens and an aging population. The national survival rate has tripled since the turn of the century with a 5-year relative survival rate now reaching a new record level at 32%, even higher for women separately at 35.3% (figures 2.37 and 2.38).
The median survival is now 18.5 months for all patients and 22.9 months for women alone (figure 2.42). As a result, the prevalence of lung cancer patients alive is more than four times higher by the end of 2024 compared to two decades ago (figure 2.3, panel B). The combination of higher survival rates, increasing prevalence and the expanding availability of new treatment options all generate a higher burden on the health system.
Patients with adenocarcinoma (ADC) have a better survival than other histologies (figure 2.41). Having an EGFR or ALK mutation gives a further advance in survival regardless of stage at diagnosis (figure 2.41 and 2.44). The frequency of EGFR mutations in ADC was 11.4% (figure 2.4), and 2.1% for ALK mutations. The fraction of patients diagnosed with stage IV lung cancer is 44% in Norway (table 2.2). Survival among these patients are still low, 7 months for NSCLC and 6 months for SCLC (figure 2.46 ). However, the 75th percentile for survival for stage IV NSCLC patients has doubled between 2014 and 2022 to now 22 months.
In 2024 the proportion of potentially curable patients (stages I–III and ECOG 0–2) evaluated at a multidisciplinaryteam meeting was 93.9%, and 92.3% in this group underwent PET/CT as part of their diagnostic work-up, both parameters slightly lower than the national target (2.5 and 2.6). There were some notable differences between hospitals. Of patients in stages IB-–III and ECOG 0–-2, 52.7% had EBUS/EUS performed (figure 2.7).
EBUS/EUS is becoming increasingly important to differentiate between operable and non-operable patients, as well as surgery with or without neoadjuvant therapy. In 2023 a putative national target of greater than or equal 45% was set. The overall proportion of lung cancer patients receiving treatment with curative intent in 2024 was 38.4% (figure 2.10). In this report, curative treatment is defined as either surgery (19%), stereotactic body radiation (10%), or traditional radiotherapy administered in curative doses as part of chemoradiotherapy (9%). This is in accordance with the level seen in our former annual reports.
The use of video assisted thoracic surgery (VATS) or robot assisted thoracic surgery (RATS) continues to increase and was performed in 87.3% of patients in stage I in 2024 (figure 2.13).The quality of surgery is high, with a national 30-day postoperative mortality of 0.4% (2.14). A new national target for the quality of surgery was introduced in 2023, which is resection of subcarinal lymph nodes. As seen in figure 2.12 there is considerable variation in the numbers.
Regarding medical treatment, hospitals serving 90% of the population have systems that automatically report chemotherapy or immune oncology (IO) to the CRN. Data regarding targeted oral therapy (protein kinases) is available nationally from registration of prescriptions. The use of IO is increasing at the same levels in different parts of Norway (figure 2.16). This indicates that there is a homogeneity in the availability of modern treatment options.
Figure 2.22 shows how the treatment modalities and the percentage of patients receiving treatment differs among age groups for every major stage set. There are, however, no major differences between regions regarding treatment given (figure 2.23). Figures 2.27 and 2.28 show the percentage of patients who received active medical oncologic treatment the last four weeks before death.
Oral treatment for driver mutations is not registered here, as this is given in an out-patient setting. For NSCLC this was 20.2% and for small cell lung cancer (SCLC) 26.4%, both acceptable numbers although there were some differences between hospitals.
Patient reported outcomes (PROMs) are still somewhat new in the registry, but some data are presented in chapter 2.11. The number and percentage of answers are still low, with only 33.9% of lung cancer patients responding (table 2.6). Still, the impression so far is that lung cancer patients have a lower quality of life than matched individuals without the disease both three weeks and six months after the diagnosis (figure 2.30).
Pain, dyspnea and anxiety are all more frequent among lung cancer patients at the two time points except for pain at six months in the age group >74 years. For the first time this report can show some data regarding smoking habits. As shown in figure 2.32, 25% of patients were still daily smokers at time of diagnosis, and 14% were never smokers. In comparison the numbers among the matching controls were 6% and 47%. In the oldest age group, >75 years, there were fewer active smokers
than in the younger patients.