Part 1 –

Hi my name is Leticia Nogueira I I’m a researcher at the American Cancer Society.

And I’m Felipe Roitberg. I’m a medical oncologist from Brazil currently work as a scientific division branch coordinator.

Welcome to another section on VJOncology. So my research focus is on climate change and climate change impacts every single step in the cancer control continue from prevention when it comes to exposure to pollution; we know that the same greenhouse gases that are driving climate change also increased lung cancer risk to treatment we know that climate driven disasters are going to end up disrupting access to cancer care and survivorship because cancer patients are a vulnerable population to the hazards of climate change.

So from my end as a Medical oncologist in preview World Health Organization technical officer my role is to discuss how much not only the climate change but all the consequence of that might affect access to care from the basic concept of Universal Health Coverage package in benefit packages for lung cancer patients and how in the continuation of care, they will have access to that because as she said the most vulnerable populations the underserved ones are the one that will suffer the most considering this climate changes and economic considerations related to that exactly.

And also the communities that have been exposed to the most pollution, and have the worst barriers in access to care, are living in places with a scarcity of resources, and have historically been the communities identified suffering a disparity or driving health inequities and I think that that is very valid and it needs to be recognized and also we need to recognize that these are the communities where the solutions that are relevant to the entire world to everybody who is being impacted by climate change are also coming from because relying solely on technocratic solutions they’re going to need more resources to be implemented is not technically going to help this problem and so understanding this context and this innovative solutions that are coming from the places that have the least amount of resources is going to be relevant to the entire world

So just recognizing what she just said one of the things we just working in Brazil in this current network that I’m coordinator for research Innovation AB Network we are trying to drive discussions and specific branches and initiatives for res related to implementation science this means that how we can adapt what has been written by academia and implementing the real practice in the real world so how can we acknowledge the inequalities and the social demographic determinants and try to shape what we discuss in academia and try to translate it into outcomes but first of all in the real tools and framework make this work and make this happen to those who effectively need and just acknowledging the discussion that will be framing tomorrow about refugees and conflict zones how can we also shape considering that the whole globe is now under constraints in terms of conflicts so how can we shape this discussion considering those who flee their countries and also we be accommodated in countries like Germany, like in Poland like happening right now in Ukraine and surely will happen in Gaza. So please be aware that is an agenda for the whole globe as she said and we should not work in our silos, the frontiers are more broader than we consider and we should care and we should work for that implementation science to be included in the agenda

Exactly because a lot of the solutions already exist right and we’re all on the same planet so in the same way there some hazards of climate change for example wildfire smoke is going to travel from California all the way to Iceland and Britain right the same way that the fossil fuels are generating greenhouse gases here then are going to impact climate in the entire world sometimes even when that disaster strikes far away from where you live it might have impacted a factory or some part of the supply chain that is needed for your cancer treatment very similarly with the regional conflicts and uh migration that happened with both climate change and conflict zones.

Absolutely just to give a sense a recent study publish on Nature just uh showed that some fogs and some chemical materials that were found in Ukraine were also found in Milan so they found a way to detect this heavy metals that will surely also impact the health of those who are in Italy in Milan right now so considering how this climate change and this conflicts will be expended not only for those who fled from their countries and will be accommodating other countries also the climate change it plays a major role. globally so I think that’s a way we can frame this discussion how can we also have this discussion our own agenda in our clinics and our discussion in our community so is important to bear in mind there’s not a discussion about ecology or people who just care about public health in the perspective public health also shapes the agenda of those who will care now and in the near future.

Part 2 –

So we already know that smoking cigarettes tobacco is one of the main causes or the main behaviors that is associated with increased lung cancer risk and this being recognized worldwide and it’s being a great success story right for lung cancer prevention so awareness campaigns and there’s been a decline in cigarette smoking and then some policies that have been implemented throughout the globe where for example you look around nobody’s smoking indoors here right so we know we learned a lot from the tobacco perspective and we know what we can do to change behavior to influence healthier behaviors right to put safeguards around some of the behaviors that might be impacting other people like secondhand smoking and there’s a parallel here with some of these other environmental causes of lung cancer right as the prevalence of smoking starts to decrease worldwide then we start to pay more attention to these other lung cancer risk factors which include pollution and minerals and so I think it’s very important if we are committing committed to reducing the lung cancer burden then we need to think beyond smoking and we need to think also about the own activities of the healthcare system how they might be uh increasing exposure to some of these pollutant in surrounding communities and globally through the emissions that are driving climate change and maybe conflict in some regions as well and how can we provide care for people who are coming from under resourced regions in a way that we reduce disparities.

Absolutely, so one of the topics we be discussed is that 20% of the current lung cancer patients never smoke it so this is a huge number 20% two out of 10 so if agree that ROM and other substances that are chemicals that we ignore absolutely ignore and don’t have a specific agenda for that it means that we are also ignoring the risk factors for 20% of the cancer that kills the most now. So we have a call for action we have a call to discuss environmental health and attach environmental health to our agenda. We should and we better because as she said the number of patients smoking is decreasing globally and we need now to take a look at those who are still waiting for us to draft this agenda to analyze it and to see how can we shape a way to detect these patients earlier and to detect their risk factors and manage the environment in the sense of to reduce their risk. So this is an agenda that has been posed by the UN to manage the environmental risk and is up to us in the scientific community to raise the voice of this agenda otherwise we’re going to still be lagging behind for 20% of cancer patients.

And most of the guidelines and recommendations for lung cancer screening are focused on the amount of pack packs of cigarettes somebody has smoked there’s very little research guidelines recommendations when it comes to screening or any other questions that your physician might ask you about your previous exposure to our pollution or have you lived in a conflict zone or did you live near a factory when you’re growing up and so increase the awareness of these risk factors we really shape who we can protect moving forward.