It’s not that long ago that lung cancer was widely considered a smokers’ disease. Which is somewhat ironic, considering it previously took scientists years to convince the world that cigarettes were extremely bad for our health – but the fact of the matter is, lung cancer is a huge public health concern, and while smoking is still the key risk factor, it’s not the only one.
Earlier this summer, Public Health England launched their ‘Be Clear on Cancer’ campaign with the aim of raising awareness of the symptoms, after releasing figures suggesting around 1.7 million people could be living with undiagnosed lung cancer, lung disease or heart disease – and so there’s no better time to put the disease in the spotlight.
Lung cancer is the biggest cause of cancer deaths in the UK, for both men and women, accounting for more than a fifth (22%) of all cancer deaths, according to Cancer Research UK figures.
While it’s long been associated with smoking, lung cancer can actually affect anybody – even those who’ve never smoked up a cigarette in their life – so everybody should be aware of the signs and symptoms.
Anybody can potentially get lung cancer, but it is more common with age (around six in 10 cases diagnosed from 2011-2013 were in people aged 70 plus), and while there are slightly higher rates in men, it’s the second most common cancer for both men and women (though the leading cause of cancer deaths). “The condition usually affects people aged 60-80,” says Dr Penny Woods, Chief Executive of the British Lung Foundation. “Young people can develop lung cancer, but this is rare.”
“Anyone can develop lung cancer, but around 85% of cases occur in people who smoke or who used to smoke,” says Woods. “The risk of getting lung cancer increases with the total number of cigarettes you’ve smoked. If you stop smoking, the risk gets less over time.” Breathing in second-hand smoke is now also recognised as a risk factor and, as Richard S Steyn, Consultant Thoracic Surgeon & Divisional Director, and Chair of the UK Lung Cancer Coalition, points out: “One in eight patients will have never smoked at all.” Exposure to certain substances, such as radon gas and asbestos, are also associated with lung cancer.
It’s acknowledged that a person’s genes may mean they’re more susceptible to developing lung cancer (which is the same for many types of cancer – though this does not mean known lifestyle risk factors should be dismissed). “It’s not so much that [lung cancer] runs in families, but that some people may have a susceptibility as such that pollution or smoking, or other things, can make them more likely to get lung cancer,” explains Steyn. This is evident in how some people seem to ‘escape’ getting cancer, while others develop the disease despite having been seemingly healthy their whole lives. “I’m sure we can all think of people who’ve said, ‘I know somebody who’s smoked 50 a day for years and never had a problem’, but some people are much more susceptible to developing cancer.”
“Cancer starts out as one abnormal cell. It might take up to five years for it to multiply and grow big enough to be noticed,” says Woods. “Often lung cancer will not cause symptoms until the tumour becomes quite large. This means it might only be discovered when you have an X-ray or scan for a different problem.”
However, there are warning signs that should not be ignored, including a cough that lasts more than three weeks, coughing up blood, feeling out of breath, wheezing, unexplained pain in the chest or shoulder area that isn’t going away, unexplained weight loss and ongoing fatigue. “The symptoms we’re pushing most, is a cough that’s lasted three weeks or more,” says Steyn. “Also, are you getting out of breath doing things you used to be able to do? Of course, we don’t expect somebody at 80 to do what they did at 20, but we do see people who at the age of 55 are not managing what they did at 53. Other symptoms include frequent chest infections, and certainly if somebody’s coughing up blood, we would consider that a red flag.”
As Steyn stresses, all of these symptoms can occur due to other causes, and don’t automatically mean you have cancer. “Some people getting an infection cough up blood,” he says, adding that other lung conditions – such as COPD, emphysema, bronchitis and pneumonia, which may present with similar symptoms – are also increasingly common in older age groups. But the message is clear: it’s always better to get things checked quickly if you are concerned, and certainly if you notice any of the symptoms listed above. If your doctor is concerned about your symptoms, a chest X-ray and blood tests are usually the first step.
As with all cancers, being diagnosed early generally means a much more positive prognosis. Steyn acknowledges there have been challenges around lung cancer awareness. Historically, a “lot of people presented late”, he notes, so survival rates were low, and there are also a lot of “negative connotations” around lung cancer because of its link with smoking. He reiterates – the disease can affect non-smokers too, and treatments have come a long way in the past 10 years. “Anyone can get it. And if we catch it earlier, it’s potentially a lot more treatable – that’s the thing we’ve got to change the belief of,” he states. “Treatments have also changed dramatically, and also a lot of people are living much longer with lung cancer even where we cannot cure it. If we catch people at stage 1, approximately 83% will live for a year after being diagnosed, whereas if it’s picked up at a late stage, that drops down to 17%, so you can see a huge benefit if we can just catch people earlier.”