Lung Cancer – Just How Are We Doing?

We were the first with a workplace smoking ban. We all patted ourselves on the back and said ‘weren’t we all great’. But are we doing better now in terms of reducing lung cancer?

Lung cancer remains the biggest cancer killer and the cause of 20% of all cancer deaths. Yet it is perhaps the most neglected of cancers.

Cancer is mainly a disease of the elderly and the population is aging, so soon more people are likely to get cancer. Most who get it are over 65.

In the future, it will be an even greater burden on society. One in four of us will get cancer in our lifetime. If you are 40 now, then you have a one in 700 chance of getting it. If you are over 70 now, then it is a one in 40 chance.

We are getting better at managing other conditions that people suffer from as they age, such as heart disease, diabetes and other chronic lung diseases. So are we surviving these diseases only to die later of cancer?

There is some evidence this is the case, but it isn’t always necessarily so. The diagnosis and treatment of all cancers has vastly improved in the last decades. Increasingly, we are talking about survivors from cancer now and not deaths. Yet lung cancer seems to buck this trend. So why is this?

In this new era of cancer survivorship, however, only a staggeringly low of less than 10% of those with lung cancer survive for five years. The problem is that most lung cancer turns up when it is too late to do anything in terms of a cure. Two thirds of newly identified cases are with late stage disease when there are much reduced chances of survival.

Most of those who present with advanced lung cancer are treated with palliative care and not given anti-cancer treatments. Surgery remains the only curative option, but it needs to be done early and delays in diagnosis much reduce the chances of success.

Lung cancer is a disease of the elderly. Many of those with lung cancer are unfit and have other medical problems making surgery and recovery even more complicated. Diagnosing cancer earlier and getting them in quicker for surgery when the disease is more manageable is the only way to improve things.

This requires a thorough screening programme; something that doesn’t have universal approval. Lung cancer like alcoholic liver disease is a problematic disease. Ninety five percent of lung cancers are directly caused by smoking, which is self-inflicted and totally preventable. So should we even bother to treat them let alone screen smokers for early signs of disease?

The most effective long-term approach to reducing lung cancers is smoking prevention. About 7,000 deaths each year are directly attributable to smoking.

Public perception of smokers and their ability to quit has not aided in the prevention of lung cancers. The idea that it is a filthy dirty habit, and not a recognisable drug addiction, is an unhealthy but popular opinion to hold.

Cigarettes are difficult to give up for many smokers, especially for those who have been smoking for a long time, and this needs to be recognised. About 80% of smokers in Ireland say they want to quit. But only 10% who try to can give up without nicotine replacement and then only 20% are successful.

Prevention of lung cancer is the prime reason the Irish Government instituted a working place ban in 2004. So has the ban reduced the number of smokers and thus reduced the number of lung cancers?

The change in the number of smokers was not as spectacular as you might have expected after the ban was introduced and levels have remained the same or increased slightly since then. It is estimated that over one quarter of Irish people still smoke, which is not that much different to before the ban. So even radical public health measures such as bans may just alter where the individual smokes and not help them quit. More smokers may now be smoking in their homes.

The total global number of male smokers, at about 40% according to WHO, has peaked and is slowly starting to decline, but it is increasing in women and it is estimated that it will double by 2025.

In the US, the decrease in male smokers in the last decades has resulted in a corresponding decrease in lung cancers in males.

The increase in female smokers in the 1960s showed a corresponding jump in respiratory disease and cancers seen 20 years later. This rise is expected to continue as not only are there likely to be more female smokers in the future women are more vulnerable and susceptible to lung cancer. Soon it is likely to eclipse breast cancer as the number one cancer killer in women.

In Ireland, the gap between the number of men and women who smoke is decreasing all the time with men representing only 52% of smokers.

Generally Irish cancer detection rates are improving with increased early diagnosis, but the stats can be confusing. Some reports indicate that Ireland is doing very badly in the screening of cancers and missing cases when results are compared  with the US for example.

There are two reasons that may be the reason for this poor performance in terms of cancer detection in Ireland: poor screening or not enough screening.

On the other hand, higher detection rates in the US might be down to the way of reporting and defining cancers. There may be variation between countries and between centres as to what might be called a cancer case in the US or benign. The definition of what is a pre-cancer or early malignancy is not uniform and clear in all cancers.

This may explain some of the discrepancy in detection rates.  So maybe we are not doing as badly in the terms of overall cancer detection, as the starkest figures seem to suggest.

There is good evidence that we are not doing enough screening of smokers in Ireland for the reasons cited before. These attitudes need to be tackled and investment in screening smokers for early signs made in order to save lives, as most patients now present too late in the disease when it is too late.