NOVEMBER is Lung Cancer Awareness Month and once again, we seek to improve public knowledge of this very common condition.

Lung cancer is the number one cause of cancer-related deaths worldwide and accounts for more deaths when compared to cancer of the breast, colon and prostate. This dismal outlook is directly related to the fact that cancer of the lung more often than not presents very late. Like most other cancers, survival is directly correlated to the stage at which the diagnosis is made and treatment is begun.

CAUSE

The number one cause of lung cancer is cigarette smoking and the risk increases with the quantity of cigarettes smoked and the duration of smoking. People who therefore start at an early age and continue to smoke for a long time are at highest risk. Cigarette and other tobacco products directly cause approximately 85 per cent of all lung cancers.

In Jamaica, there is still a worrying amount of young people who, unfortunately, yield to pressure and pick up the habit of smoking. This trend continues even despite the recent smoking ban. Even more concerning is the increase in the number of young women becoming smoking addicts. Not only is direct smoking a problem, but second-hand smoke can be just as bad with people who live with smokers having an increased risk. Other minor causes of lung cancer include asbestos, soot and heavy metals such as nickel and chromium.

SYMPTOMS

The lungs have tremendous reserve and people with lung cancer may remain without symptoms for quite a long time. When the disease starts to manifest, it may already be in an advanced stage. Symptoms include a cough, which may be associated with the expectoration of blood, shortness of breath, chest pain, frequent lung infections, and unintentional weight loss. These symptoms and signs are not specific for lung cancer and may cause some confusion with other diagnoses and cause a delay in diagnosis.

A degree of vigilance is expected on the part of physicians to suspect the diagnosis, especially in people who are at risk, such as chronic smokers. People suspected of having lung cancer are best investigated with a computer tomography (CT) scan of the chest with further diagnostic tests done based on what is shown on the images. These may include further imaging studies and biopsies.

TREATMENT

Treatment for lung cancer is based on the stage at diagnosis. If detected early, surgery offers the best chance of a cure and confers the best prognosis. Later stages are treated with chemotherapy, which may or may not be combined with radiotherapy. In very advanced cases, patients may only be offered what is called palliative care. This involves general treatment to make the patient as comfortable as possible and may include pain management and control of other symptoms.

SCREENING FOR LUNG CANCER

Due to the poor outlook of late stage lung cancer, a lot of work has been done in investigating the best modality to screen for lung cancer. In general, screening allows the detection of cancers at an earlier stage, which will allow curative treatment to be offered. Well-established screening protocols already exist for other common cancers such as breast, prostate, cervix, and colon. These have been publicised and people are now more aware of what to do.

We are finally catching on with lung cancer and within the last couple of years, screening for lung cancer has become more popular. This has been shown to benefit people who are considered to be in a higher risk category such as those who have been smoking for a long time and are over age 50.

A CT scan of the chest is used and the scanner is adjusted to deliver a lower dose of radiation, which is less than a conventional CT scan. This low dose CT screening modality has been shown to reduce lung cancer mortality by 20 per cent when compared to using a standard chest X-ray as the screening tool. This is great news, as now finally earlier cancers can be detected and curative surgery offered.

Unfortunately, in Jamaica today, most people, including some physicians, are not aware of this recent information and we still continue to get patients at an advanced stage. Over 95 per cent of patients referred to cardiothoracic surgeons are too advanced to be offered curative surgery. Hopefully, with greater public awareness, more at-risk patients will be investigated earlier. Increased vigilance is also required on the part of primary care physicians.

With the recent smoking ban plus increased awareness of lung cancer screening, hopefully the next few years will see a decrease in the number of people smoking and we will also be detecting lung cancer at an earlier stage. This will both reduce lung cancer incidence and mortality as we go forward. While we can’t eliminate this disease, we certainly can control the greatest risk factor with more push to halt the smoking habit among our population.

Dr Sunil G Stephenson is a consultant cardiothoracic surgeon at the University Hospital of the West Indies and a lecturer at the Faculty of Medical Sciences at the University of the West Indies, Mona campus.