NOVEMBER is reserved each year as a time when we all try to raise awareness about lung diseases. This includes not only lung cancer, but other conditions such as chronic obstructive pulmonary disease.
Usually during October there is a lot of buzz surrounding breast cancer, but efforts to raise awareness of lung cancer pale in comparison. This is not just from private entities, but even from the Ministry of Health and the Jamaica Cancer Society.
The problem is, there are usually not many advocates for lung cancer awareness, despite it occupying a significant place in cancer epidemiology.
Lung cancer accounts for over a quarter of all cancer-related deaths and therefore establishes itself in the top spot as the leading cancer killer. It accounts for more cancer deaths than breast, colon and prostate cancers combined.
While the majority of people diagnosed with lung cancer are current or former smokers over the age of 65, there is the rare occurrence of younger individuals who have never smoked that develop lung cancer each year. These are usually women under age 50 who have developed a genetic mutation, causing uncontrolled growth of the abnormal cells.
Nevertheless, over 85 per cent of lung cancers occur in people with a history of smoking, which makes tobacco use as single greatest risk factor. There is a direct link between tobacco exposure and lung cancer, with the risk increasing the longer you smoke and the number of cigarettes you smoke each day. Compared to non-smokers, smokers are 25 times more likely to develop lung cancer, and this cannot be overemphasised.
Exposure to second-hand smoke is just as bad, and lung cancer risk is known to increase in family members who are exposed over a long period of time.
The high mortality of lung cancer is related to the advanced stage of the disease at presentation. The lungs have significant reserve and the process needs to be quite advanced before symptoms develop. This puts patients at a disadvantage, where curative surgery cannot be offered at the time of diagnosis.
In Jamaica, our last data suggest that over 92-95 per cent of patients present with advanced disease. The option for many, therefore, is systemic treatment with chemotherapy, and in some instances radiotherapy.
It is important to note that if you are a smoker, stopping at any point is beneficial. While smoking cessation might not reduce some of the irreversible changes that have already taken place, you will reduce any further risk. Quitting might be difficult but seeking professional help and the use of different forms of therapy can achieve success in many.
Don’t ignore the chronic cough! This might be a sign that something is not right and not just the cold or “smokers cough”. This is significant, especially if it is associated with shortness of breath. Coughing up blood is never, ever normal and is an indication to get checked out right away.
Repeated lung infections can also occur and is due to blockage of a part of the airway in the lung. Other symptoms might include changes in the voice and difficulty swallowing.
Weight loss, weakness, unexplained broken bones, headaches, and swelling of the face are some indications of advanced disease.
The majority of patients, however, as pointed out before, will have no symptoms until late. This is where screening and early detection become important.
Screening for lung cancer is becoming more established in some societies and has been shown to reduce lung cancer mortality by up to 20 per cent.
Screening for lung cancer involves the use of what is called a low-dose CT scan. This is a special type of X-ray that can provide detailed images of the lung.
Yearly screening is recommended if you meet the following:
• You are 55-80 years old;
• Current smoker or you have stopped in the last 15 years;
• Have no symptoms or signs of lung cancer at the moment;
• Have at least a 30-pack year history of smoking.
This is where it gets a bit technical. To calculate pack years it is the number of packs per day x number of years smoking (a pack contains 20 cigarettes).
Therefore, one pack per day for a year is one-pack year. Ten cigarettes per day (half pack) for 30 years is 15 pack years.
If you are having symptoms or your screening test is suggestive of a cancer, you will undergo a series of further tests to diagnose and stage the cancer.
Early diagnosis and treatment with surgery is the best chance of achieving a cure. Surgery in most cases involves removing a part of the lung. In some instances, it might be necessary to remove an entire lung to enable complete removal of the cancer.
At later stages, you will be referred to the oncologist for further treatment options. In some cases of very advanced disease, where the person is too weak for any form of treatment, you will be asked to see a palliative care specialist who will offer options to control your symptoms and for overall well-being.
Again, the importance of smoking cessation must be highlighted, and individuals must take some responsibility to get checked out either for screening — if they meet the above criteria — or for investigations of any concerning symptoms or signs.
It is important that measures are put in place to reduce tobacco use as this, in turn, will reduce lung cancer incidence. The benefits to gain are many as cigarette smoking is not only associated with lung cancer, but a whole host of other cancers and cardiovascular disorders.
The Ministry of Health has promised more comprehensive tobacco legislation in 2019, as announced by the minister a few days ago. Let’s see where this leads us.
Dr Sunil Stephenson is a consultant cardiothoracic surgeon at the University Hospital of the West Indies. He is also a lecturer in the Faculty of Medical Sciences at The University of the West Indies, Mona. Please send questions and comments to firstname.lastname@example.org. He may be contacted through the office numbers 977-6883 or 927-1270.