Early signs of lung cancer: why the NHS advice to patients isn’t good enough

    23 June 2015

    The number of people dying from lung cancer in the UK is woefully high. Compare us with Sweden, where twice as many individuals live for the five years following diagnosis, and you begin to see the problem.

    So why is Sweden doing better? It comes down to how quickly they refer patients to treatment and they type of screening they use. A North American trial of lung cancer screenings confirms this, finding a 20 per cent reduction in death rates among those screened with low-dose helical computed tomography (CT) versus those screened by chest X-ray.

    The lung cancer of over half of the individuals was picked up at the earliest stage within the CT scanning group, compared to only one third in those having regular chest X-rays.

    The approach by the NHS and the government-backed ‘Be Clear on Cancer’ campaign has been insufficient. Individuals of all ages are merely encouraged to see a GP for a chest X-ray if they have a persistent cough. But chest X-rays will miss lung cancer in around a quarter of people with the condition.

    So what can be done to make sure lung cancers are picked up early enough to be treated? I have four suggestions:

    1. Know you risks and make sure your own doctor knows them as well: As a GP the way I respond to symptoms is linked to my assessment of an individual`s level of risk.

    None of us are at zero risk for lung cancer but in some cases it will be tiny – such as the 10 year-old boy who was brought to see me recently by his parents as a direct consequence of the ‘Be Clear on Cancer’ campaign.

    Most of us know that smoking and getting older are linked to lung cancer – but passive smoking matters, too. Exposure to certain substances (e.g. asbestos, silica and diesel exhaust) or a personal history of other lung diseases (e.g. TB, chronic obstructive pulmonary disease/emphysema) also increase the chances of developing lung cancer. If you have a close relative – e.g. brother or sister – with lung cancer this doubles the risk. Naturally occurring radon gas in certain parts of the UK is estimated to account for five per cent of lung cancer deaths and individuals can use this map to assess the likely radon level in their area

    2. Be aware of the early symptoms of lung cancer aside from a cough:

    These can include:

    • a persistent cough
    • shortness of breath
    • chest/rib pain matter
    • coughing up blood
    • an unexplained loss of weight.

    Don`t wait to cough up blood twice – once is enough for a referral.

    3. If you have had a chest X-ray, ask to see the result: If you fall into the category of people at increased risk of lung cancer, you should ask for further assessment if your chest X-ray is not entirely normal. A large study undertaken nearly 50 years ago in Philadelphia demonstrated that, in individuals at increased risk due to smoking, any abnormality of their chest X-ray – however non-specific – significantly increased their risk of lung cancer.

    4. Keep an eye on your friends and family: Be aware that cancers can have other effects, not just those mentioned above. For example, some interesting recent research has demonstrated that the ability to stop smoking after many years can be a symptom of lung cancer, possibly caused by secretion of a substance interfering with nicotine addiction.

    Finally, I don`t want patients to wait to see me if they have a symptom such as coughing up blood. Having access to Skype for consultations in the NHS would rapidly increase the number of referrals.

    As a GP with a long-standing interest in earlier cancer diagnosis, I am really keen that we catch up with my colleagues in Sweden – even at the risk of upsetting my eminent colleagues running the ‘Be Clear on Cancer’ campaign.