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A Ten years ago, I decided to dedicate my career to solving what many considered to be one of the greatest challenges in medicine: lung cancer, a "sick smoker's disease" shrouded in unfair, widespread stigma among the most disadvantaged. Patients often arrived at the clinic with the disease well advanced, with few options beyond hard radiotherapy and chemotherapy to buy a few more months. Curative surgery is only effective for a small, fortunate proportion of patients diagnosed early.
Ten years later, much of this remains true. The disease still kills 35,000 people prematurely each year, many of whom belong to the most disadvantaged sectors of society. Late diagnosis remains a major problem, with two-thirds being diagnosed at an advanced and incurable stage. In terms of survival, our situation is even worse than that of many comparable countries.
And yet, in terms of mentality, things have changed almost beyond recognition. The new sophisticated drugs offer more options, which can be profoundly effective for some. Donors are putting lung cancer research first, as never before, to better understand how and why this disease develops, evolves and spreads. As the smoking rate declines, the stigma of lung cancer rises slowly – perhaps too slowly, but all the same – rises.
Today's announcement by the NHS England of a multi-million pound lung health monitoring program, deployed in 10 of the poorest regions of the country, is another reason for optimism. People at risk – smokers and ex-smokers – will be invited to a "pulmonary PTM": questionnaire, advice to quit smoking and, if necessary, chest CT scan which can often be done on site specialized trucks. This initiative will undoubtedly detect enough lung cancers early enough to save lives.
The program will also provide important information on how to establish a comprehensive national lung cancer screening program, if the data and cost-effectiveness badysis were to show it. The first results of a major European lung test last year suggested substantial benefits. Do they overcome the disadvantages? We urgently need to see the full results – not least because not everyone will have access to this program; ensuring equal access for all, avoiding postal lotteries, will be essential.
But much more needs to be done beyond early detection.
Lung cancer can progress quickly and treatment times can be fatal. While the NHS is also taking action here, the persistence of reports of labor shortages and missed wait times remains a serious concern. The new lung cancer screening program must be accompanied by parallel plans to manage and maintain it properly.
We also need to find ways to detect the disease at an early stage among non-smokers – a group of thousands who often feel marginalized by the tragic stigma of the disease.
And there is another complexity: even with early diagnosis and prompt treatment, careful examination of NHS data reveals another uncomfortable fact. Too many people with early curable lung cancer seem to lack curative treatment – especially surgery. And this is especially true among older people in some areas.
For example, in the best hospitals, 80% of patients with early-stage lung cancer undergo surgery. In others, only 20% do it. This unjustified variation in treatment is one of the root causes of the country's poor lung cancer statistics, as well as late and slow diagnosis, and deserves innovative solutions. For example, when different clinical teams have time to meet and share data, experiences and solutions, it brings everyone to the same high standard. This must become the norm, not the exception – but it's harder than ever to leave time for reflection in a busy NHS.
And we must not forget the elephant in the room. About 15% of the UK population still smokes and about 8 out of 10 lung cancers are tobacco related. Most smokers want to quit smoking, but cuts in local authority budgets have limited the help available. This is tragically myopic: for every £ 1 invested in smoking cessation services, £ 2.37 is saved by preventing smoking-related illnesses.
And yet, despite these challenges, I do not regret a minute of my decision to specialize in lung cancer. There is hope on the horizon. As the announcement today shows, the disease is finally coming out of the shadows. We owe it to our patients to keep it in the spotlight.
• Professor Charles Swanton is the principal clinician at Cancer Research UK.
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