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Should ALL smokers over 40 be tested for cancer?

When Maria Arundel’s husband, Richard, died from lung cancer aged 65, she felt her life was over.

Yet she also credits his death as the reason she was saved from succumbing to the same disease.

With no screening programme for lung cancer in this country, it was only because she’d seen her husband’s illness that Maria reacted quickly when she too started to feel breathless and lost weight.

Lung cancer is the biggest cancer killer in the UK, causing around 35,000 deaths a year

‘I was much luckier than Richard,’ recalls Maria, 61, a former publican from South London who used to smoke.

‘My lung cancer was picked up early.

‘By the time Richard was diagnosed it had spread to his liver. His suffering was terrible.

‘He went through so much to fight it with aggressive chemotherapy. But he didn’t have a chance.’ 

What saved Maria’s life was a CT scan — which, unlike an X-ray, sends several beams simultaneously through the body to produce a much clearer, more detailed picture of the lungs.

With a chest X-ray, which Richard had, cancer can remain hidden behind the heart in one of the lung tubes or may be too small for a single X-ray to pick up.

So while Maria had to endure six months of chemotherapy and ten bouts of radiation, her cancer was picked up early and the treatment appears to have been a success.

She was one of the lucky ones. Lung cancer is the biggest cancer killer in the UK, causing around 35,000 deaths a year. 

Last week, research revealed that lung cancer has overtaken breast cancer as the deadliest form of the disease among female Britons, killing 16,000 women each year.

The statistics make for grim reading, with the five-year survival rate for a stage-four (advanced) cancer between 2 and 5 per cent. 

Worryingly, 85 per cent of patients remain undiagnosed until the disease has reached an advanced stage, when it is very difficult to treat.

In order to catch lung cancer while it is still treatable, some experts are calling for a national screening programme of pre-emptive CT scans for people at risk

Early detection offers the greatest chance of survival. NHS advice is to seek medical attention if a cough has lasted longer than three weeks.

But in order to catch the cancer while it is still treatable, some experts are calling for a national screening programme of pre-emptive CT scans for people at risk.

‘Ironically, the most common form of the disease — non small cell lung cancer, affecting 85 per cent of patients — is slow growing,’ says Dr Rohrit Lal, a medical oncologist specialising in lung cancers at  Guy’s and St Thomas’s Hospital, South London. 

‘But because a tumour has so much space within the lungs in which to grow, patients aren’t aware they have the disease until they experience symptoms such as a perpetual cough, by which time the cancer is difficult to treat.

Once the cancer spreads, it lodges most commonly in the lymph nodes, then moves to the bones, liver and brain.

By this stage, surgery and radiotherapy cannot target it, and chemotherapy is often of a limited benefit.

‘A CT scan could detect these early growths at a time when we can treat them,’ says Dr Lal. 

Indeed, a recent U.S. study following 50,000 smokers or former smokers found that in five years, there was a 20 per cent decrease in lung cancer mortality in a group offered routine CT screening.

Maria Arundel’s husband first fell ill in January 2009 — he started to experience sharp, indigestion-like pains in his chest. 

Though he was a 20-a-day smoker, Richard was 5ft 11in, slim and enjoyed a physically demanding job laying tarmac.

He went to his GP every couple of weeks, after tablets to treat indigestion didn’t work. 

By now he’d also started to feel out of breath and developed a cough.

By the summer he was losing weight, but was only referred to a specialist in October 2009. He died five months later, in March 2010, aged just 56.

‘It was the most terrible time,’ says Maria. ‘He’d gone from being this strong, fit, robust force in my life to someone who was fading and suffering before my eyes.’

In the midst of her grief, Maria started to feel under the weather: within a few months she began to lose weight, and developed night sweats.

She also had a tickly, intermittent cough.

‘I was so overcome with grief, I didn’t care about my health. I just wanted to die, to be with Richard. But my son, Scott, insisted that I went to the doctor.

‘Because of what had happened to Richard, maybe that’s what prompted my GP but I was sent for a CT scan at Guy’s Hospital and that’s when they found the cancer.’

Maria had smoked up to 20 cigarettes a day until her husband’s cancer diagnosis.

‘I suddenly realised I had to fight it. It had killed him and it wasn’t going to kill me.’ 

Dr Lal says a screening programme would involve inviting patients over the age of 40 who are, or have been, smokers to be scanned once a year for three years.

This could be done through a list compiled by GPs regardless of whether patients have symptoms.

‘There is good evidence to show that lung cancer risk rises slowly during your lifetime if you continue to smoke. When you stop that risk flattens off — but it never goes away completely.’

However, cost aside, though CT scans are effective at detecting early lung cancers there are concerns about false positive results.

‘A huge number of lung abnormalities — possibly as many as 98 per cent — that are picked up by CT scan will be harmless,’ says Stephen Spiro, professor of respiratory medicine at the Royal Brompton Hospital and a board member of the UK Lung Cancer Coalition.

‘Finding anything can cause extreme anxiety for the patient as it requires further testing — namely CT scans with heavier doses of radiation. This is a particular issue for women, as it could raise the risk of breast cancer.’ 

There could be even more invasive tests, such as needle biopsies or even surgery to remove a portion of lung.

A small number of people who do not have cancer or have early-stage cancer have died from these tests because of partial lung collapse and respiratory problems.

Similar problems beset the national breast screening programme.

One controversial Danish study found that 7,000 British women a year needlessly undergo treatment, including mastectomy. 

Doubts about unnecessary treatment have been raised following suggestions that a similar screening programme for prostate cancer should be introduced.

‘The other issue is how long do you go on screening for?’ adds Dr Keith Prowse, of the British Lung Foundation.

‘What happens after three years — do we just keep scanning people who don’t have symptoms?

‘Also, a lung cancer can develop at any time. You could scan someone today, and tomorrow they could develop a cancer.’

That’s why any lung cancer screening has to be narrowed, adds Professor Spiro, perhaps to people over 50 that have had a 20 pack or more habit a day and already have chronic obstructive pulmonary disease (COPD) — the umbrella name for a collection of lung diseases, including chronic bronchitis, emphysema and chronic obstructive airways disease, which are linked to an increased risk of lung cancer.

Another option is a blood test screening programme, which is being trialled with 10,000 smokers in Scotland.

The participants have smoked at least 20 a day for more than 20 years — half are being offered a blood test that detects cancer at its earliest stages of development up to five years before it would normally be detected; the other half will not be screened. The first results are expected in 2014.

Another option being researched is breath analysis. Scientists at the Keele University, Staffordshire, have found that compounds in breath could be used as indicators for tumours.

This treatment would be cheaper and less invasive.

However, neither of these offers the definitive diagnosis of a CT scan, which is what Maria favours.

‘A CT scan saved my life — I want others to have that option, too,’ she says.

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