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screening is key to beating deadliest cancer
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shortly before finding out she had cancer, christie blatchford was hiking in scotland. during the trip, she showed no symptoms, no shortness of breath, no coughing. but when she returned home, complaints about lower back pain led to a diagnosis of lung cancer. it had already spread to her spine and hip.
unfortunately, stories like these are all too typical, says dr. paul wheatley-price, president of lung cancer canada and a medical oncologist at the ottawa hospital cancer centre.
lung cancer is the most commonly diagnosed cancer in canada and, by far, the most fatal. when it’s diagnosed as stage 4, it has often already spread to other parts of the body; typically the bones, the other lung, the brain, or the liver. when somebody starts getting symptoms, they’re getting symptoms from the places it’s already spread to.
late diagnosis makes it deadly
in canada, lung cancer has become the leading cause of death from cancer for both men and women. there are several reasons for this.
“we’re facing a cancer that’s the most common cancer diagnosis in the world, and it’s usually diagnosed too late,” says wheatley-price, who specializes in thoracic malignancies.
lung cancer is the first of the ‘big four’ cancers in terms of incidence rates, with new cases per year reaching 29,000. breast cancer comes second at 27,000, then colon cancer at 26,000 and prostate cancer at 23,000. lung cancer killed 21,000 people — more than the other three combined, says wheatley-price.
part of the reason for the high death rate is the fact that only about a quarter of people are diagnosed with lung cancer when it is in stage 1 or 2, he says, when the odds of survival are actually in their favour. about half are diagnosed when the cancer has already advanced to stage 4, which is the most advanced stage and often considered incurable. stage 3 is potentially curable, but it’s still difficult.
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“there are a lot of new treatments, particularly immunotherapy, that try to get the body to fight its own cancer, and we’ve seen people even with stage 4 live for many years using those approaches,” he says. “but the real trick is trying to diagnose it at stage 1 or 2, not stage 3 or stage 4.”
it can be stopped with screening
there is, however, a way to diagnose cancer earlier.
just like how mammogram screening detects breast cancer at an earlier stage, it is possible to detect lung cancer at an early state in screening in the form of a ct scan. there are numerous studies that show it is effective and can save lives. so why aren’t we doing it?
“canada has some of the leading screening experts in the world, but we don’t have broad access to these programs,” says wheatley-price. “if we had screening programs for those who were eligible, instead of 75% of people being diagnosed at stage 3 or stage 4, we could have 75% of people diagnosed at stage 1 or 2.”
lung cancer carries a stigma that affects its funding
and then there is the stigma that everyone who develops lung cancer is a smoker and is somehow to blame for their disease.
wheatley-price refers to a report where one in five canadians interviewed said they would have less sympathy for people diagnosed with lung cancer than those with any another cancer. he says that this stigma has led to less access to treatment and less appetite to implement screening programs. despite the fact that lung cancer causes more than a quarter of all cancer deaths, it only gets seven per cent of cancer funding.
“smoking can be a factor in so many different diseases, such as heart diseases and other cancers,” says anne marie cerato, a lung cancer patient. “but we associate it with lung cancer and that’s where the stigma comes from — and that’s unfair for patients.”
when cerato was diagnosed with lung cancer at age 30, it was a shock. she was in good health, she exercised, ate a healthy diet, hadn’t been coughing, and she didn’t smoke. her cancer was caught only because she asked her general practitioner about a bump on her collarbone and complained about feeling ‘a little run down.’ it was the chest x-rays that revealed she had stage 3a lung cancer. she had almost slipped through the cracks.
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“when people find out i have lung cancer, 99 per cent of the time, they ask if i smoke,” says cerato. “i used to say ‘no,’ but now i say, ‘it doesn’t matter if i smoke or not.’ i didn’t [smoke] but i have friends who didn’t smoke and have cancer, and i have friends who did smoke and they have cancer. as long as you have lungs, you can get lung cancer.”
wheatley-price says about 15 – 20 per cent of his lung cancer patients, are people who have never smoked. secondhand smoke, exposure to radon (a naturally occurring, radioactive gas often found in basements), mining, pollution, and occupational exposure are some of the suggested causes of lung cancer.
“i would encourage anyone who’s had a persistent cough that lasts more than three weeks to seek medical attention, ” says wheatley-price, adding that there are centres that offer screening programs. “even if it’s somebody who has been a cigarette smoker for a long time, we don’t want them to think, ‘it’s just a smoker’s cough.’ it should be checked.”
he also extended condolences to blatchford’s family and friends, saying that her death illustrates the importance of catching lung cancer early.
“her story highlights the fact that too many patients with lung cancer are diagnosed late,” wheatley-price says. “implementing lung cancer screening would be a major step to addressing this problem.”
cerato also urges others to talk to their doctor if they feel something is not right.
“if you’re feeling ill, if a cough doesn’t go away, if you’re coughing up blood, or if you’re feeling run down and you’re usually not run down, check it out,” she says. “it could be nothing, but it could be something. advocate for yourself. if i hadn’t [brought how i was feeling] to my physician’s attention, i probably wouldn’t be here today.”
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