Why is lung cancer not like breast cancer?
By Mary ER O’Brien MD FRCP, Kofi Nimako MBChB MRCP, Sanjay Popat PhD MRCP
Recent statistics and a trend over the past 5-10 years show that the mortality from breast cancer is decreasing in the UK. This is good news and the result of a combined effort of government, health professionals and women themselves. What about lung cancer?
Lung cancer is the largest cause of death from cancer by far- both in the UK and globally. It accounts for more deaths than the other top 3 common cancers (breast, colon, prostate) combined, with less than 5% of all patients diagnosed surviving 5 years. Sadly, these survival figures have improved little over the past 30 years.
Why are we not making progress in lung cancer? To start at the beginning – smoking. ‘It is never too late to stop’ and ‘don’t quit quitting’ have hit a plateau. Recent initiatives like the ban on smoking in public places and decreasing the sale of cigarettes to young adults will also hopefully help a bit. There is much work to be done in the workplace where the smokers in our work force should be actively distracted during their ‘breaks’ to do something other than smoke – this applies to all workers including those smoking at the entrance to our city buildings.
Young people should never start; how do we get this message across? Why does it happen? Is it the ‘weed’ appeal? How do we deglamorise this ugly habit? Or could a day come when we could genotype young people to pick up those with the addictive gene who will not be able to kick the habit? Prevention is better than cure-curing lung cancer is very difficult. Addictive behaviour and the biology, genetic and treatment thereof needs to rise much higher on the health agenda.
In our work we see lung cancer every day. We are seeing more young women some of whom have never smoked. However, most of our patients are aging men with a long tobacco history. Surprisingly, both seem to suffer in the same way and until recently both extreme groups had a similar prognosis. Lung cancer patients feel guilty about smoking and are often very undemanding. However, things are changing and targeted treatments have suddenly started to appear on the NICE agenda and are making differences to patients and clinicians that we have never seen before.
These treatments are expensive but keeping patients working and supporting their families will always be cost effective. This is where lung cancer and breast cancer differ. In 2006, the National Cancer Research Institute published a multi-organisational review of the state of lung cancer research in the UK. They demonstrated that only 1.4% of the entire cancer research spending in 2005 was for lung cancer, even though it is the largest cause of cancer deaths. They identified a culture of “nihilism”. The UK lung cancer research publication output was only 60% of the world average, and scientists and clinicians researching into lung cancer spend less than half-their time on this cancer type. Post-code analysis of scientific publications demonstrated that even the most productive institutions in biomedical research as a whole have little presence in lung cancer research.
Finally, since the survival from lung cancer is so poor, the patient advocacy body is poorly developed. Whilst certain types of lung cancer and breast cancer can look identical under the microscope-lung cancer has few living advocates-there are no large patient bodies lobbying Downing Street.
Despite these issues, UK-based research often in collaboration with global collaborators and the pharmaceutical industry is alive and full of hope for a better future for our patients.
We must never tire of trying to get the message across that smoking is expensive, kills, causes heart disease, impotence, stained teeth, smelly breath, a cough, worsening asthma, emphysema and lung cancer.
Acknowledgements: The authors would like to acknowledge NHS funding to the Royal Marsden/Institute of Cancer Research NIHR Biomedical Research Centre. Dr Popat is in receipt of a Clinical Senior Lectureship award from the Higher Education Funding Council for England. Dr Nimako is partly supported by the Royal Marsden Hospital Alan J Lerner Lung and Mesothelioma Research Fund and an NCRI SuPaC Lung Cancer Research Grant