Looking for lung cancer

Lung cancer has very few symptoms at early stage and many people dismiss it as a possibility. We know that 37 per cent of lung cancer patients are only diagnosed when they make an emergency trip to A&E which is far too late. Only around 30 per cent of people with lung cancer survive one year after diagnosis, one of the lowest survival rates in Europe.  It would be so much better if those people were diagnosed in primary care and I think that survival rates would improve dramatically.

It is very important to take a full family history and ask the right questions. One of my patients – an elderly lady of Asian descent – was diagnosed with late stage lung cancer when she finally came to see me about her persistent cough. She had never smoked so it never occurred to her that her annoying symptoms might be a red flag for lung cancer. But when I told her that the tests had come back positive, she told me that her husband had smoked their entire married life. She was a victim of passive smoking, which is firmly linked to the disease.

There is not much I can do if patients rarely come to surgery, but I am able to take a proactive approach with those who do come fairly regularly – as long as I get to see them. For example, I had another male patient who had chronic bronchitis and used an inhaler. He was a smoker and had developed this complaint. Because I had known him a long time, I was aware that his symptoms were getting worse and his breathlessness was no longer adequately controlled by his medication. I was able to organise for him to have a chest X-ray which confirmed that he did indeed now have lung cancer, but it was still in the fairly early stages. This shows how important it can be for patients to see their own named doctors who can pick up changes and abnormal patterns. Unfortunately, it isn’t really practical in busy GP surgeries. If you think that I work in a practice with 10,000 patients, there are going to be times when I am not going to have ‘my’ patients on my lists. Another GP may not have noticed that the patient had got worse because even the patient himself hadn’t picked up that his symptoms had deteriorated over a long period of time. I realised because I had been dealing with his health problems for some years.

To everyone who has a persistent cough and unexplained breathlessness, I would say that it is a very good idea to see your doctor and explain your concerns. Yes, it could be gastric reflux or hayfever, but it is worth getting an accurate diagnosis. Don’t ignore it. A GP can put unwarranted fears at rest but also provide a safety net and pick up serious problems like lung cancer when they can be treated effectively.  Don’t wait for dramatic symptoms such as coughing up blood, which often means that the disease is reaching its terminal stages. We know that 37 per cent of lung cancer patients are only diagnosed when they make an emergency trip to A&E which is far too late. It would be so much better if those people were diagnosed in primary care.

To physicians, I would say, don’t dismiss your patients’ concerns about a persistent cough and breathlessness. It might be something trivial but it could be a sign of something serious. Ask them to come back for another appointment if the symptoms don’t settle. It might be appropriate to refer them immediately for further investigation.

Greater awareness about the signs of lung cancer by patients and GPs would make a huge difference to outcomes.