Professor Sam Janes of The Physicians' Clinic reports on a recent study1 from researchers in Nottingham that has shown that doctors struggle to identify patients with lung cancer. For many years health care providers have thought that the poor outcomes of lung cancer patients in Britain were in at least part because patients present too late to their doctors, when their chances of cure have gone. This study challenges this mind-set and demonstrates that doctors in Britain “are missing opportunities” to spot lung cancer early.
Lung cancer is the biggest cancer killer of both men and women in the UK, with approximately 35,000 deaths per year. Many of these patients sadly die in the first few months after diagnosis. The Nottingham researchers found that many of those that died early presented to their GP on average 5 times before being diagnosed.
Doctors struggle in diagnosing lung cancer because most of the symptoms, such as cough and shortness of breath, are also produced by other lung problems such as the smoking related lung disease COPD, asthma and infections. This means GPs will see many patients with symptoms of lung cancer each year but might see only one case of lung cancer itself over several years of practice. Therefore who should GPs investigate further?
The researchers note that at least patients with lung cancer are often aware something is wrong and are presenting to surgeries. Now we have to get better at diagnosing lung cancer when patients present. Another obstacle is that CXRs are not terribly sensitive at seeing lung cancers compared to CT scans and as yet there is still a feeling that CT scans should be somehow rationed. The NHS is currently being forced to examine its position on chest CT scanning with recent data from America clearly showing CTs scans save lives. In a large trial of over 50,000 people at risk of lung cancer (rather than having symptoms which would increase risk further) the US investigators found that CT screening between the ages of 55 and 75 led to a 20% decrease in lung cancer deaths and a 7% decrease in overall mortality.
For more information about lung cancer screening at The Physicians' Clinic, please contact Professor Sam Janes, Professor of Respiratory Medicine, via firstname.lastname@example.org.
1O'Dowd EL, McKeever TM, Baldwin DR, et al. What characteristics of primary care and patients are associated with early death in patients with lung cancer in the UK?. Thorax. Published online October 13 2014