Lung cancer

The biggest cancer killer in the UK. Diagnosed late far too often, and targeted screening is changing that.

What it is

Around 48,000 people are diagnosed with lung cancer in the UK each year, and it causes more cancer deaths than any other.

Survival is poor mainly because it is found late. Caught at stage 1, around 6 in 10 people survive five years. Caught at stage 4, fewer than 1 in 20 does.

Smoking causes the large majority of cases, but around 6,000 people a year who have never smoked are diagnosed, and that stigma is a real barrier: people delay presenting because they expect to be blamed.

The NHS Targeted Lung Health Check programme invites people aged 55 to 74 with a smoking history for a CT scan, and it is finding cancers at stage 1 and 2 at far higher rates than symptomatic presentation does. It is being rolled out across England.

Signs you might notice

A cough lasting more than three weeks, or a change in a long-standing cough.

Coughing blood, in any amount.

Breathlessness, chest or shoulder pain, and recurrent chest infections.

Unexplained weight loss, fatigue, and loss of appetite.

A hoarse voice lasting more than three weeks.

Finger clubbing, where the fingertips become broader and the nails curve.

Any of these in a never-smoker deserves exactly the same investigation.

How it can affect day-to-day life

Stigma is the barrier that distinguishes this cancer from others. People blame themselves, expect to be blamed, and delay. Nobody deserves cancer, and treating people as if they brought it on themselves costs lives.

Attend the lung health check if invited. It is not a test to see whether you should have stopped smoking; it is a scan that finds curable cancers.

Treatment has changed substantially: targeted therapies and immunotherapy have improved outcomes considerably for some tumour types, so genomic testing of the tumour matters.

Breathlessness management, including breathing techniques and handheld fans, makes a real difference and is under-offered.

Supporting someone well

Take up the lung health check invitation, and encourage others to.

Present early with a cough lasting three weeks, and insist on a chest X-ray.

Do not delay because you smoke or used to. Say it plainly to anybody who does.

Ask about genomic testing of the tumour and about clinical trials.

Ask for a lung cancer nurse specialist, and for palliative care input early, which improves quality of life and sometimes survival. See palliative care.

Use a handheld fan for breathlessness; the evidence is better than people expect.

Stopping smoking still helps after diagnosis, improving treatment tolerance and outcomes.

Where to get help

See a GP for a cough lasting three weeks and ask for a chest X-ray.

Coughing blood needs an urgent appointment, whatever the amount.

Roy Castle Lung Cancer Foundation run a helpline on 0333 323 7200.