Irish Cancer Society calls for national screening programme

The Irish Cancer Society has called for the first time for a national screening programme for lung cancer.

An estimated 282,000 people across Ireland are at risk of getting lung cancer, primarily smokers and ex-smokers over the age of 50.

Lung cancer is the deadliest cancer in Ireland with an average of 1,800 deaths a year. It accounts for a quarter of all cancer deaths among men and a fifth among women.

Rates of lung cancer are 60 per cent higher in poorer communities than in better-off ones, mostly because of the prevalence of smoking in poorer communities.

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It has the lowest survivor rate of cancer in Ireland with the exception of pancreatic cancer which is much less common. Just 16 per cent of men and 21 per cent are still alive five years after diagnosis with lung cancer.

The disease is regarded as a silent killer because victims usually present when the disease is well advanced.

International research has indicated that targeted screening programmes substantially reduce mortality from lung cancer.

In one Dutch study, mortality rates from lung cancer dropped by 40 per cent though other studies in the US and the UK have found that drops of 20 per cent are more normal.

The society’s lung cancer action plan does not cost such a screening programme, but points out that the National Institute for Clinical Excellence (Nice) in the UK has said it is cost-effective in picking up lung cancers before they manifest themselves at a stage too late for effective treatment.

‘Enormous potential’

Irish Cancer Society chief executive Averil Power said a screening programme had "enormous potential" to bring down rates of lung cancer and would amount to a cost saving for the health service in the long term.

She cautioned against describing a screening programme as a “silver bullet” and said lung cancer incidences would drop dramatically only if people stopped smoking. Smoking accounts for 80-90 per cent of all lung cancer cases.

Tom Field, the professor of molecular oncology at the University of Liverpool, said low-dose CT scanning for lung cancer was also useful in picking up early instances of chronic obstructive pulmonary disease (COPD) and coronary heart disease – the "big three" as he described them.

“If you put together lung cancer, COPD and coronary heart disease, it kills more people than any group of people,” he said.

“At this moment in time, all the evidence suggests that screening is cost-effective.”

He pointed out that early diagnosis of lung cancer had an “extremely good outcome” with survival rates of five years up around the 80 per cent mark.

Prof Field recommended that a screening programme be combined with a smoking cessation programme for maximum efficiency.

“Even if people give up smoking, there is still a risk. When we introduce people into a screening programme and offer them a smoking cessation programme, we have found that smoking cessation rates were much better than in the general population.

“They seem to be listening to the message and a much higher proportion are giving up smoking.”

Case study: Tom Monks from Dublin

“In 2012 I was feeling a little short of breath. It was something that was building up over a year. I tried to walk the Wicklow Way which shouldn’t be that difficult, but I was struggling with it. I knew there was something wrong with me.

“I went to see my GP who sent me for a chest X-ray and a cardiogram at St Vincent’s Hospital. The following day she told me they had discovered cancer in a lymph node.

“I was sent to the rapid access clinic. I had a few weeks of diagnostics for various things. They told me I had lung cancer and they referred me to an oncologist. She told me my diagnosis was ‘shocking and incurable”. It was at stage 4.

“There was no option but to put me on various types of chemotherapy. It’s a very tough treatment. Eventually, though, the cancer started to get smaller and smaller.

“They did a biopsy on my neck and concluded that I needed more chemotherapy. I went in for six cycles of chemotherapy. After four they scanned me again and told me I was in remission in 2016.

“I was a smoker, but I gave them up quite a few years before I was diagnosed with lung cancer. Everybody who is a smoker or a non-smoker should be scanned. If I had been scanned, my cancer would have been picked up a lot earlier. If I had my way, I would ban all tobacco companies from Ireland.”