November is Lung Cancer Awareness month and an opportunity to highlight the role of physiotherapists in identifying the disease in never-smokers
Smoking is a common risk factor for lung cancer, but 15 per cent of lung cancers are diagnosed in never-smokers, and the rate is increasing1. In the UK, 6,000 people die of non-smoking lung cancer each year – more than the numbers who die of lymphoma, leukaemia and cervical cancer2.
Most never-smokers do not think they are at risk of lung cancer and symptoms can be obscure. As a result, 90 per cent of patients are diagnosed with non-smoking lung cancer at stage 3-4, too late for curative treatment4.
This is especially true for young, fit and active patients, in whom a large proportion of non-smoking lung cancer diagnoses occur. Indeed, more than half of cases occur in people younger than 50, with a large proportion occurring among women3.
Symptoms include shoulder, spine or chest pain that may present without respiratory or ‘alarm’ features (cough, breathlessness, fatigue and unintentional weight loss). Physiotherapists, including first-contact physiotherapists, could play a pivotal role in identifying patients with lung cancer as symptoms may initially present as musculoskeletal in nature.
Red flags include pain that is unfamiliar or unexplained and that does not ease with a change in position. In some cases, symptoms may wax and wane.
The See Through the Symptoms campaign, led by charities ALK Positive UK, EGFR Positive UK, and the Ruth Strauss Foundation, highlights these symptoms and encourages healthcare professionals to act on them, regardless of a person’s smoking status.
Lung cancer should be considered as a differential diagnosis in patients whose symptoms persist for 12 weeks or more. In such cases, patients should be referred back to their GP for a chest x-ray, which can rule out lung cancer, consistent with national guidelines5.
In doing so, and in broadening awareness of non-smoking lung cancer, we can strive for earlier diagnoses and, ultimately, save lives.
1 Advocating for focus on NON-SMOKING LUNG CANCERS.
2Bhopal, A., Peake, M.D., Gilligan, D. and Cosford, P., 2019. Lung cancer in never-smokers: a hidden disease. Journal of the Royal Society of Medicine, 112(7), pp.269-271.
3 Changing perceptions of lung cancer - ALK Positive UK.
4EGFR Positive UK; ALK Positive UK patient survey 2020.
5 NICE Suspected cancer: recognition and referral.
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