Lung cancer may not be fatal, say doctors

SUBANG JAYA: Most people think that lung cancer is among the most deadly of cancers with no chance of survival, but consultant cardiothoracic (heart and lungs) surgeon Dr Anand Sachithanandan says it is not all true.

“Lung cancer may have the worst survival rate overall (11% five-year survival for all stages) but if discovered at stage one and treated, the five-year survival rate can be close to 90%,” he said, adding that stage two has a relatively high survival rate too.

Dr Sachithanandan said the National Cancer Registry for 2007-2011 (published October 2016) revealed a staggering 90% of lung cancer cases being diagnosed at stage three (locally advanced) or stage four (metastatic spread).

“We are catching it too late,” he said.

To catch it early, he said low-dose CT (LDCT) scan for lung cancer screening was recommended for those at an elevated risk of getting the disease – chronic smokers or ex-smokers aged between 45 and 75.

Studies (the 2011 North American National Lung Screening trial and the recently published 2018 European NELSON trial) had shown that LDCT screening could detect early cancers in high-risk groups and with effective early treatment, such patients have a high chance of long-term survival, he noted.

The single most identifiable and preventable lung cancer risk factor is smoking and screening should complement smoking cessation efforts.

Dr Sachithanandan also pointed out that more non-smokers were suffering from lung cancer (20%-25% of cases) and a high proportion of them was women.

“Traditionally, lung cancer affected mainly men and smokers but not anymore. Ethnic Chinese have almost double the risk compared to Malays and Indians, suggesting a genetic predisposition,” he said.

Other possible reasons were long-term exposure to second or third-hand smoke and wok cooking fumes in an enclosed space, he said.

Asked if non-smokers constantly exposed to cigarette smoke need to go for screening too, he said there were no firm clinical guidelines yet on how to screen this group but Singapore would soon introduce LDCT screening for the non-smoking female on a case-by-case basis.

Consultant physician and respiratory physician Dr Chua Keong Tiong gave an example of a 70-year-old man with stage one lung cancer who died when his chances of survival were very high.

“He only had to get the tumour removed surgically but he kept refusing. Four years later, it went to stage four and spread to the bones.

“He had gone to a fortune teller and was told that he was going to die at age 75. He said it was his fate to die at that time but as a doctor, I explained that a person’s survival rate was based on scientific data,” he said.

Dr Chua said most patients diagnosed with lung cancer came with dry or productive cough (with phlegm) or cough with blood and weight loss.

Other less common symptoms were chest pains and breathing difficulties while some patients had stroke-like, half-paralysed body and were unable to talk because the cancer had spread to the brain, he said.

Dr Sachithanandan and Dr Chua will speak on lung cancer at the StarLIVE talk organised by The Star and Ramsay Sime Darby on March 23 at Menara Star, 15, Jalan 16/11, Petaling Jaya.

Admission is free and will be on a first-come, first-served basis. Those interested can register at http://starlive.eventbrite.com

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