Blogs by the online BMJ respiratory medicine champion
Lung Cancer, is it all doom and gloom? Forum X-Post
At the ERS in Amsetrdam last year I heard a nice presentation from a Resp SpR in Kent (Maidstone, I think) who had looked at the cause for delayed referral to secondary care in patients with lung cancer. They looked at the NICE guidance on who should be referred, and when, with what symptoms: in a large number of cases it was felt that GPs didn't refer early enough, given the symptoms documented.
But that doesn't tell half of the story. If every GP referred every smoker or ex smoker with breathlessness and persistent cough to secondary care, we would be swamped by referrals very quickly. I don't think we'd pick up any more cases, so our sensitivity would stay the same, we would pick them up earlier, more of which later, but our hit rate would plummet, as we see far too many 'false positives'.
Picking up disease early in lung cancer is always going to be difficult without a formal screening program. The lungs have no pain receptors, so patients can't feel their tumour. They can't see their tumour. Tumours generally don't bleed until they're large, or proximal, and generally un-curable. Patients more frequently present with symptoms caused by metastases, local invasion, or general systemic complications, by which point, it's inoperable/uncurable.
We need screening programs to make an impact into lung cancer mortality. The 5 year survival of lung cancer has not changed in the past 20 years - compare this with some childhood leukaemias where the 5 year survival has gone from single fingers to over 90% in the same timescale.
Nicola Sturgeon announced last week that Scotland is to begin a large prospective study looking at a molecular marker for lung cancer screening. I'm the local respiratory lead for this study, here in Dundee - the other centre will be Glasgow. We are planning an October start for this study, and I'll be updating my blog, and the respiratory forum with our progress as we go along.
The study will bring its own difficulties, and complications, but once we have more formal go ahead to discuss it, I'll write more here.
Interesting times, no doubt.
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