Heavy smokers are often reluctant to be screened for lung cancer, according to doctors who are pioneering new clinics dedicated to spotting the disease at its early stages in the hope of lifting the stigma.
“Some people feel guilty about their smoking. We’re trying to wash away a lot of the stigma associated with lung cancer and smoking,” said Dr Richard Lee, consultant respiratory physician at the Royal Marsden, an NHS hospital specialising in cancer treatment.
The hospital’s private clinic in central London is now screening patients for early stage lung cancer, years before the National Health Service completes its nationwide rollout of the same programme, known as Targeted Lung Health Checks.
Patients aged between 55 to 74 whose history of smoking puts them at high risk of lung cancer will be offered a low-dose computed tomography scan.
“One of the big challenges has been how do you get people to come to the programme. It's important to raise awareness about what lung cancer is and the opportunity for positive outcomes,” Dr Lee told The National.
But the scan could help doctors to catch the cancer early, saving lives and reducing the need for chemotherapy. “It seemed like an obvious thing for us to do,” Dr Lee said.
“Research has shown that low-dose CT scans of patients that are at high risk of lung cancer reduce the number of people who die from it,” he said.
“It’s quite a limited service at the moment on the NHS, so we wanted to be able to offer another route to access the service,” he added.
Lung cancer is the most common cause of cancer deaths in the UK, because the disease is often caught in the late stages. The survival rate for the disease is currently 10 per cent, and this has not improved in 50 years, according to the charity Cancer Research UK.
The NHS announced a national rollout of its lung cancer screening programme in June, which it expects to complete by March 2030.
More than 200,000 smokers and former smokers aged between 55 and 74 were scanned in the first pilot phase of the NHS programme, which began in 2019. Of these, lung cancer was detected in 2,000 people, with 76 per cent at an earlier stage compared to 29 per cent in 2019 outside of the programme.
Prime Minister Rishi Sunak hopes the programme will “provide a lifeline to thousands of families across the country.” Yet the NHS is plagued by a shortage of diagnostics technology, including CT scanners, a report by the King’s Fund think tank found in June.
Dr Lee was involved in developing the NHS model, and this experience helped him set up the clinic at the Royal Marsden in between 12 and 18 months. “We’re quite agile in what we’re able to offer in the Marsden. We have the capacity, we have the new facility at Cavendish Square, so it seemed like quite a straightforward thing for us to add to the services we offer,” he said.
The service will be extended to people under 55 and over 75 with potential symptoms of the disease, such as a persistent cough, shortness of breath and coughing up blood.
The screening will involve a 30-minute consultation with a specialist to assess whether the patient would benefit from a CT scan. “If you’ve not smoked enough we wouldn’t recommend a CT scan,” said Dr Lee, pointing to the imaging technology’s low radiation exposure.
The risks are assessed on a case-by-case basis which looks at the patient's smoking habits, their family history and existing respiratory problems. The consultations can, “in theory”, be booked for the next day, with a CT scan usually offered on the same day or within a few days. The results of the scan will be offered within two weeks.
Early diagnosis could improve the patient’s treatment options. “It’s much more likely that those patients will get lung surgery to remove the cancer, rather than more complicated chemotherapy regimens,” said Dr Lee.
“Some patients will still need chemotherapy or radiotherapy, but the treatment will be much more straightforward when you diagnose at an early stage,” he added.
More than one in 10 people in the UK (13.3 per cent) smoke but the habit is on the decline, according to 2021 census data from the Office of National Statistics.
Yet Dr Lee believed the effects of smoking would continue to be visible in the next decades. “It would take many years for the damage that’s been done to subside. If you think of the number of people who are smoking now, their risk is going to be high for decades,” he said.
“It's important to make sure there's awareness of what lung cancer is and the opportunity for positive outcomes,” he said.
The new clinic's launch comes as researchers are increasingly linking lung cancer to air pollution.
In April, a study by the Francis Crick Institute, University College London and Cancer Research UK found that air pollution “wakes up” dormant cancer cells which could “grow and form tumours”.
Lung cancer is the seventh most common cause of cancer death among people who have never smoked.
“We don’t fully understand the risks behind that. Pollution and indoor cooking smoke are probably factors,” said Dr Lee. “That will likely become more important as the population ages or as smoking becomes less prominent.”
Yet it is still too early to assess the risks air pollution and devise treatment options, said Dr Lee. “We’re not there yet clinically. But you could hope that in the future we could quantify people at risk from other factors that they’ve been exposed to,” he said.