"Do not go home. Order a taxi, go to A & E and take a chest x-ray. I do not think that's related to asthma. Something is wrong here. "The words of her family doctor scared Jenny Abbott.
It had not started like that. A few weeks earlier, before Christmas 2017, she got a bad cold and a cough. An out-of-hours doctor believed that her many years of viral-induced asthma had come to the fore and prescribed her steroids. A week later, her own family doctor also took the same view. It was a comforting diagnosis. But it was wrong Abbott was surprised when she ran around in the park near her northern London home, as usual, breathless. "I just thought I was tired. But the next day I noticed that I was breathless when climbing stairs. And the day after that I had to read aloud at work, and even that made me breathless, "she recalls. These symptoms prompted her doctor's request to go to A & E.
The radiograph showed fluid on her right lung. After a CT scan, the staff told Abbott that there were three options: cancer, an infection, or a blood clot. "When they called me to a side office and introduced me to a lung nurse, I knew it would not be good," says Abbott, a former BBC producer who became a psychoanalyst. She was 54 years old at the time.
The doctor told her that she had lung cancer and that it was not curable. "I was just totally shocked. That was my first thought: that can not happen. I locked myself in the bathroom and cried and cried. Her diagnosis made her stagger. "I never smoked because the cigarettes got bad. I was fit I was a runner. "
Lung cancer is indelibly associated with cigarettes in the public, and with good reason: around 86% of those who receive it are smokers or ex-smokers. But Abbott is one of the growing numbers of women who have never smoked and yet are diagnosed with illness, even though she is still "young" – that is, under 55 years of age. Doctors who specialize in the disease now see so many people who have never smoked, has an acronym coined: LCINs – lung cancer in never-smokers. They are the other 14%. Their numbers are on the rise, though experts can not explain exactly why.
The numbers are amazing. In an article published in the Journal of the Royal Society of Medicine, Prof. Mick Peake, the clinical director of the University of London's Cancer Center (UCLH), estimates that nearly 6,000 people have never smoked Lung cancer die year. That's more than the number of people who die of cervical cancer (900), lymphoma (5,200), leukemia (4,500), and ovarian cancer (4,200): "When considered as a separate entity, LCIN is the eighth most common cause of cancer-death in the UK and the seventh most common cancer in the world, "he writes.
While about 10% of men diagnosed with lung cancer in the UK are non-smokers, the proportion of women is higher: 15-20%. The decline in cigarette consumption over the last 15 years means that the proportion of people suffering from the disease suffers from LCINs. In addition, the absolute numbers and rates of LCINs are increasing. Abbott abhors the stigma that non smokers face when receiving "the smoker's illness"; Every time she tells someone about her diagnosis, she feels obliged to add, "I have never smoked."
"Like all people in my situation, you think: why? I ask that question every day. It's the first thing I think about in the morning, the last thing I think about at night, and what I think about when I wake up at night. It's the melody that always plays in my head. "
The media's focus on breast, cervix and prostate cancer obscures the fact that lung cancer is Britain's largest cancer killer, claiming about 35,600 deaths each year; more than breast, prostate, liver and bladder cancer combined. Since the late 1970s, the rate of lung cancer diagnosis has dropped by 14%. While it has decreased by 44% in men during this time, it has increased by 69% in women, since women stopped smoking only years later. "When I started treating lung cancer in the early 1980s, I saw four men for each woman. It was almost a male disease then. Now it's almost one on one, "says Peake. Of the 46,388 diagnoses in 2015, about 53% were men and 47% were women. About one in eight had never smoked.
Ruth Strauss, wife of former English cricket captain Andrew Strauss, and a non-smoker, died shortly after Christmas last year at the age of 46 from the disease, barely a year after her diagnosis. Her husband recently said, "It is believed that if you get lung cancer, you are a smoker. Ruth never smoked a cigarette in her life. "
The illness also claimed the lives of Siân Busby, the writer and wife of Robert Peston, the political editor of ITV News. She was 51 when she died in September 2012. Peston said that his wife "was probably the only person I know who has never smoked a cigarette" and referred to lung cancer as "a monster that devastates our family."
There is no consensus among experts on why lung cancer affects more and more non-smokers. Peake lists four main causes: passive smoking; occupational factors such as asbestos exposure; Exposure to radon gas; and a history of severe breathing difficulties. If you grow up in a home where one or both parents have smoked, the risk increases, as does a close relative with the disease. While it is known that asbestos causes certain cancers, including mesothelioma, different patterns of work between men and women mean that only a few cases of lung cancer in women are likely to occur. A study has estimated that Radon causes 1,500 people to develop the disease each year. There are also clear statistical links between tuberculosis and pneumonia and the risk of lung cancer.
But there are also strong assumptions that air pollution could be a factor. Outdoor pollution is being scrutinized, though, according to Peake, open fire and even Sunday roast cooking can increase the risk (stressing that neither has been proven). However, it is noteworthy that more than half of the lung cancers in women in China occur in non-smokers. "This is probably due to indoor air pollution that is boiled when cooking oils at high temperature in a non-ventilated area at high temperatures," he says. Some LCIN women believe that chemicals in perfume, make-up, aerosols, or detergents could be to blame, but Peake is adamant that there is no evidence that could incriminate them.
Many LCINs, including Abbott, have a form of the disease called adenocarcinoma, which is less related to smoking than the other types. Although experts are amazed why, the proportion of all lung cancers is increasing and is more common in women than in men. The result: women's LCINs account for a higher proportion of cases seen by lung cancer specialists.
Dr. Neal Navani, a respiratory specialist at UCLH, says he used to tell frequent healthy, non-smoking women under the age of 55 that they have been diagnosed with one of the most deadly cancers at stage 4 – if it is incurable. "It's hard to describe what feelings they feel. Everything just runs off her face, "he says. "I told two women under the age of 55 today that they have advanced lung cancer. One was under 50 and had never smoked. She had a hoarse voice, but none of the other symptoms, such as a cough, chest pain or shortness of breath. When I went through the scan with her, she reacted completely incomprehensible and said, "Why me?"
According to Navani, general practitioners even among smokers usually see fewer than two cases of lung cancer each year – so it's not surprising that they are often mistaken for something else first. Debbie Platts prepared for IVF in April last year, when she learned she was suffering from stage 4 lung cancer at the age of 43. They all confused her with painful back problems and asked her to take painkillers. Like Abbott, she was only diagnosed with lung cancer in A & E. "Sick, scared and devastated," she said to her three daughters, who were then 23, 21 and 16 years old. "I was so scared and still worried that they might or might lose their mother," she says. "I raised the girls on their own, who will protect them now?"
The disease is often asymptomatic until it has spread. This explains why for those who do not light up, they are almost always diagnosed at a time when the patient can not be cured. Peake says, "If you're a 35-year-old woman who has never smoked with a cough, most primary care physicians would rank lung cancer at 155 of its possible causes."
Dr. Claire Pearson, a doctor, knows all this. The pain she had in her buttocks last August was initially considered tendinitis. In fact, the 55-year-old – who had never smoked – had lung cancer in the fourth stage, which had already spread to her pelvis and liver. "At that moment, my world collapsed. On the Tuesday after the first scan, I had a normal evening surgery, and on Friday afternoon, I was told that I was suffering from a very uncomfortable cancer with very poor survival statistics, "says Pearson Kinder. "In nearly 30 years as a general practitioner, I cared for lung cancer patients, but never saw anyone who was neither a smoker nor an ex-smoker."
Navani says there is "nihilism" against lung cancer in people with the disease and health professionals. This reflects the belief that due to the few treatments that significantly extend life, a diagnosis is essentially a death sentence. However, the prospects are starting to improve. Survival rates of one and five years have improved over the past decade as more patients have undergone surgery, although the UK remains poor in this regard.
The key is that new medicines are used, and they are more effective in non-smokers. Particularly optimistic is a class of drugs called tyrosine kinase inhibitors (TKIs) that prevent the spread of cancer cells. Pearson's TKI has extended its forecast from six months to at least 18 months. Platts tumors were reduced in size after only 10 weeks of the cancer drug gefitnib. Now that she has become resistant, she now has chemotherapy.
Abbott had success last year with a drug called Afatinib, and has been in second place with osimertinib since October. She is "lucky" that can be used by the mutations in their cancer different drugs. She emphasizes, "Although these drugs can dramatically extend a person's life, they will not last forever as the cancer develops resistance."
Being fully aware of her own mortality, she has two main wishes. First, to stay alive as long as possible, to observe and guide their children as they grow. And secondly? "All lung cancer patients hope that the researchers will launch a drug that turns the disease into a chronic disease. This will allow you to live long, just as AIDS has become a disease that people with drugs can have a normal life expectancy with. "Now it's medical science.