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MORE PEOPLE DIE from lung cancer each year in Ireland than from any other form of the disease, but monumental strides in treatment mean that many lung cancers caught early can now be cured.
However, we remain a long way behind where we want to be. The latest available data shows that as few as a third of lung cancer patients are diagnosed at early stages, which allows them access to earlier, more effective and potentially lifesaving treatment. In contrast, fewer than one in ten patients diagnosed at the latest stage will survive for more than three years.
As the impact of the pandemic is laid bare in the form of waiting lists, staff burnout and shared loss, it is clearer than ever before that there needs to be a radically new approach to healthcare in this country. Central to this must be a renewed focus on ensuring good health outcomes, including diagnosing diseases at the earliest possible stage.
We know that lung screening works in detecting more cancers at earlier stages, and multiple global large-scale studies have conclusively shown this.
This is why the Irish Cancer Society has responded to the first call for submissions from the National Screening Advisory Committee with a proposal that lung cancer screening should be offered to the people most at risk of lung cancer in Ireland, amid mounting international evidence on its efficacy.
Evidence from abroad
In our submission, we propose that current or former smokers aged 50-74 be eligible for lung screening, which will involve inviting them for a CT scan, given this group is most at risk from the disease.
The NELSON trial from the Netherlands and Belgium has shown that the adoption of lung cancer screening reduces the number of people dying from this disease, with participants also significantly more likely to have lung cancer detected at an early stage.
In the UK meanwhile, a pilot lung screening programme is currently underway. Not only will lung screening save more lives, but it will also help to address the difference in cancer survival rates between communities that suffer other health, economic and social disadvantages.
The reality is that despite improvements in survival for all cancers over the last 30 years, the people who suffer the most from systemic health inequalities continue to have worse health outcomes compared to the rest of the population.
This is certainly the case for lung cancer, which is a complex disease in terms of its diagnosis and treatment. It is well-established that higher rates of social deprivation go hand-in-hand with higher rates of lung cancer.
Patients may also delay presentation because of the stigma associated with lung cancer and smoking, as there can be an element of denial and a lack of awareness of signs and symptoms. These factors all contribute to the sad reality that as many as two in three lung cancers in Ireland are diagnosed at a late stage.
Delays in diagnosis
The Rapid Access Lung Cancer Clinics, which are a consultant-led service for patients whose GPs have referred them for urgent assessment or diagnosis, were established to help support an early diagnosis. But as just over half of patients are diagnosed through this route, it is essential that other effective ways of achieving early diagnosis of lung cancer are introduced in Ireland.
A 2018 report published by the Irish Cancer Society and National Cancer Registry found that a shocking one in four lung cancers were still being diagnosed in emergency departments, and that patients with lung cancer from the most deprived populations were 50% more likely to present as emergencies.
We must do all we can to end such health inequalities, and the introduction of lung cancer screening is vital in this effort.
More and more health systems across the globe are applying the learnings from the research that is out there and introducing lung cancer screening programmes themselves.
Given the overwhelming evidence in its favour, there is an imperative for Ireland to keep pace with other countries and examine how lung cancer screening can be introduced here, lest Irish patients get left behind.
Lung cancer screening must be included in the future of healthcare in Ireland as an essential component of a collaborative national effort ensuring that more lives will be saved from cancer.
Rachel Morrogh is the Director of Advocacy at the Irish Cancer Society.
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As a respiratory consultant with a fellowship in advanced lung cancer diagnostics I am a very strong supporter of annual CT thorax Lung Cancer Screening for Ireland but i understand the current reason it has not been introduced to-date in Ireland is the fear of the medicolegal payouts it will cost the State in due course; currently the State Claims agency owes €4billion in medicolegal payouts; in healthcare economics terms thats 2 x National Children Hospitals – hopefully the State can find a way to resolve this and implement Lung Cancer Screening
@Oisin O’Connell: can you please explain how lung cancer screening will lead to an increase in claims and how the cost is higher when offset against catching cancers early, I assume less treatment is required and therefore lower costs. Or is it actually more costly on the heath service in terms of treatment versus palliative care. Or is it the fear of mistakes during screening. I’m a little confused by your comment.
@Rmaybe: No screening can ever detect 100% of cancers. Also, in diagnostics there will be an overlap between normal and abnormal features, so on retrospective review another reader may come to another conclusion. These types of “mistakes” tend to lead to very large payouts to patients whose cancer was missed, and make screening programs very expensive.
@Oisin O’Connell: if u had private health insurance I think u would stand a better chance of getting it done as a check up,I’m 52 I’m off the cigarettes 5 years but I’m still using the vape,now the dangers can be seen Oisin,if u have a medical card u will not be seen,I’m on the waiting list almost 18 months,to have a test done,my body stopped sweating about 3 years ago from a really bad virus I got,I might aswell be dead,because my skin is constantly hot,and starts burning as the day goes on,to the stage where it’s like your been burnt from the inside out,My own GP has contacted the place 4 times,but coz I’ve a medical card,but if u had private insurance,i could have been seen so much sooner,and not have 4 differnt autoimmunes now,money is everything now
@Kate Peters: Hi Kate, apologies if my question is inapproprate, but couldn’t you see the consultant privately? You will have to pay for the visit, but if your condition is serious they would find a way to get you “in” for public treatment. It will cost you 150-200 euro, which is a lot of money (and private insurance covers at most half of it anyway) but hopefully you won’t have to pay after that!
@Zmeevo Libe: once you enter the health service as a private patient you must remain as a private patient gor your treatment. There’s no hopping the queue over to the free public service. So if you pay for a private consultant and need further treatment it gets very expensive very quickly if you don’t have health insurance
@Oisin O’Connell: How much do you know about Pulmonary Fibrosis? do you know if its advanced that open heart surgery is probably a very bad idea? Because my father died last week despite the consultant in the Mater saying his lungs ‘arent great’ this was her bs way of telling me he had advanced pulmonary fibrosis. She casually mentioned what he had midway through a phone call after a consultation with my father that i realize now i should have been present for, as much of it went over dads head. He had open heart surgery in November and died exactly two months later, gasping for air on high flow oxygen because he refused to go on a ventilator. He spent the last two months of his life scared and suffering terribly. The fibrosis would have gotten him in the end, but why did they perform open heart for a heart valve replacement instead of doing keyhole, when they should have known he wouldnt survive long afterwards. Im so angry that this wasnt diagnosed sooner, he had regular checkups, until covid happened.
Some information on the signs and symptoms would be beneficial here. https://www.cancerresearchuk.org/about-cancer/lung-cancer/symptoms
50,000 trucks in a convoy in Canada. Elon Musk supporting them. Largest convoy in the history of planet earth. Millions out on the streets supporting them. Not one mention on Irish MSM. This place is NOT journalism. Open your eyes.
@The Almighty: actually I read about it yesterday on irish MSM.
So it’s yesterday’s news. Its gone, you missed it. Goes to show that if you don’t see or hear of something happening it doesn’t mean that it didn’t.
@The Almighty: https://www.rte.ie/news/world/2022/0129/1276670-truckers-canada/
Ironic though that you insist on a story about freedom of choice being reported.
@The Almighty: 1. This article is about lung cancer 2. a truck convoy in Canada has little if no bearing on Ireland.
@The Almighty: That was covered yesterday. Plenty of other online Canadian links available if we want to brush up on our French, mind you.
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