Time to Tackle Lung Cancer Inequalities?

November is lung cancer awareness month, our Policy and Public Affairs Manager, Greg Pycroft, reflects on the inequalities long associated with lung cancer in Wales and notes the activity we can expect to see over the course of the coming twelve months.

Lung Cancer in Wales

Earlier this year Tenovus Cancer Care published "Tackling Inequalities: Lung Cancer". The report sets out the challenge posed by the disease, the inequalities at the heart of the problem, current preventative interventions and more innovative approaches being developed to identify and diagnose lung cancer earlier. 

Around 1900 people die every year from lung cancer, making it the biggest cause of cancer death in the country. 

So many people die as a result of late diagnosis. Around 45% of people are diagnosed with stage 4 lung cancer when the cancer may have spread around the body and fewer viable treatment options exist. 

Yet despite its seriousness, a lung cancer diagnosis need not be a death sentence. As the image below illustrates, caught early enough, rates of survival are reasonably high.

Cancer Inequalities

Lung cancer is also regarded as one of six “Less Survivable Cancers”, cancers of the lungs, liver, brain, oesophagus, pancreas, and stomach.  These have an average five-year survival rate of just 14%. Compared to other common cancers, these cancers remain as deadly as they were decades ago.

We believe that pan-cancer commitments, ambitions, and targets have led to less survivable cancers being overlooked and under-resourced.  Tenovus Cancer Care contributes to the Less Survivable Cancers Taskforce, the UK-wide charity-led campaign drawing attention to these inequalities.

Across Wales, lung cancer is not experienced equally. The disease is linked to socio-economic inequalities and takes a terrible toll on Wales’ most vulnerable communities.

Stop Smoking Services

Wales’ stop smoking services play a significant role preventing lung cancer through getting smokers to overcome their addiction.

All smoking cessation services in Wales fall within the Help Me Quit brand, and over time these will tackle rates of lung cancer, and lung cancer inequalities.

However, these services are also prone to inequalities.

People in more deprived areas are less likely to quit, although they might make the same number of attempts to stop as people in less deprived areas. They face significant barriers that must be addressed to prevent an increase in health inequalities:

• Smoking is normalised and embedded in communities, contributing to reduced peer support.
• Other unmet needs make quitting a lower priority.
• Decreased access to pharmacies or GP surgeries due to distance, time or transport issues.
• Increased socio-economic stress can lead to smoking becoming a coping mechanism.

Targeted Lung Cancer Screening

The introduction of targeted lung cancer screening across Wales could prevent more than 20% of lung cancer deaths amongst those screened and improve outcomes for many more patients.

By targeting smokers between the ages of 55 and 77, it is predicted that many lung cancers could be identified at a much earlier stage.

More than 190 lives a year in Wales could be saved by diagnosing people before they visit their GP with lung cancer symptoms.

Tenovus Cancer Care has been closely involved as a 3rd sector partner in the development of a lung health check pilot that’s due to be carried out within the Cwm Taf University Health Board area from late 2022/early 2023 onwards.

Less clear is the development and rolling out of a targeted lung cancer screening programme across Wales. The Welsh Government has not yet said whether it will direct Public Health Wales to implement a targeted lung cancer screening programme in light of a positive recommendation from the UK National Screening Committee (UK NSC).

Despite the recommendation and Wales’ own history of socio-economic deprivation and industrial heritage, there are no pilots or studies in Wales to study the effectiveness of lung health checks.

A new screening programme would complement Help Me Quit. Trials elsewhere have shown that smokers who attend Lung Health Checks are more likely to successfully stop smoking, especially if they were identified for screening.

However, other cancer screening programmes have encountered low or reducing uptake, particularly amongst people from low socio-economic backgrounds.

The success of any targeted lung screening programme will depend on uptake. We believe that screening will only be successful if we can change the narrative surrounding lung cancer.

With such high survival rates when caught early, it is important that lung cancer is not regarded as a death sentence. Many people also believe that screening for health conditions is important only if you are symptomatic, this must be addressed as a matter of urgency.

The Year Ahead

Screening can catch cancers before they are symptomatic. They drastically improve outcomes for patients, reduce the cost to the NHS and in the case of lung cancer targeted screening will help address cancer inequalities.

As a nation we will look back on the next twelve months as a critical period for lung cancer diagnosis in Wales. If we can catch more cancers earlier, we will allow more people to spend more time with their loved ones.

To help ensure this happens Tenovus Cancer Care calls on the Welsh Government to:

• Welcome the positive recommendation from the UK NSC concerning targeted lung cancer screening.
  
  
• Commit to delivering a sustainable targeted lung cancer screening programme that detects lung cancers at an earlier stage.
  
  
• Fully support the delivery and evaluation of the Cwm Taf Lung Health Check pilot, and
  
  
• Direct Public Health Wales to work with the Wales Cancer Network, the UK NSC, the third sector and other stakeholders to develop and sustain a targeted lung cancer screening programme for Wales that is integrated with smoking cessation services and optimised to address socio-economic barriers to take up. And finally,
  
  
• Plan action to diagnose less survivable cancers earlier and faster; to ensure everyone receives the best care and treatment available; and for substantive research funding to close the gap on cancer inequality.