The number of women with lung cancer is on the rise but one lung expert is determined to stop the trend, writes Theresa Judge
A lung cancer expert has described as "ridiculously high" the rates of the disease among young women in Ireland.
Dr Joseph Keane, who is leading an Irish team involved in research to develop a genetic test to show early warning signs of lung cancer, says he got involved in the study because he felt "morally obliged" to do something to stop the "carnage" caused by the disease.
A consultant respiratory physician in St James's Hospital in Dublin, Keane says that among people aged under 50 there are now as many women as men being treated for lung cancer at the hospital.
Around 1,500 people die from lung cancer in Ireland every year and about 20 per cent of these are treated at St James's. Up to 95 per cent of these cancers are believed to be caused by smoking. Deaths from lung cancer are twice as high as those from the next most common form of cancer, which is colon cancer.
Keane says it is heartbreaking for doctors to see young patients who have very little chance of survival because the cancer has usually spread by the time they experience symptoms and come for treatment.
"At St James's, multidisciplinary teams meet to discuss every single case. When we show an X-ray of a 35-year-old woman, the whole room goes silent, the talk about what you were doing at the weekend all stops and every stomach falls," he says.
People with advanced-stage cancer may not even live for a year after their diagnosis and only about 15 per cent of people are alive five years after diagnosis.
Keane appeals to smokers to stop, saying that the "epidemic" among young women is of particular concern. He points out that lung cancer rates among young Irish women are by far the worst in the EU.
"This is something we can change. A woman may think that she could get breast cancer and there is not much she can do about it, but when women see that we are the black hole of Europe for lung cancer this might make them think about stopping smoking."
The aim of Keane's research, which involves scientists and medical clinicians at St James's Hospital and the Boston University Medical Centre, is to develop a test which will predict whether a person will contract lung cancer. To date the study has developed a genetic test which can identify patients with early-stage lung cancer.
Published last week in the prestigious journal Nature Medicine, the study is based on a measurement of activity in about 80 different genes. It was found that about half the genes become more active and half less active in a person with early-stage cancer. It will now be necessary to run a larger trial to establish if the test can predict whether a person will contract the disease.
Keane says the genetic test is better than available tests at identifying people with early-stage lung cancer but if it were found that it could also predict those who would contract it, this would be a "seismic" step forward as early treatment is crucial to saving lives.
He cautions, however, that such a test may be many years off and that smokers should not see this as any reason for complacency, in the belief that those at risk of cancer could be identified early. "The message is simple and old-fashioned - people have to stop smoking, and there are at least 15 other reasons why people need to stop other than lung cancer," he says.
He says people need to be aware of "the malice of forethought" on the part of tobacco companies in that the dose of nicotine contained in a cigarette is carefully designed to ensure people become addicted and to keep them smoking one pack of 20 a day for the rest of their lives.
Keane says he has no issue with smokers and that at no stage does St James's give up on lung cancer patients or tell them that there is no hope but says he has a huge issue with the tobacco industry "who push this drug".
Consultant respiratory physician Finbarr O'Connell, who also works at St James's Hospital, says he agrees that there is a lung cancer epidemic among young women. "Twenty to 25 years ago there were 10 times as many Irish men as women with lung cancer, now overall the ratio is 1.6 to one, and for those under 50 the ratio is one to one," he says.
The prevalence of lung cancer among Irish women is double the EU average. While new cases in men are falling, there is still a slight upward trend in new cases among women.
Most people who get lung cancer contract it in their 60s or later so the high rates now reflect rates of smoking in previous decades. Usually a person is smoking for about 20 years before developing lung cancer.
However, O'Connell stresses that women tend to develop the disease younger than men, and when they do get it, they have an even poorer chance of recovery. He also says it is never too late to stop smoking as the risk of lung cancer reduces from the time a person quits but it is obviously preferable to stop as young as possible.
"If you give up at age 35 your risk will fall to very close to that of a non-smoker by the time you reach 45."
He says that while many people who smoke in their 20s believe they will be able to quit when they're older, they do not realise just how addictive smoking is. "When they get to their 30s, they're really hooked and it has become a huge part of their life."
O'Connell says he smoked in the 1970s and that he and other doctors recognise that it is "a lonely, hard thing to do".
He says that it has been shown in the US that screening for smoking-related illnesses is successful in helping people to quit. "Even a brief intervention by healthcare practitioners can help people," he says.
He also says that stricter controls are needed to counter the power of the tobacco industry saying that he still sees examples of indirect advertising in magazines. While the tide may be turning after the introduction of the smoking ban, to date the tobacco industry has been winning the war, he says.
"The link between smoking and lung cancer was proven in 1960 and yet we still have one in four people smoking," O'Connell points out.
Dr Fintan Howell, of anti-smoking lobby group Ash, says a whole range of measures still need to be taken. While the workplace smoking ban may have resulted in people cutting down on the number of cigarettes they smoke, he says it "was never going to impact hugely on the numbers who smoke".
While smoking rates have fallen over recent decades - the rate for adults is now about 24 per cent - there is concern that the rate for 15- to 18-year-olds is nearly as high at 20 per cent. Among this age group there are slightly more girls than boys smoking.
Howell says there are 6,500 deaths in the Republic each year from smoking-related illnesses.
While it is difficult to convince teenagers of the dangers of smoking, "it only takes 50-100 cigarettes to make someone an addict".
Ash is arguing for a complete ban on point-of-sale advertising, with cigarettes being kept out of view in shops "so that they are not seen in the same context as sweets and newspapers". It also wants registration of tobacco retailers, graphic pictures showing health risks on cigarette packets - as has been introduced in Belgium - and continuous price increases to counteract the fact that teenagers now have more disposable income.
"We need to act on all of these measures in a very significant way - we have only been tipping around these so far," Howell says.