The rise of lung cancer reflects local smoking trends... especially in women. Stephanie Fsadni finds the vice accounts for about 90 per cent of cases of the disease, the risk is directly related to the number of cigarettes smoked and that the effect of smoking is irreversible.
Lung cancer remains the most common cause of cancer-related deaths, and figures show that the rate of mortality by lung cancer in Malta is on the increase.
From 149 deaths in 2008, the numbers went up to an average of 156 yearly deaths between 2009 and 2011, to 183 deaths in 2012; and these are expected to double in the next 20 years.
The majority of new lung cancer patients diagnosed last year (182) were males. However, there has been a significant rise in females over the past 10 years.
“This reflects our local smoking trends,” says respiratory consultant Josef Micallef. “Smoking among the middle-aged and elderly has decreased, but there has been a substantial increase in the number of female smokers, especially in the younger generation.”
Smoking accounts for about 90 per cent of lung cancer cases, and the risk increases with the number of cumulative cigarettes smoked throughout the years.
“The risk is directly related to the number of cigarettes smoked and, contrary to popular belief, the effect of smoking is irreversible, even if one smokes only for a few years,” claims Dr Micallef.
“We frequently encounter lung cancer even in those who have stopped smoking for more than 10 years.”
Second-hand smoking is another recognised risk. Other causes of lung cancer include genetic factors and excessive alcohol intake.
Long-standing degenerative and fibrotic lung conditions can predispose one to lung cancer.
Rare causes for Malta include exposure to toxic radiation, chemicals and gases, such as asbestos, arsenic, chromium, rubber, nickel, cadmium, beryllium, coal, radon and air pollution.
This form of cancer is more deadly than others because its symptoms, such as coughing up sputum, lower appetite, weight loss and shortness of breath take long to develop despite the tumour being of a significant size.
Fifteen per cent of patients diagnosed with lung cancer live up to five years, but the average survival is 20 months
“Most patients present themselves for diagnosis very late, when the tumour would have spread to the lymph nodes,” says Dr Micallef.
“Treatment has improved survival, but cure rates remain low.”
Fifteen per cent of patients diagnosed with lung cancer live up to five years, but the average survival is 20 months.
Tumours can only be surgically removed when they are very small and with no sign of distant spread.
“A significant number of patients might have potentially resectable tumours, but they are unfit for surgery due to emphysema or other co-morbidities, like significant heart disease.”
The mainstay of treatment is radiotherapy, which may be radical or palliative. Chemotherapy is another option and some lung tumours do respond to this treatment. The latest treatment options include molecular-targeted therapy.
“All the three options prescribed by our oncologists have been shown to improve survival in lung cancer and are available in Malta,” maintains Dr Micallef.
However, he stresses that the most important and effective measure to decrease the incidence of this “devastatingly malignant disease” is effective smoking cessation campaigns and education.
“We must direct our efforts at adolescents in schools and younger generations to never start smoking. The cigarette/cigar remains a legally accepted addictive drug.”
He refers to the belief that “smoking makes you look cool and thinner, especially among the younger generation” and calls it “a really false perception”.
Dr Micallef believes that there is enough awareness and everybody knows about the health-related adverse effects of smoking, but many think they can kick the habit at any time. However, reality shows otherwise.
He complains that smoke cessation clinics are available, but are poorly attended and few manage the full course. Besides, only a minority decide to follow the doctor’s advice and prescription.
Dr Micallef says he would like smokers to talk to individuals who are suffering from lung cancer and their family and care providers to see what they go through, and perhaps understand better the harm they are doing to themselves.
“Few smokers will admit that ‘they will get lung cancer’. Everybody thinks it will not be his/her turn or that they will die from some other condition. However, when it happens, the truth is that the disease will lead to a very short life expectancy.”