Readers like you keep news free for everyone.
More than 5,000 readers have already pitched in to keep free access to The Journal.
For the price of one cup of coffee each week you can help keep paywalls away.
Shutterstock/Inside Creative House
VOICES
Opinion Lung cancer screening must be introduced to address health inequalities
Rachel Morrogh says Ireland must keep pace with other countries and examines how lung screening can be introduced here.
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.
