Late diagnosis, the bane of lung cancer…

Lung cancer represents a major health burden in India. It continues to be a devastating disease that defies all therapeutic endeavors to improve five-year survival. More than eighty percent of lung cancers are diagnosed at an advanced stage. This is mainly due to a long lag between the onset of symptoms and establishment of a diagnosis and finally, initiation of treatment.

A persistent cough, shortness of breath, pain in the chest, hoarseness of voice, blood in the sputum are some of the early symptoms of lung cancer. However, more often they may remain asymptomatic or ignore non-specific symptoms like nagging cough for several months before seeking medical help. Misinterpretation of symptoms, misdiagnosis, non-specific antibiotic treatments for several weeks to months delays the actual diagnosis! Even the social stigma and scare off being diagnosed of cancer also delays the medical attention and late diagnosis. This may lead to more advanced-stage lung cancer and less likely to get curative treatment.

The most important factors that are responsible for the delayed diagnosis of lung cancer are:

• Lack of awareness of symptoms of lung cancer and hence reporting late to their primary care providers.
• Self-management of early symptoms by patients and reporting late!
• Mis interpretation of symptoms – Symptoms are mostly mistaken for symptoms associated with smoking, upper respiratory tract infection, allergic bronchitis or chronic obstructive pulmonary disease. Hence they delay in cancer diagnosis.
• Mis interpretation of findings – As the presenting symptoms and initial radiographic findings are similar for lung cancer, lung infection and tuberculosis, the local physicians likely assume that the patient’s findings are consistent with more common diagnosis like non-specific pneumonia or tuberculosis rather than lung cancer!
• Finally… Lack of access to the medical care required to diagnose early.

To overcome the delay in diagnosis and management of lung cancer:

• We need to Create lung cancer awareness, the risks, signs, and symptoms.
• Proper evaluation of patients presenting with symptoms if they do not resolve in 2-3 wks with conservative management.
• Identify the High-risk group:– like smokers, factory workers etc. They need routine screening and prompt evaluation of new respiratory symptoms
• Early diagnosis is of paramount importance, especially in lung cancer.
• The expedited diagnosis and administration of treatment significantly increases the chances of a cure and long-term control.
• Lastly, you should understand that although smokers have a higher chance, anyone can get lung cancer! You need to be alert and seek medical advice if you have symptoms.
• Do not ignore and delay the medical attention because of scare being diagnosed of cancer. Unnecessarily you land up in late diagnosis!
• To conclude. being vigilant for early symptoms, regular annual screening, not delaying the investigations when advised, helps you to diagnose lung cancer in early stage. Early diagnosis and early intervention are very important! Lung Cancer is curable if diagnosed early!

Take care and stay healthy.

Dr. P Vijay Anand Reddy
Director, Apollo Cancer Institute, Hyderabad.