Lung cancer has been one of the most important epidemics of the twentieth century. Late-nineteenth-century physicians and surgeons rarely diagnosed lung cancer and, even though techniques for making the alternative and more frequent diagnosis of tuberculosis were only partly developed at that time, it is unlikely that they were failing to make the diagnosis and much more likely that lung cancer was a medical rarity at that time. Now lung cancer is, in all probability, the commonest cancer in the world, with nearly 700.000 cases per year. In the United Kingdom, it accounts for 25 per cent of cancer deaths.The epidemic has been especially damaging. The disease strikes down men who are still economically productive and have dependent families. Sadly, the outlook for a patient diagnosed as having lung cancer remains one of the most dismal of all cancer diagnoses. Whereas the surgeon may hope to cure a third or a half of all of the patients whom he treats for other common cancers, the situation is quite different with lung cancer. When the diagnosis is made, no more than one quarter of patients have a disease that can be removed by surgery. Even when surgery is carried out and it seems that the cancer has been removed, only about one quarter of those patients are cured. Overall, less than 10 per cent of patients will be cured by surgery.Other means of treating lung cancer have been equally unsuccessful. Radiotherapy has been applied vigorously in a wide range of doses and with a wide range of schedules for the last fifty years. Although the treatments have become simpler and safer, and in many ways more sophisticated, very few patients are cured by radiotherapy alone. The introduction of drugs for the treatment of lung cancer in the 1960s gave rise to great hope for the group of patients with a sub-group of very dangerous cancers known as small-cell lung cancers. Combinations of drugs have proved capable of producing frequent remissions for this group of lung cancer patients. The disease shrinks readily away when the drugs are used and, during the 1970s and 1980s, intensive research was directed to using this effect and trying to turn it into lasting remissions and cures. Such efforts have, however, been met with disappointment. Patients with small-cell lung cancer can usually expect remissions as a result of these combination chemotherapies, but very few are cured.The scale of the epidemic of lung cancer is illustrated in Figure it. The disease started to increase in the 1920s and 1930s and achieved its present epidemic proportions during the 1950s and 1960s. The number of deaths due to lung cancer is however, beginning to show signs of a significant reduction. The graph shows the death rate against the number of cigarettes consumed; we must now accept that this indicates the clearest and most important explanation of this century’s lung cancer epidemic.There is an indisputable and strong link between lung cancer and smoking. In fact, almost all lung cancers are attributable to smoking and, if the smoking habit were dropped, lung cancer would revert to its former status as an infrequent diagnosis, of concern only to the individual patient and doctor. Instead, it remains one of the most overwhelming public-health issues facing the world as it moves towards the twenty-first century.*37\194\4*

“The cancer treatment is worse than the disease.” You may think this while or after you struggle with cancer treatments, develop complications following treatments, or suffer permanent problems as a result of them. Is it true?

Despite what you may think, cancer treatment is not worse than the disease. The fundamental fact is that most people with cancer who forgo treatment die from their disease. Without treatment, cancer is not only chronic but also terminal. Cancer treatment has allowed you to avoid a life of pain or debility because of progressive cancer. It has given you a chance for a longer life.

Cancer treatments have progressed dramatically over the past few decades, transforming cancer from a near-certain death sentence to one of the most treatable and curable chronic diseases. Encouraged by the successes, doctors have offered patients increasingly more intensive therapies, such as high-dose chemotherapy and bone marrow transplant. And their strategy has paid off. For the first time there exists a huge population of long-term cancer survivors.

But this undeniable success has been won at some cost. Much to survivors’ surprise and disappointment, it is very common to experience ongoing and new symptoms and medical problems after treatments are successfully completed. A small but significant percentage of cancer survivors, though cured of their cancer, live the rest of their lives with permanent medical problems. Another small but significant percentage of long-term survivors develop new medical problems, even new cancers, that are directly related to their prior cancer treatments.

The problem is that many people try to see their cancer as a short-term, temporary disease. When people expect surviving cancer to be like surviving a bout of viral meningitis or a broken leg, they find it hard to deal with longer-term problems related to cancer or its treatment. This view of cancer makes people feel that the cure is worse than the disease. A more realistic view of cancer would help.

Cancer is a chronic disease, like heart disease, arthritis, diabetes, asthma, or kidney stones. For some people, minor changes in lifestyle and regular checkups are all that is required. For them the chronic disease has little impact on daily life, and it is easy to forget about the disease. For others the disease profoundly affects every sphere of daily life. In all cases knowledge helps people improve their quality of life and, possibly, lengthen their lives.

The more you learn about the prevention, recognition, and treatment of medical problems, the more you can do to stay healthy. This holds true for anyone living with chronic disease.

Consider the story of two young men in the intensive care unit with their first heart attack.

The first man was very cooperative, but as soon as he was well enough, he wanted to leave without hearing any more about his heart problem. He said that he did not want to worry about his heart for the rest of his life. He promised to be faithful with his checkups and stress tests, believing that his doctors would pick up any significant changes. With his diet and smoking habits unchanged, he was at risk for recurrent heart attacks. Moreover, he did not know how to recognize problems. A year later he developed pain-free shortness of breath when he climbed the stairs. He thought he was tired that day or might be coming down with a cold. He did not worry about it, let alone call his doctor. He thought he had to have chest pain if he had a heart problem. That night he suffered a massive heart attack.

The other man made every effort to learn about his heart disease. He made changes in his diet, exercise program, work schedule, and over-the-counter medications to minimize his risk of future heart problems. A year later, when he developed some indigestion after mowing the lawn, he went straight to the emergency room. Even though he had no chest pain, he knew that his symptoms could be a warning sign of an impending heart attack. His knowledge saved his life.

*50/32/5*