"Do not go home, order a taxi, go to A & E and have a chest x-ray. I do not think this is related to asthma." Something is not right here. "The words of her doctor struck the fear of Jenny Abbott.
It did not start that way. A few weeks earlier, before Christmas 2017, she got a bad cold and cough. GP out of working hours thought that its long-standing asthma caused by viruses plays and prescribes steroids. A week later, her family doctor took the same position. It was certainly a known diagnosis. But that was wrong. Abbott was surprised when her usual time around the park near her home in northern London left her breathless. "I thought I was tired, but the next day, I noticed that I was breathless, walking down the stairs. And one day after that, I had to read something at work, and even I did it without breath," she recalls. These symptoms prompted her doctor to go to A & E.
X-ray has detected fluid on the right lung. After CT scanning, Abbott employees said there are three possibilities: cancer, infection or blood clotting. "When they called me in a side office and introduced me to a nurse on the lung, I knew it would not be good," said Abbott, a former BBC producer who became a psychoanalyst. At that time, she was 54 years old.
The doctor told her that she had lung cancer and could not be cured. "It was my first thought: this can not happen. I locked myself in the bathroom, I cried and cried." Her diagnosis left her recovering. "I never smoked, because cigarettes made me sick. I was ready, I was a racer."
Lung cancer is indissolubly linked to public opinion with cigarettes, and for good reason: about 86% of those who take it are smokers or former smokers. But Abbott is among the growing number of women who have never smoked, yet are diagnosed with the disease while they are still "young" in medical terms – that is, under 55 years of age. Doctors who specialize in this condition now see so many people who have never smoked that they have invented an acronym: LCINs – lung cancer in never smokers. They are the other 14%. Their number is on the rise, although experts can not fully explain why.
Figures are surprising. Professor Mick Pick, a clinical director of the Cancer Center at the University College London Hospital (UCLH), reported in the Royal Society of Medicine newspaper, estimates that nearly 6,000 people who never smoked die from lung cancer a year. It is more than the number of people who die of cervical cancer (900), lymphoma (5,200), leukemia (4,500) and ovarian cancer (4,200): "If considered a separate entity, LCIN is the eighth most common cause of cancer-related deaths in the UK and the seventh most widespread cancer in the world, "he writes.
While about 10% of men in Britain diagnosed with lung cancer are non-smokers, the percentage of women is greater: 15-20%. The drop in cigarette consumption over the past 15 years means that the percentage of people with the disease who are LCINs is increasing. In addition, the absolute numbers and rates of LCIN are increasing. Abbott hates the stigma that non-smokers face when they receive a "burst disease"; every time she tells someone about her diagnosis, she feels obliged to add: "I never smoked."
"Like all people in my situation, do you think: why? I ask the question every day. It's the first thing I think in the morning, the last thing I think about the night, and what I'm thinking about when I wake up at night. play in my head ".
The media focus on breast cancer, cervical and prostate cancer has overlooked the fact that lung cancer is the largest British cancer killer, claiming some 35,600 lives a year; more than breast, prostate, liver and bladder cancer combined. Since the late 1970s, the rate of diagnosis of lung cancer has fallen by 14%. However, while at that time it fell by 44% among men, it grew by 69% in women, as women began to quit smoking years later. "When I began to treat lung cancer in the early 1980s, I saw four men for every woman, then it was almost a male illness, now almost one-on-one," says Pick. Of 46,388 diagnoses in 2015, about 53% are men and 47% are women. Of the total, about one in eight never smoked.
Ruth Straus, the captain of former English cricket player Andrew Strauss, and non-smoker, died of the disease just after Christmas last year at the age of 46, just one year after her diagnosis. Her husband recently said: "There is a presumption that if you have lung cancer, you were a smoker. Ruth never smoked a cigarette in her life."
This illness also experienced the life of Sian Busby, a novelist and wife of Robert Peston, political editor of ITV News. She was 51, when she died in September 2012. Peston said his wife is "probably the only person I know, who never smoked a cigarette," and described lung cancer as "a monster that fell to our family."
There is no consensus among experts on why lung cancer affects more and more non-smokers. Peake lists four main reasons: passive smoking; professional factors, such as exposure to asbestos; exposure to radon gas; and a history of serious breathing conditions. Being raised in a home where one or both parents smoke increases the risk, such as a close relative of the disease. Although it is known that asbestos causes certain types of cancer, including mesothelioma, different ways of working between men and women mean that it can cause several cases of lung cancer in women. One study estimated that radon leads to 1,500 people a year in the development of the disease. There are also clear statistical links between tuberculosis and pneumonia and the risk of lung cancer.
But there are strong suspicions that air pollution can be a factor. External pollution is under surveillance, though Peak says open fires and even cooking may increase risk on Sunday (and stressing that it has not been proven). However, it should be noted that more than half of lung cancer in women in China occurs in non-smokers. "It's probably explained by the pollution of indoor air from indoor cooking of high-temperature oils – wok digestion – in an unheated area," he says. Some women from ZIN believe that chemicals in perfumes, makeup, aerosols or cleaning products may be guilty, but Peake is adamant that there is no evidence of incriminating any of them.
Many LCINs, including Abbott, have a form of disease called adenocarcinoma, which is much less strongly related to smoking than other species. Although experts are confused why, it increases as part of all lung cancer and is more common in women than in men. Result: Female LCINs are a larger percentage of cases where lung cancer specialists are seen.
Dr Neil Navany, a respiratory specialist at UCLH, says she often has to tell previously healthy non-smokers for under 55 years of having been diagnosed with one of the deadliest forms of cancer in the fourth phase – when it is incurable. "It's hard to describe the emotion they feel. Everything just drains out of their face," he says. "Today, I told two women under the age of 55 that they have advanced lung cancer. One was under 50 years old and never smoked." She had a hoarse voice, but none of the other symptoms, such as a cough, pain in chest or lack of air. When I went through a scan with her, she reacted with ridicule and said, "Why me?" "
Navani says general practitioners usually notice fewer than two cases of lung cancer annually, even in smokers – so it is not surprising that often the first mistake is something else. In April last year, Debbie Platts was preparing to undergo IVF when she was told she had lung cancer at the age of 43. The NCD's nurse – who also never bleak – is furious that several doctors over eight weeks all confused her back pain for a muscular problem and told her to take painkillers. Like Abbott, she was only diagnosed with lung cancer in A & E. "Sick, frightened and destroyed", she had to tell her three daughters, who were 23, 21 and 16 at the time. "I was so scared, and yet I'm with the prospect of losing a mother," she says. "I brought the girls alone, so who will protect them now?"
This disease is often asymptomatic until it spreads, explaining why, among those who do not illuminate it, it is almost always diagnosed at a stage when the patient can not be cured. Pick says: "If you are a 35-year-old woman who has never smoked with a cough, most doctors will place lung cancer in the 155th place on their list of possible causes."
Dr Claire Pearson, a doctor, knows all about it. The pain she felt in her back stool last August was initially considered to be a tendinitis. In fact, the 55-year-old, who never smoked, has lung cancer in the fourth degree that has already spread to the pelvis and liver. "My world collapsed at that moment. I went from a normal operation on Tuesday night after the first scan I was told on Friday afternoon that I was extremely ill with what I knew was a very unpleasant cancer, with very poor survival statistics, says Pearson, who has four children. "In almost 30 years as a GP, I have taken patients with lung cancer, but I've never seen anyone who was not a smoker or a former smoker."
Navani says there is a "nihilism" for lung cancer in people with condition and health workers, reflecting the belief that – because there are so few treatments that significantly prolong life – the diagnosis is essentially a death sentence. But the prospect is beginning to improve. Rates of one-and-a-half-year survival have improved over the past decade, as more patients have undergone surgery, although internationally, the UK is still doing bad work in this regard.
Of great importance, new drugs come into use, and they are more effective in non-smokers. There is particular optimism about the class of drugs called tyrosine kinase inhibitors (TKIs), which prevent the spread of cancer cells. Pearson's TKI has expanded the forecast from the first six months to at least 18 months. Plattz tumors declined in size after just 10 weeks of taking a drug against the genetic drug; because they have become resistant to it, it now has chemotherapy.
Abbott had some success in the drug called afatinib last year and is a second, extraordinary, since October. She is "happy" that mutations in her cancer means different drugs can be deployed. But, as he points out, "although these drugs can dramatically expand one's life, they do not last forever because the cancer develops resistance".
Acutely aware of her own mortality, she has two main desires. First, let's stay alive as long as possible, watch and guide our children while they grow up. And secondly? "All patients with lung cancer hope the researchers will come up with a drug that will turn the disease into a chronic illness – which you can live for a long time, just as SIDS has become a disease that people on drugs can have normal life span ". Now medicine is finished.