A conference this week will discuss treatment for a disease often met with pessimism. Dr Muiris Houston talks to a leading lung cancer expert about the changing approach to the condition
Lung cancer has never generated the same emotions, research interest or media coverage as other common cancers in the Republic.
Despite the enormous burden of the disease even health professionals have regarded lung cancer with some pessimism. This is partly because society has, subliminally at least, regarded lung cancer as a self-inflicted disease (most cases occur in smokers).
But the situation is changing. More than 500 delegates will attend a major conference on lung cancer at the Burlington Hotel in Dublin this week.
Dr Ken O'Byrne is chairman of the British Thoracic Oncology Group which will spend from tomorrow until Sunday discussing all aspects of the disease, including the latest treatment breakthroughs.
Dr O'Byrne returned to the Republic in November 2003 to take up a post as consultant clinical oncologist at St James's Hospital. His particular area of expertise is lung cancer and he is determined to change the outlook for lung cancer patients here.
"I want to develop a multidisciplinary approach to patient management involving specialists and other health professionals to ensure the right treatment is given to a person based on the extent of their disease at presentation," he says.
Less than 10 per cent of the 1,500 people diagnosed with lung cancer here each year are alive five years later.
This means lung cancer is the leading cause of cancer mortality in the State, with 20 per cent of all cancer deaths due to tumours in the lung. The main reason for this poor outcome is the late presentation of the disease.
This is not the patients' fault; it's just that the major symptoms - such as coughing up blood - come late in the disease. And others, such as cough or chest pain, have initially more common explanations. But other factors have included poor access to radiotherapy and a historically low rate of surgical resection of lung tumours.
Another issue, which affects the early diagnosis of lung cancer worldwide, is the lack of a good screening method to pick up early cancers.
Researchers in New York are looking at the feasibility of introducing CT screening for high-risk patients and it may well be that we will soon have the scientific evidence to start such a programme for heavy smokers over the age of 50, who already have signs of chronic lung disease.
But Dr O'Byrne also sees a role for identifying the genes that predispose people to contracting lung cancer.
He and a team at the Institute for Molecular Medicine, located on the St James's campus, are busy researching this and other aspects of the disease.
This week's conference will devote a session to a particular form of lung cancer called mesothelioma. Strictly speaking it is a tumour of the sac that lines the lung (the pleura); it is a type of cancer that is quite distinct from the tumour types that arise within the lung tissue itself.
But it is interesting for two reasons: one is the strong link between exposure to asbestos and the development of mesothelioma; the other is the rising number of cases appearing both here and in Britain in recent years.
According to a paper published in the Irish Medical Journal (IMJ) in December 2003, there was an annual increase in mesothelioma of 14.4 per cent between 1994 and 1998. The researchers also predicted 70 deaths from pleural cancers in 2007 and 2008. Incidence is expected to peak in 2015.
Most mesothelioma victims have worked in trades that are closely associated with asbestos exposure. "There is a strong correlation between the extent and duration of exposure to asbestos [a type of asbestos silicate fibre] and the development of mesothelioma," Dr O'Byrne, who has a special interest in the condition, says.
Because there is a considerable time lag between exposure to asbestos dust and the development of mesothelioma, it is only now that we are seeing a significant rise in the number of cases among those exposed in the 1960s and 1970s. Most male patients worked in the shipbuilding, automotive and insulation industries; some women with the disease worked as pastry cooks using asbestos-insulated ovens.
Progress is being made in improving the quality of life for patients.
The conference will discuss future treatment options and will continue the search for a "silver bullet" breakthrough for those yet to develop the unusual occupational cancer.