When Debra Montague goes to the doctor, the first thing she says is: & # 39; I am a non-smoker, I have never smoked & # 39 ;.
Debra, 54, has advanced lung cancer – despite the fact that she has never picked up a cigarette in her life – and, as she says: & I still feel that I am doctors, nurses, everyone I met for the first time, must tell that I have never smoked, because unless I say it first, I feel condemned or accused; that the cancer is somehow my fault.
& # 39; Of course it is wrong to also assess smokers who have cancer. But I still have the feeling that I have to explain myself. People think of lung cancer as something that only smokers get. & # 39;
While smoking is the largest risk factor for lung cancer (caused by more than 60 carcinogenic chemicals in tobacco), actual research has shown that lung cancer is increasing in non-smokers, while it is responsible for 85 percent of cases.
Debra Montague, 54, has advanced lung cancer – even though she has never picked up a cigarette in her life (stock image)
Cases have doubled in the last seven years, according to a recent study led by Eric Lim, a thoracic surgeon at the Royal Brompton Hospital and Harefield NHS Trust in London, published in the European Journal of Cancer.
Non-smoking lung cancer is good for a third of patients undergoing surgery at the Royal Brompton Hospital and worrying, says Lim, that non-smokers have more difficulty diagnosing, meaning that their cancer is noticed later when it is diagnosed harder to treat.
& # 39; In general, patients with lung cancer are late because there are no symptoms such as pain or coughing when the cancer is small & he says.
& # 39; If there is a cough for non-smoking lung cancer, the problem is exacerbated because they are considered low risk – a persistent cough in a smoker and a non-smoker will be treated very differently, with doctors less likely to send non-smoking patients for lung scans. & # 39;
Debra, a former marketing manager from Guildford, Surrey, was fit and otherwise healthy when she returned in the summer of 2016 with a cough from vacation.
& # 39; It was not a normal throat or chest, & # 39; Debra remembers. & # 39; It was from low to bottom – a deep, strong cough. It resonated through my bones. & # 39; She had no other symptoms and otherwise felt fine.
& # 39; My colleague & # 39; s started to leave joking cough sweets on my desk because it was so annoying. It is thanks to them that I finally decided to visit the doctor. & # 39;
This was eight weeks after the cough first appeared.
& # 39; The doctor listened to my chest and said it sounded clear and that, since I had never smoked, there was no risk of anything ominous & # 39 ;, Debra says. & # 39; But she sent me for a blood test and an X-ray to stay on the safe side. & # 39; A few days later her doctor called with the results – the blood tests were normal, but the x-ray was & # 39; not decisive & # 39 ;.
Non-smoking lung cancer accounts for one third of patients undergoing surgery at the Royal Brompton Hospital (stock image)
Debra had private health insurance through her work at a pharmaceutical company, so she went to a private breathing advisor to be seen faster. Another X-ray showed that one of the lungs was clear, but the other seemed & # 39; snowy & # 39; and the consultant recommended further scans, including CT (a form of X-ray that produces a cross-sectional image of the body).
Again, Debra was reassured that it would not be lung cancer and so returned a week later after work for the results. & # 39; I was told several times that I didn't have an increased risk, so I wasn't nervous & # 39 ;, she says.
Initially, her consultant said he wasn't sure what the scan was, but she pushed it. & # 39; I saw that he was kind, reserved & # 39 ;, she says. & # 39; I asked: & # 39; Is it cancer? & # 39; and he replied that it was probably cancer. & # 39;
Debra, who is divorced, has a 21-year-old son, Tom, who had just started college. Because he didn't want to worry, she told her sister Laura.
The next day Debra went looking for more scans, including a PET – a positron emission tomography – scan of her entire body; this creates three-dimensional images and can show whether the cancer has spread.
Three days later, cancer was confirmed – she had two tumors in her right lung and the disease had spread to her right hip, the base of her spine and her adrenal gland (just above the kidneys).
& # 39; I was taken to a room where a Macmillan nurse was waiting & # 39 ;, Debra says. & # 39; I knew it was serious then. I kept thinking: how could this happen? & # 39;
& # 39; It's hard to say why non-smoking lung cancer is increasing & # 39 ;, says Mr. Lim.
& # 39; Or why it tends to influence women more than men. One possibility is that women are often exposed to more volatile organic compounds (VOCs) that are released by cosmetics, deodorants and cooking vapors. & # 39;
VOCs are particles that are released into the air and that we can then breathe in, causing damage to cells. They can be found in many products including paint, air fresheners and cleaning sprays.
Various studies have linked VOC & # 39; s to health problems.
Another possible factor in the rise of non-smoking lung cancer is increased levels of contamination.
A study by the International Agency for Cancer Research in 2013 found that the risk of lung cancer rises to the more minute dust-like particles – called particulate matter – there are in air pollution.
Cancer Research UK estimates that pollution causes 3,600 lung cancer cases every year in the UK – about one in ten lung cancer patients.
Symptoms of lung cancer are often non-specific, but a cough is common. Others include a lump in the neck, a hoarse voice, weight loss, and coughing up blood. Mr. Lim, however, emphasizes that these & # 39; occur very late in the disease & # 39 ;. & # 39; Doctors need to be more aware of non-smoker-lung cancer & # 39 ;, he adds. & # 39; But their tools for diagnosing are limited. & # 39;
Breast photos are not always sufficient, because the images are not precise enough. A CT scan entails higher radiation exposure, which doctors may be reluctant to subject to a patient unless they are at high risk. Most non-smoking patients are diagnosed after they have scanned for something else, such as a CT scan for heart conditions.
Debra was told that her type of lung cancer would respond best to & # 39; targeted therapy & # 39; – medicines that block chemicals, such as growth factors that cancer cells need to grow. It can stop the cancer, but it is not a cure.
Debra was put on Xalkori (crizotinib). She developed extreme nausea as a side effect, but luckily after a few weeks, PET scans showed the drug to work and had stopped tumor growth.
& # 39; It meant that I had gone from a six-month forecast to maybe five years – it was a ray of hope & she said.
She is now taking a second type of targeted therapy as the first one stopped working and she plans to do a triathlon, as well as abseiling from Liverpool Cathedral to raise money for the Roy Castle Cancer Foundation.
& # 39; I know that this second therapy will stop working one day and that I am on borrowed time & # 39 ;, she says. & # 39; In the meantime, I want to live life to the full and make people aware of lung cancer. I am proof that it is not only smokers who understand. It needs the sympathy that other cancers get. & # 39;
Debra believes that there should be a routine screening process so that it can be retrieved faster.
Mr Lim agreed, but noted that, since the vast majority of the population is now non-smokers, we must & # 39; be careful when screening & # 39 ;. For example, a CT program would expose people who would otherwise run a very low risk of unnecessary radiation.
He and his team are working on a blood test that can offer an alternative. It looks for DNA in the blood that is shed by cancer cells. & # 39; We are doing clinical trials this year & # 39 ;, he says. The hope is that it will provide a safe, inexpensive screening method and make the diagnosis of lung cancer easier.