No. 1 cancer in men: Lung cancer, No. 1 cause: Smoking

Nine out of 10 male patients with lung cancer have a history of smoking

I have a patient, Simon Woo, who comes to see me every month. Each time, he has this toothy grin.

“So doc, how am I doing?” he jokes, and then adds that I should be handing him a birth certifi cate. “Reborn, meh,” he says cheerily, but sometimes I see the depth of emotions behind his hale and hearty laughter.

He is 59 this year, an engineer and a stout man. He walks around a big ITE campus, overseeing its facilities, shouting greetings to his many staff. He has a wife and a son, 27, who is studying to be a medical specialist.

When I first saw Simon more than two years ago, he had stage IV lung cancer. His family had been told that he had three months to live.

He was in a wheelchair, hardly able to sit because of the pain in his back. His bones were disintegrating, and he had severe back pain, because the bones were crushing his nerves, and weakness in both legs.

I thought he had a 60 per cent chance.

“Get ready to do battle,” I told him, and he shook my hand, as if a pact had been made.

He responded well to chemotherapy.

After five months, he was able to walk. The hospital orderly who used to push him up to my clinic was amazed he could run for the lift.

Simon tells me impishly: “It makes me feel good to see the expression on his face.”

In the bad old days, a patient like Simon would probably have been given six to 12 months to live. Nowadays, some patients do so well that they may even live beyond five years (This does not mean that they are cured of the cancer but that the disease is controlled).

When I first started my fellowship at MD Anderson Cancer Centre in the United States in 1988, one of the first journal articles reviewed by the fellows was whether stage IV lung cancer patients should even be treated. The article compared the modest improvement of six weeks for patients receiving chemotherapy with those who received the best supportive care.

Now, 20 years later, all stage IV lung cancer patients considered fit enough are offered chemotherapy. There are many trials which now show that patients live long and good lives if they receive treatment.

Lung cancer is the most common cancer among men in Singapore. The major cause of lung cancer is smoking.

Defeating this top killer requires one simple step: Do not start the habit, and if you are a smoker, stop smoking today.

Nine out of 10 male patients with lung cancer have a history of smoking.

Some 80 to 85 per cent of all lung cancer patients are diagnosed only when they are in the advanced stages (stages III and IV). This is because most patients with lung cancer do not have any symptoms or they have non-specific symptoms.

They usually have a cough, which can be mistaken for something more innocuous like a throat infection or allergy.

Only 15 per cent of lung cancer patients are diagnosed early enough for surgery to be considered.

While it is true that – with medical advances – we can tackle lung cancer in many ways now, and give many patients a good quality of life, nothing works better than prevention.

The incidence of lung cancer correlates well with the percentage of smokers in the population.

The good news for Singapore is that the prevalence of smoking among men is declining and this is reflected in the slight drop in lung cancer cases among men.

The bad news is that more young women are taking up smoking and if this trend is not halted, I fear that there will be even more female lung cancer patients in the years to come.

In Simon’s case, he told me he smoked while he was a teenager, but by the time he came to see me, he had already stopped for 20 years.

When he first heard that he had stage IV lung cancer, he was devastated and ready to give up.

But – crucially – his family, his friends, the many people who worked with him, all encouraged him.

What touched him was that the security guards and gardeners whom he oversees, took turns to visit him each week, or sent notes to cheer him up.

“They told me: ‘We want you to come back to work!’ I understood what they were trying to say. In these moments, you really understand what is family, what is kinship, what is love,” he said.

“So even though it’s only been two years that I’ve been cancer-free, I’ve had a beautiful time. I live happily, every day.”