Lung Cancer and Men

More men than women are diagnosed with lung cancer each year in Ireland. The most recent statistics from the National Cancer Registry Ireland (NCRI) documented that 1,386 men and 1,199 women get lung cancer each year in Ireland. It is the 3rd most common cancer in men in Ireland after non-melanoma skin cancer.1 The NCRI stated that the number of lung cancer cases is increasing and is expected to rise to 3713 cases (+131%) for males and 2313 (+105%) for females by 2045.32

Lung cancer is the leading cause of cancer death in both sexes, with an average of 1,946 deaths per year but more men die from lung cancer than women, 1,081 men versus 865 women.1

In recent years, lung cancer incidence has been 27% higher among males compared to females though both incidence and mortality are declining more rapidly in males than females. These trends are generally attributed to differences in gendered smoking patterns.31

Risks and causes of lung cancer

• Age – About 7 in 10 people diagnosed with lung cancer in Ireland are age 65 and older. It’s rare in people younger than 40 but it can occur6
• Smoking tobacco – Smoking tobacco is the leading cause of lung cancer, responsible for approximately 85% of all cases4

o Even light or occasional smoking increases the risk of lung cancer. But your risk increases the more you smoke and the longer you smoke7

o Using other types of tobacco products can increase your risk of lung cancer, e.g. cigars, pipe tobacco, snuff (a powdered form of tobacco) and chewing tobacco9, 10

o Primary prevention (such as tobacco control measures and reducing exposure to environmental risk factors) can reduce the incidence of lung cancer and save lives4

• Passive smoking – Adults who do not smoke and are exposed to second-hand smoke which increases their risk of developing lung cancer by 20–30%11
• Previous lung diseases – Previous lung diseases can increase your risk of lung cancer. These risks are usually higher in smokers. Your risk of lung cancer is higher if you have Chronic Obstructive Pulmonary Disease (COPD). It is sometimes called emphysema or chronic bronchitis.

o Idiopathic pulmonary fibrosis (IPF) also increases the risk of lung cancer developing19

o Tuberculosis (TB) at a young age is a risk factor for lung cancer, regardless of the underlying disease or smoking history20

• Chemicals and workplace risks – Some substances which people are exposed to in the workplace can increase the risk of lung cancer. These include asbestos, silica, and diesel exhaust, arsenic, beryllium, cadmium, coal and coke fumes and nickel7, 10
• Exposure to radon – Radon gas is a naturally occurring radioactive gas that comes from tiny amounts of uranium present in all rocks and soils that can increase the risk of lung cancer. Parts of Ireland have high amounts of radon. Your risk of getting lung cancer from radon is 25 times higher if you smoke than someone who has never smoked7, 10, 12
• Marijuana and lung cancer – Smoking marijuana may raise your chances of lung cancer, but scientists aren’t sure yet. Marijuana smoke has many of the same harmful substances as tobacco smoke, which could damage lung tissue and lead to cancer. Also most people who smoke cannabis mix it with tobacco, inhale more deeply and hold the smoke in their lungs for longer10, 13
• Family history – Your risk of lung cancer is higher if you have a close relative (such as a parent or sibling) who has had lung cancer7
• Genetics – Some experts estimate that a genetic predisposition to lung cancer contributes to approximately 8% of cases. Some of these genetic risk factors are inherited while others are not. Some studies suggests that an individual’s genes are more likely to contribute to an increased chance of lung cancer if they are young and have never smoked. However, lung cancer can also run in families because of shared environmental factors and lifestyle habits14

Regardless of whether you carry a higher hereditary risk for lung cancer, doctors recommend that all people avoid tobacco smoke and other exposures that increase the risk of lung cancer15

Signs and Symptoms?

The most common symptoms of lung cancer are:

• having a new cough or a cough most of the time
• getting out of breath doing the things you used to do without a problem
• having an ache or pain in the chest or shoulder
• chest infections that keep coming back or a chest infection that doesn’t get better
• feeling tired all the time (fatigue)
• losing your appetite
• losing weight
• coughing up phlegm (sputum) with blood in it21

Less common symptoms of lung cancer include:

• larger fingertips and curved nails (finger clubbing)
• finding it difficult to swallow (dysphagia) or feeling pain when swallowing
• wheezing
• hoarse voice
• swelling of your face or neck
• chest or shoulder pain that does not go away22

Some of these symptoms are very common and may not be caused by cancer, but you should see your GP to be sure.

Types of lung cancer

Cancer that starts in the lung is called primary lung cancer. Cancer that spreads to your lungs from somewhere else in your body is called secondary lung cancer.

There are different types of primary lung cancer and they are divided into 2 main groups:

• small cell lung cancer (SCLC)
• non-small cell lung cancer (NSCLC)

The most common type is non-small cell lung cancer.(26)

How lung cancer is diagnosed

If you experience any of the above symptoms, see your GP without delay. Your GP will ask you about your general health and may also examine you.

They may feel your lymph nodes (glands) in your neck and under your arms and they may listen to your chest and breathing with a stethoscope. They might also ask you to breathe into a small device called a spirometer. This device measures the amount of air you breathe in and out and also measures how quickly you breathe. This test is called spirometry. Your GP might arrange for you to have blood tests and a Chest X-ray. If your GP is concerned about your symptoms and your test results they may refer you to a Rapid Access Lung clinic.23

The aim of this clinic is to quickly establish whether lung cancer is present, to determine the extent of the disease and to have a multidisciplinary team of experts discuss your individual case. Test carried out in the Rapid Access Lung clinic may include one or all of the following: chest X-ray, bronchoscopy and CT scans (CT or PET-CT). Commonly, a biopsy, or small piece of the lung tissue, will be obtained to confirm the diagnosis. Most often, this is obtained by a bronchoscopy or by a CT-guided biopsy.24

Treatment for lung cancer

Many hospitals have multidisciplinary teams (MDTs) that treat lung cancer. This team together will discuss and plan your treatment. Your treatment depends on several factors including the following:

• the type of lung cancer you have
• how big it is and whether it has spread (the stage)
• your age and general health
• if it is primary or secondary lung cancer

The most common types of treatment for lung cancer are:

• surgery
• radiotherapy
• chemotherapy
• immunotherapy
• targeted therapy

You may have a combination of treatments. You can also ask if you can take part in a clinical trial.29, 30

Smoking and lung cancer

Tobacco smoke contains more than 70 toxic substances that are carcinogenic (cancer-producing).

Your risk of developing lung cancer:

• is higher if you smoke or smoked
• gets higher the more you smoke
• gets higher the longer you smoke27

If you smoke, the best way to reduce your risk of lung cancer is to quit. Quitting can be hard but with the right help you can double your chances of success. The HSE offers free support and advice on the different options that help with nicotine withdrawal. Their team will support you every step of the way.

• Freephone 1800 201 203 for a free Quit plan
• Visit the HSE website to create your own Quit Smoking Plan Create your quit smoking plan – Quit.ie (hse.ie)28

References available on request

Written by Bernie Carter, Assistant Director of Nursing, Marie Keating Foundation

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