Lung Cancer

Lung cancer kills over 35,000 people a year in the UK, and over 80% of cases are due to smoking and exposure to polluted air, radiation, and dangerous chemicals. So, what is the history of lung cancer? And what are the public health challenges with lung cancer?

Today, lung cancer is the third most common cancer in the UK. Cases peaked in the 1980s and have been decreasing slowly since then thanks to recent advances in the management of lung cancer. How has the government helped the fight against lung cancer in Britain? Let's find out!

Meaning of Lung Cancer

The meaning of lung cancer is that it is a disease that affects the lungs when cells abnormally divide to form tumours. There are different causes of lung cancer, but many cases are preventable.

Causes of Lung Cancer

Lung cancer is a result of mutating cells forming tumours and can affect anyone. However, certain factors and lifestyle choices can increase the risk of lung cancer. Let's look at some causes of lung cancer.

• Smoking tobacco is the most common cause of lung cancer, responsible for around 72% of all cases in the UK.

• Air pollution can contribute to the risk of lung cancer. There are particulates present in exhaust fumes from cars, factories, and incomplete combustion of fossil fuels. Polluted air accounts for roughly 10% of cases of lung cancer.

• Dangerous chemicals can also lead to lung cancer, such as asbestos, chromium, cadmium, and uranium. Exposure to these substances can be common in certain jobs, such as working in power plants.

• Exposure to radioactive substances, such as radon gas, can cause cancer. Radon exposure can occur naturally from soil, and some areas of the UK are more concentrated than others. Radiation causes around 5% of cases of lung cancer.

• Genetics are also a factor. A family history of lung cancer can increase the likelihood of being affected.

These reasons demonstrate how physical and environmental factors can increase the risk of lung cancer. Reducing exposure to these causes can help the fight against lung cancer in the UK.

Fig. 1 - An x-ray of lung cancer in a patient. There are many causes of lung cancer, but the majority of reasons are preventable

Public health challenges with lung cancer

Public health challenges with lung cancer are often associated with the economic costs of limiting the causes. Dangerous chemicals, poor air quality, and smoking are the top 3 preventable causes of lung cancer, and yet they are the result of beneficial economic development in the UK. Let's find out the difficulties with legislating against the causes of lung cancer.

Asbestos and harmful substances

Asbestos became a major concern after it was linked as one of the causes of lung cancer because it was a commonly used substance. Let's look at how asbestos was used, its dangers, and the legislations put in place to prevent against its exposure.

Fig. 2 - A Lancashire asbestos factory in 1918. Women often worked in asbestos factories during the First World War whilst the men were at war. Asbestos was used to make roof tiles, mattresses and many other products. Source: Wikimedia Commons

Benefits of asbestos

Asbestos was an incredibly useful substance that was used on a mass scale during the Industrial Revolution (1760-1840). It was used to make:

• Roofing.
• Thermal, Electrical and Acoustic insulation.
• Bricks.
• Mattresses.

The versatility of asbestos meant that it was used widely in the UK's industries and had a massive benefit to the economy. Even as of 2021, it is estimated that 20% of workplaces and 75% of hospitals and schools have asbestos-containing materials in them.

Dangers of asbestos

Although asbestos was an incredibly useful substance, there are dangers associated with exposure to it.

• The long thin fibres of asbestos can cause lung scarring when inhaled.
• Asbestos was originally handled freely by factory workers without regulation, increasing their risk of health problems.
• Fine dust can be released from materials containing asbestos if the item is damaged.
• The lung scarring from asbestos inhalation can mutate into lung cancer after long exposure to the substance.

Legislation to reduce asbestos exposure

Asbestos exposure became one of the key public health challenges with lung cancer. Let's look at the government acts that have aimed to reduce exposure to asbestos for factory workers and users of the products.

• After the 1930 report on the dangers of asbestos by the Government Factory Inspector, the 1931 Asbestos Industry Regulations Act was introduced to control the amount of asbestos particulates in factories.

• The 1937 Factories Act put in place regulations for employees of industrial factories, including regulation of asbestos. The Factories Act was revised multiple times, including in 1948, 1959, and 1961, to improve employee health and safety.

• In 1969, The Asbestos Regulations Act was passed, imposing more controlled regulations on asbestos.

• Voluntary asbestos bans were put in place throughout the second half of the 20^th century, eventually resulting in the 1999 Asbestos (Prohibition) Act banning all use and importation in the UK.

Even though asbestos was eventually banned for the severe health problems it caused, this process was slow because of the usefulness of the substance in industry.

Polluted air

Air pollution often contains particulate matter, such as soot, which is released from the fumes of factories and exhausts from vehicles. Along with the poisonous gases, these substances increase the risk of certain health conditions. In particular, polluted air is one of the causes of lung cancer.

Fig. 3 - Guy's Hospital released harmful pollutants into the air in 1987 despite regulations. Many industries in Britain burned fossil fuels and released toxic substances.

"Benefits" of polluted air

Although polluted air is a major public health concern, the processes causing it were beneficial to the British economy.

• Power plants released lots of pollution from burning fossil fuels to create steam power. Steam was used to generate electricity which was useful for many processes throughout the UK.

• Pollution is also released from transport such as trains, cars, lorries, boats and planes. The infrastructure and economy of the UK have dramatically improved because of these new links but air pollution is a by-product.

Dangers of polluted air

Air pollution itself did not directly affect industries or the economy but became one of the significant public health challenges, with lung cancer being a result. Such problems with polluted air include:

• Toxic smogs caused by factory pollution such as the Great Smog of 1952 in London were a massive public health risk, with the Great Smog being responsible for the deaths of up to 12,000 people.

• Air pollution is one of the causes of lung cancer, alongside other health problems such as strokes, asthma, and organ damage.

Legislation to reduce air pollution

The 1956 Clean Air Act was a major turning point for controlling harmful emissions. Air Quality Legislation throughout the 20^th and 21^st centuries has attempted to reduce the potential risks of lung cancer and other diseases.

Smoking

Smoking is particularly difficult to legislate against because the habit is a personal choice, smoking is addictive, and there was pushback from the tobacco industry.

Fig. 4 - A soldier smokes whilst cleaning his rifle in the trenches in 1918. Smoking was very popular among troops to boost morale, but many became addicted

"Benefits" of smoking

Although smoking is bad for your health, the tobacco industry was booming because of the habit. Below are some of the "benefits" of smoking.

• Smoking became a popular habit during the World Wars whilst in the trenches. Cigarettes were provided to troops to boost morale, and by the end of the 1940s, 80% of men and 40% of women smoked.

• Cigarettes contain the addictive substance of nicotine, which can make you feel relaxed. Smoking is used by some to reduce stress.

• The cigarette industry brought a lot of money and jobs into the UK throughout the 20^th century. This made legislation difficult because it would have detrimental economic effects on Britain.

Dangers of smoking

Despite its relaxation effects, smoking causes considerable health problems.

• Smoking is one of the causes of lung cancer, alongside heightened risks of strokes, diabetes, and heart disease and many other problems. Modern cigarette smoke contains more than 60 carcinogens, and previous cigarette contents were a lot worse.

• Smoking affects others around you who breathe in second-hand smoke. In 2019, roughly 1 in 6 victims of lung cancer were non-smokers, affected by air pollution and inhaling second-hand smoke.

Legislation against smoking

As smoking is a personal choice rather than an effect of other industries (like asbestos and air pollution), legislation to reduce smoking in the UK came through public health anti-smoking initiatives and taxation and legislation against tobacco companies.

• In response to the 1962 "Smoking and Health" report released by the Royal College of Physicians, cigarette tax was increased, tobacco advertising was restricted and more information was released about the potential harm of smoking.

• In 1965 the government banned TV advertising of cigarettes. In 1972, cigarette advertising was heavily restricted in the UK and health advice was issued on cigarette packets.

• In 1991, The Children and Young Persons (Protection from Tobacco) Act was introduced, prohibiting cigarette sales to anyone under 16.

• All advertising was eventually banned in the 2002 Tobacco Advertising and Promotion Act.

• In 2007, smoking indoors in public was made illegal due to the requirements of the 2006 Health Act. This reduced the risk of second-hand smoke in public venues.

Throughout this process of legislation, the tobacco industry pushed back hard against the economic changes to their industry. Often tobacco companies would publish conflicting reports on the health benefits of smoking, which made turning public opinion difficult. The economic pushback from these companies contributed to the many public health challenges with lung cancer.

History of Lung Cancer

Lung cancer was first identified in the mid-19^th century and was considered relatively rare at the time. But what has the trend in the rate of lung cancer been like since? Let's look at the history of lung cancer.

• Throughout the 20^th century, due to advancements in textiles (asbestos), industry (air pollution) and social habits (smoking), cases of lung cancer increased dramatically.

• Many studies linking smoking and lung cancer were conducted throughout the 20^th century, such as Ernest Wynder and Evarts Graham's research in 1950. Their paper concluded that smoking was a factor in cases of lung cancer, but was not considered a cause. Despite the evidence presented, it was not until 1954 that Wynder established that smoking caused lung cancer.

• Mortality rates from lung cancer peaked in the 1980s but have started to decline since. Between 1971 and 2018 the number of deaths from lung cancer decreased by 29%.

• Recent advances in the management of lung cancer have managed to reduce the number of deaths, particularly with the work of WHO and its campaigns against smoking.

Fig. 5 - A 1950s Nigerian anti-smoking poster explaining the risks of smoking whilst Nigeria was under British rule. Despite similar kinds of poster campaigns in the UK, smoking rates continued to increase throughout the 20^th century.

WHO and lung cancer

WHO (World Health Organisation) is a United Nations agency established in 1948 and is responsible for global public health. WHO cannot pass legislation but has had the ability to declare global health emergencies as of 2007.

The public health challenges with lung cancer have largely been helped by WHO's declaration that tobacco consumption is a global health emergency and the organisation's subsequent campaigning. So how did WHO help to reduce the rate of lung cancer?

• Government efforts had largely failed up until the 1970s, as is evident from the rising number of cases of lung cancer up until the 1980s.

• In 1970, WHO released "The limitation of smoking" report which campaigned for the end of tobacco advertising with other health recommendations. The report was widely publicised and caused cigarette use to drop by 5%.

• WHO released another report in 1979 entitled "Controlling the smoking epidemic", which was heavily publicised in the news.

• In 1998, WHO wanted to reduce the number of European smokers to under 20% by 2015.

• The 2008 "Global Tobacco Epidemic" WHO report estimated that by 2030 tobacco would be responsible for 1 billion deaths globally without government intervention.

WHO's comprehensive research, campaigns, and reports have demonstrated how health warnings, banning tobacco advertising and taxes are effective at reducing tobacco consumption. They have also campaigned for effective public health initiatives to help smokers to quit due to addiction issues.

Recent advances in the management of lung cancer

The treatment of lung cancer has changed in recent years due to highly funded cancer research charities. This has helped to reduce the number of deaths from the disease. Let's look at some recent advances in the management of lung cancer.

• Most patients receive radiotherapy or chemotherapy to treat their lung cancer. Radiotherapy was developed in the late 19^th century and chemotherapy was discovered in 1935 but became available as a treatment in the 1940s.

• Over the 20^th century, these treatments were majorly improved, with chemotherapy first curing metastatic cancer in 1956.

• These expensive treatments were provided for free when the NHS was established in 1948, with funding provided by general taxation and national insurance.

• In 2012, it was reported that patients with lung cancer were costing the UK economy more than £2.4 billion a year due to NHS treatment, work absences, and premature deaths.

• After diagnosis, roughly a third of patients live for a year after they are diagnosed, and 5% live for 10 years. Although death rates are dropping, they are still very high.

Fig. 7 - An example of a radiation therapy machine used in hospitals to treat cancers. The machines have been improved since the use of this treatment began in the late 1800s.

The fight against lung cancer has been a major public health challenge since cases of the disease began to rise significantly in the early 20^th century. Due to advances in medical technology, the mortality rate has dropped, but the rate of cases is still a concern to public health. As lung cancer is considered a preventable disease, more work is needed to reduce the risk of the disease.