Peter Cardy on a new focus on lung cancer

In twenty years of working with the so-called dread diseases I have read many bleak reports. None has got under my professional guard like one I read when I was chairing the planning group on lung cancer for the National Cancer Research Institute (NCRI). It was a study of the services available in one area of the Midlands for lung cancer patients and their carers. To be honest, it made me weep.

Why? In its dispassionate language it brought alive the desperate plight of people with this ghastly condition, never being able to catch up with the calamitous progress of the disease, never being able to adapt to the constantly changing circumstances. Health and social care services too, even in a relatively well-provided area, never catch up. Home adaptations are often agreed while their disability progresses, but not carried out before the patient dies. Even the supply of necessities, literally vital like oxygen, is unreliable for patients for whom every breath is like climbing Everest.

Harry Burns, chief medical officer for Scotland, recently created a stir when he suggested that the ban on smoking in public places could lead to the virtual eradication of lung cancer within the 'next couple of decades'.

He exaggerated, of course: even if every smoker gave up today new cases of lung cancer would continue to emerge for the remaining lifetime of that group. And some 10 per cent of lung cancer cases are sporadic, occurring among non-smokers. Lung cancer is now the biggest killer among cancers, causing one fifth of all cancer deaths, almost three times as many as breast cancer, even though there are almost the same number of new cases.

Even if the most optimistic projection were true, it would be unimaginable to sit and do nothing while people die quickly and wretchedly from this disease. It is unfortunately true that very few of the 33,000 patients diagnosed this year will still be alive by the end of next. Few are suitable for surgery, currently still the best curative option, because the disease is generally discovered late. It has symptoms - persistent cough, fatigue and malaise - that it shares with many non-cancer diseases. It develops in tissues that are hard to examine, so is usually undetected until advanced and often metastatic.

While there has been striking progress in some cancers (women with breast cancer have three times more chance of surviving five years than they did thirty years ago), lung cancer research has languished. The point of the NCRI report was to put energy and funding behind it; Macmillan has pledged a further£1m for supportive and palliative care research.

Health and social care resources are also meagre and there are few evidence-based models of care. Because of its rapidly disabling effects, usually among older people (the median age at diagnosis is 72), lung cancer is almost invisible. Perhaps because of the stigma attached to a disease widely seen as self-inflicted through tobacco use, and the accompanying nihilism, it has had low priority. Lung cancer is a personal, social and health service disaster: it needs urgent attention.

Peter Cardy is chief executive of Macmillan Cancer Support