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  » Cancer: risk chart  »  Lung cancer Risk Assessment

Risk Factors

  • Tobacco smoking. More than 90% of cases of lung cancer have a history of regular smoking. The risks increase with the total duration of smoking and the amount smoked.
  • Age. Lung cancer is unusual below the age of 50 years and becomes increasingly common up to the age of 70+.
  • Chronic Airflow Obstruction. The presence of CAO confers a 4-6 fold increased risk of developing lung cancer independent of smoking.
  • Occupation. Asbestos is the commonest occupational risk factor
  • Exposure to environmental radon

Note that male gender is no longer a risk factor.

Common presenting syndromes

Smoker or an ex-smoker with:
1. persistent cough, with or without sputum, not responding to antibiotic and consulting GP more than twice.
2. haemoptysis, coughing streaks of blood in the sputum, often worse in the morning.
3. Gradually progressive breathlessness, chest pain and weight loss over a few months.
4. Known COPD with apparent exacerbation not responding to conventional treatment.
5. Non-specific illness with anorexia, malaise and cough +/- weight loss.
6. Sudden onset of hoarseness that does not improve rapidly.

Non respiratory syndromes associated with Lung Cancer

1. Anaemia, (normochromic, normocytic).
2. Hypercalcaemia
3. Hypercoagulability
4. Inappropriate ADH secretion (hyponatraemia)
5. Ectopic ACTH, neurological syndromes, rashes, Hypertophic Pulmonary OsteoArthropathy and a variety of other conditions are all rare.

Flow chart for Lung Cancer risk


High risk groups

The first pre-requisite to reaching the diagnosis of lung cancer accurately and quickly is an awareness of the risk profile of your patient together with their clinical features. You need to have a particularly high index of suspicion in:

  • Smokers or ex-smokers aged 50 or over, especially with a smoking history of 30 pack years or more.
  • Patients with the above category are particularly susceptible if they also have evidence of chronic airflow obstruction.

The disease is also commoner in men and in those from lower social echelons.