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When Karen Boniface started coughing and wheezing one summer, she immediately recognised the symptoms. Like an estimated ten million Britons, she suffers from seasonal hay fever and this time felt no different. 'Usually I cough up phlegm, my nose runs and I tend to get chesty and wheezy - typical hay fever symptoms,' says Karen, 53, from Studland, Dorset.
'I had these symptoms for a few months, but I thought nothing of it: it seemed the same as the previous three years I'd had hay fever.' Yet unbeknown to Karen, she was actually displaying early signs of lung cancer.
'I thought nothing of it': Like ten million Britons, Karen Boniface suffers from seasonal hay fever, so when she started coughing and wheezing, she assumed that was the cause of her symptoms
Although it is the second most common cancer in the UK, with 35,000 cases a year, many people are unaware of the symptoms so it is caught too late, says Dr Rohit Lal, a consultant oncologist from Guy's and St Thomas' NHS Foundation Trust.
As a result, just 9 per cent of patients survive for five or more years after diagnosis, making it the most common cause of cancer death for men and women in the UK.
But it can be a hard disease to spot, adds Dr Lal, who also works at the BMI Blackheath Hospital. The early signs can be subtle or attributed to other conditions, leading many people to assume they are down to allergies, colds and flu.
This point is echoed by Sean Duffy, national clinical director for cancer at NHS England. 'A number of people are generally unaware of the potential symptoms of lung cancer, or associate a persistent cough with the seasons - hay fever, allergies or winter coughs and colds. This can often result in people delaying a visit to their GP, which could be the difference between receiving an early or late diagnosis.'
But it's the duration of symptoms that sets colds and hay fever apart from lung cancer, explains Dr Lal.
'Hay fever happens in bouts, can vary from day to day and should be eased with antihistamines. But lung cancer symptoms don't disappear after a few weeks, and progressively get worse.'
Mistaken illness: The symptoms of lung cancer can be tricky to spot - many assume they are a result of allergies, cold and flu
Lung cancer is most common among the over-50s, but the biggest increase in the past four years is in the over-75s due to the ageing population, says Mr Duffy.
There are also around 10 per cent more cases in the under-40s compared with ten years ago. Dr Lal says the youngest case he has seen has been in a 23-year-old. It is thought it is becoming more obvious in women because rates of men smoking are declining faster.
In 1948, 65 per cent of men smoked, compared with 41 per cent of women. Now, 20 per cent of women smoke, compared with 21 per cent of men.
Evidence has also shown that women are more prone to a particular type of lung cancer, driven by a genetic defect. This type of cancer is called an adenocarcinoma, and scientists are unsure why women are more at risk, although it may be linked to hormones.
Scientists from the University of Turin, Italy, found there was a slightly increased risk (less than 5 per cent) of lung cancer for women on HRT, so it's thought the female sex hormone oestrogen may play a role, but more research is needed.
The most common symptoms of lung cancer are a cough lasting three weeks or more, loss of appetite and weight loss, tiredness, breathlessness and chest pain. Yet people are often reluctant to bother their doctor with these symptoms, says Mr Duffy, which could be contributing to the high death rates from the disease.
'Compared with other European countries' survival rates, England significantly lags behind because over two thirds of patients are diagnosed at a late stage,' says Mr Duffy. 'By this point, curative treatment is often no longer viable. Some people might not want to bother their doctor, but please do - it's always best to be sure.'
But there are other, more surprising, symptoms of lung cancer that patients often miss, says Dr Lal. One of these is rounded 'clubbed' fingernails, which occur in one case in ten.
No one knows exactly why, but this symptom can be seen in conditions where there is a lack of oxygen getting into the body, such as congenital heart defects. More often, though, it is a sign of lung problems.
Typically, nails feel spongy and look curved. The ends of the fingertips appear swollen and are often slightly blue in colour.
'They look a bit like matchsticks,' says Dr Land,
'For some patients, lung cancer is diagnosed only after a doctor notices their nails and sends them for an X-ray, although it's usually one of many symptoms. However, not all doctors are aware it's a sign.'
Karen developed clubbed fingertips and nails around five months after first getting her 'hay fever' symptoms, but she noticed them only when a chiropractor, whom she had visited for an unconnected back complaint, remarked on them and advised her to see her doctor.
She had seen her GP previously, as she had started to feel incredibly tired. She was diagnosed with borderline anaemia and given iron pills, but these didn't ease her exhaustion.
On seeing her fingernails, however, her doctor sent her for a chest X-ray because he knew they could be linked to lung problems. Karen was horrified when this showed a tumour on her right lung, and further tests confirmed cancer.
The tumour was removed and fortunately the cancer hadn't spread. Karen had a short course of chemotherapy and was given the all-clear five years later. Karen was lucky, but Dr Lal says that in other patients the symptoms are missed.
Apart from clubbed fingernails, other surprising symptoms include pain in the shoulder and weakness or numbness in the hand. This occurs in around 10 per cent of lung cancer cases, when the tumour grows at the top of the lung. When it expands, it presses on the nerves running through the shoulder.
'People go to their doctor with shoulder, wrist and arm problems that they've tried a few things for but the pain hasn't gone after a couple of weeks,' says Dr Lal. 'The GP sends them for a chest X-ray and finds something at the top of the lung.'
However, he stresses that pains such as these are usually due to arthritis or muscle strain.
Dr Lal adds it's also important to take note when a chest infection does not clear up after a course of antibiotics, as many GPs prescribe three of four courses before sending a patient for a chest X-ray.
Surprise symptom: Rounded 'clubbed' fingernails are a sign of lung problems; this patient's nicotine-stained finger exhibits the condition
'GPs can be hesitant to send people for X-rays, for example someone who is coughing up blood but is young and seems otherwise fit. But they don't cost much - about £40.
'It can also be due to lack of awareness. Symptoms are often put down to hay fever, chest infections and bronchitis before lung cancer is considered.'
Non-smokers should not assume they are not at risk, he adds. Although smoking is the biggest risk factor (Karen had smoked for 26 years, but gave up when her cancer was diagnosed), one case in five occurs in non-smokers.
This is thought to be largely due to other environmental factors. These include second-hand smoke, air pollution and exposure to asbestos.
For smokers, the risk of lung cancer drops significantly five to ten years after quitting, although it stays higher than in a non-smoker. Karen is glad she saw her doctor when she did.
'Since my diagnosis at 44, I've looked at life differently,' she says. 'I try to be less stressed, have more fun and be positive. When you go through cancer, you realise what's important.
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