Lung Cancer: why early awareness matters

What is lung cancer?

Lung cancer develops when abnormal cells grow uncontrollably in the lungs. It is categorised into two main forms based on where the cancer originates. Non-small-cell lung cancer (NSCLC) accounts for around 80–85% of lung cancer cases. Small-cell lung cancer (SCLC) is much less common but typically spreads faster than non-small-cell lung cancer.

What increases the risk of lung cancer?

Smoking is the largest single risk factor, responsible for an estimated 72% of lung cancer cases. 

Other risk factors include:

• Cigars, pipe tobacco, and smokeless tobacco products
• Smoking cannabis
• Long-term exposure to air pollution
• Radon gas, a naturally occurring radioactive gas found in some buildings
• Occupational exposure to substances such as asbestos, silica, arsenic, coal dust, or coke fumes
• Regular exposure to diesel exhaust

For many industries such as construction, transportation and manufacturing, workplace exposure can contribute to long-term lung health risks if not properly managed.

What about vaping?

There is currently limited long-term data on the relationship between vaping and lung cancer.

While e-cigarettes are generally considered less harmful than smoking tobacco, they are not risk-free and may still have health impacts that researchers are continuing to investigate.

What are the early symptoms of lung cancer to watch for?

According to the NHS, symptoms of lung cancer can include:

• A persistent cough lasting more than three weeks
• A long-standing cough that gets worse
• Coughing up blood
• Frequent chest infections
• Pain when breathing or coughing
• Persistent breathlessness
• Unexplained weight loss
• Loss of appetite
• Ongoing fatigue or low energy
  
  

Less common symptoms include:

• Changes to the shape of the fingers (known as finger clubbing)
• Difficulty swallowing
• Wheezing
• Hoarseness
• Persistent chest or shoulder pain
  

These symptoms can have many causes, but persistent or unusual symptoms should always be checked by a healthcare professional.

Why lung cancer is often diagnosed late and why early detection is important

In its early stages, lung cancer often produces few or no symptoms, or symptoms that mimic less serious conditions such as asthma or chest infections. This can delay people seeking medical advice, and by the time more recognisable symptoms appear — such as coughing up blood — the cancer may already have progressed.

Detection is also challenging because the lungs sit deep within the chest, meaning tumours cannot usually be felt from the outside. Unlike cancers such as breast or testicular cancer, lung cancer rarely presents as a noticeable lump, so diagnosis relies heavily on imaging tests rather than physical signs.

A chest X-ray is often the first step in investigating possible lung cancer. However, these scans are not always definitive. Research suggests that more than 20% of lung cancers may be missed on an initial chest X-ray, meaning further tests are sometimes needed.

Access to screening also plays a role. 

One screening method used  is a low-dose CT (LDCT) scan. This type of scan uses a lower level of radiation than a standard CT scan while producing more detailed images of the lungs than a chest X-ray, allowing smaller abnormalities to be detected earlier. Large clinical trials have shown that LDCT screening can reduce lung cancer deaths in people at higher risk, which is why it is used in targeted screening programmes. However, LDCT screening is not routinely offered to everyone.  Scans can sometimes identify abnormalities that turn out to be harmless, which may lead to additional investigations and anxiety for patients. For this reason, screening programmes are usually focused on people at higher risk, such as adults aged 55–74 with a history of smoking.

In the UK, the NHS is gradually expanding Lung Health Check programmes, which combine a risk assessment with LDCT scanning for eligible individuals, although availability still varies across regions.

Together, the lack of early symptoms, the difficulty of self-detecting changes in the lungs, and limitations in screening help explain why lung cancer is frequently diagnosed at a later stage. Currently, only around 25% of non-small cell lung cancer (NSCLC) cases are diagnosed at stage 1 or 2, when surgery is more likely to be a treatment option.

Early diagnosis can make a significant difference to outcomes. Survival rates decline as the cancer spreads — from around 65% five-year survival when diagnosed at stage 1, to around 5% at stage 4. This highlights the importance of awareness of symptoms and risk factors, particularly for people with a history of smoking, as well as wider preventative health strategies that support smoking cessation and long-term lung health.

Reducing your risk

While not all lung cancer cases can be prevented, several steps can significantly reduce risk:

• Stopping smoking or reducing tobacco use
• Avoiding second-hand smoke
• Reducing exposure to harmful workplace substances
• Maintaining good air quality at work and home
• Attending screening if eligible
  

For employers, particularly those with frontline or safety-critical workforces, supporting smoking cessation, improving air quality, and encouraging preventative health awareness can play an important role in protecting long-term workforce health.

Recommendations for employers

• Designate smoking areas away from entrances to reduce second-hand smoke exposure for non-smokers.
• Review absence policies to ensure they do not penalise employees who are actively trying to quit. Nicotine withdrawal can temporarily affect concentration, mood, and productivity.
• Allow time for Nicotine Replacement Therapy (NRT) or vaping (where used as a smoking cessation tool) in the same way smoking breaks are permitted, supporting employees during the quitting process.
• Subsidise NRT to lower the financial barrier for employees who want to quit smoking.
• Run an internal No Smoking Day or Week. Aligning this with National No Smoking Day can increase engagement and awareness, but organisations can also choose a date that fits their internal wellbeing calendar. This initiative can act as a conversation starter, encourage employees to seek support, and promote available quitting resources.
• Create a peer support network for employees who want to quit together. Research shows that quitting with a partner or support group significantly improves the chances of long-term success.
  

Why workplace support matters

Smoking is the leading cause of lung cancer, responsible for the majority of cases. While stopping smoking can significantly reduce a person’s risk over time, quitting is often challenging without the right support. Workplaces are in a unique position to help by creating environments that encourage healthier choices and make it easier for employees to access smoking cessation support.

By promoting awareness, providing practical resources, and fostering a supportive culture, employers can play an important role in reducing smoking rates and helping to lower the long-term risk of lung cancer across their workforce.