Nicole Ives was about to leave hospital after surgery to remove her infected appendix when medics made a chance discovery that would save her life.
An abdominal scan in October 2021 picked up a lump in her right lung.
“And there was a high probability that it was lung cancer,” Ms Ives said.
The timing was both devastating and lucky.
Just seven months earlier, the Queenslander had lost her much-loved husband Michael to “horrific” oesophageal cancer, leaving their three teenage children bereft.
Another cancer diagnosis was too much.
“I was very averse to even saying the word cancer to anyone in my family, especially my children,” she said.
While she was exposed to a lot of cigarette smoke in the 1970s and ’80s, as an avowed non-smoker herself, the type of cancer was also a shock.
“Because they [health authorities] did such a great job educating us about lung cancer and smoking, for someone like me, who never smoked, I probably wouldn’t have thought myself vulnerable in any way,” the 57-year-old said.
But the early diagnosis was also a blessing.
Her medical team monitored the mass until changes were spotted on scans last year, prompting her surgeon to remove a wedge of lung containing the tumour.
“It just blows my mind that I had that surgery and with clear margins, and that I haven’t had to go through chemotherapy or anything else,” the primary school teacher said.
Ms Ives had no symptoms when the scan first detected her early-stage cancer.
“I had no idea that it was there,” she said.
The world’s top cancer killer
Thoracic physician Dr Kwun Fong said lung cancer is the number one cause of cancer deaths in Australia and worldwide.
Around 9,000 Australians die from the disease each year.
“The reason why it’s got such a poor outcome is because when we detect it, usually it’s at a very late stage where cure is no longer possible and that’s because the lungs are an internal organ,” Dr Fong said.
“By the time we get symptoms, the cancer might be well advanced.”
The lung cancer researcher said smoking is the biggest risk factor for the disease, but other contributors include air pollution, diesel fumes, asbestos exposure and a genetic predisposition.
“In women who’ve developed lung cancer, about a third of women do not have a history of smoking,” Dr Fong said.
One in 10 men diagnosed with lung cancer are non-smokers, according to the Lung Foundation Australia.
Large new screening trial includes non-smokers
For the past decade, the specialist, based at The Prince Charles Hospital in Brisbane, has been conducting trials to assess the value of screening certain groups of people for lung cancer.
The latest phase will include 3,000 participants from across Australia in three different arms: never or light smokers, Aboriginal and Torres Strait Islander people, and current or former smokers.
Those who qualify for the trial will have a low-dose chest CT scan to check for early signs of lung cancer.
Senior health worker Mark Dorante encouraged eligible Indigenous Australians to participate.
“We are twice as likely to develop and die from lung cancer than non-Indigenous Australians,” Mr Dorante said.
National lung cancer detection program now underway
Dr Fong said the research aims to discover evidence that can help “tweak and improve” the newly launched National Lung Cancer Screening Program for heavy current or former smokers aged between 50 and 70 years old.
It’s estimated the targeted program will save 12,000 lives over the next decade.
“We’re very fortunate, we’re one of the few countries where this national program will be rolled out,” he said.
But not everyone is eligible, and Dr Fong said his latest trial aims to “advance the knowledge by finding out who else will benefit [from checks]”.
Firefighters are one group eager for screening due to the risks of cancer-causing smoke.
General manager of the Rural Fire Brigades Association Queensland, Justin Choveaux, said firies can be exposed “day in and day out” for months during the nation’s long fire seasons.
“My suggestion and my hope would be that all firefighters, whether you be full-time, part-time or volunteer, would be able to access free screening,” Mr Choveaux said.
The downsides of screening programs can include false positives, exposure to radiation from scans, and the detection of conditions that might never cause harm.
Dr Fong said his screening trial is expected to take up to three years to complete.
“[We] have to make sure that the benefits outweigh the harms and it’s affordable and can be feasible and practical in our health care system,” he said.
A spokesperson for the federal Department of Health said the National Lung Cancer Screening Program (NLCSP) is “underpinned by strong clinical evidence”.
“The NLCSP will undergo a comprehensive evaluation after two years to ensure that it remains responsive and evidence-based, which may include changes to the eligibility criteria,” the spokesperson said.
“Individuals who believe they may be at risk of lung cancer or have concerns about their lung health, should not wait for screening and are strongly encouraged to consult their healthcare provider.”
These days Nicole Ives is focused on her “strong” and “pragmatic” children, her kayaking trips and lifelong love of art.
She’s “overwhelmed” by the standard of health care she received and doesn’t dwell on her lung cancer, a life perspective she shared with Michael.
“He and I understood very well that the only thing you have is your attitude and the way that you think about things,” Ms Ives said.
Details of the Australian Lung Screen Trial can be found here.
