The Frequently Misinterpreted Cough


Investigating Lung Cancer with Dr. Rabab Gaafar

Lung cancer is the uncontrolled growth of abnormal cells in the lung. It is the cancer that took the lives of cartoon and film producer Walt Disney, painter Claude Monet ‘Beatle’ George Harrison, Egyptian actress Ma’aly Zayed and Egyptian superstar Ahmed Zaky.

In a country where pollution is high, where 20 billion cigarettes are smoked annually, shisha water pipes are part of the common culture, and where people continue to neglect the heath risks of smoking even after the government passed legislation requiring graphic warnings to be placed on tobacco packaging, lung cancer continues to be a serious topic that must be touched upon.

To get to know more about lung cancer, Cairo West Magazine met up with one of Egypt’s most prominent specialists in this field, Dr. Rabab Gaafar, Professor of Medical Oncology at the National Cancer Institute (Cairo University). Dr. Gaafar is also the National Representative of Egypt at the European Society of Medical Oncology (ESMO) and a Board Member of the European Organization of Research and Treatment of Cancer (EORTC Lung Group).

CWM: Dr. Gaafar, what are the primary symptoms of lung cancer?

Dr. R.G.: Usually patients come with a cough, chest pain, fatigue and difficulty in breathing (dyspnea). Unfortunately, most patients are diagnosed late. Around 70% of the patients are diagnosed when the cancer has reached advanced stages. This happens due to the fact that most people misinterpret their cough as a normal smokers cough, or they confuse it with a cold or bronchitis. They consequently lose time, and do not do proper medical tests to check for cancer. Early detection is crucial in treating lung cancer.

Is smoking the primary cause of lung cancer?

Definitely. Smoking is the cause of lung cancer in around 85% of the cases. Other causes of lung cancer include pollution, radiation, and insecticides. Smoking does not only cause lung cancer, it causes cancer in any body part it goes through: lips, larynx, pancreas, bladder. For example, in countries like Yemen where they chew tobacco, mouth cancer is prevalent.

Is shisha a less dangerous smoking option?

This is a myth. Shisha is actually more dangerous than cigarettes. One shisha stone may be equivalent to 60 – 70 cigarettes. But cigarettes are just handier and you smoke them much more frequently than shisha. The misconception that shisha is a light type of smoking because the tobacco in it contains fruit flavors is what is causing younger generations of both genders to resort to it in their normal outings in cafés. This is a dangerous phenomenon.

What about the electronic cigarettes?

E-cigarettes contain only nicotine and some vapors. They have the advantage that they do not contain the extremely dangerous carcinogenic parts like tar and hydrocarbons. However, it is still under research and investigation. Lets not forget that nicotine alone has many harmful effects. People can use e-cigarettes as a method to stop smoking, but not as a long-term solution.

What age group is lung cancer most prevalent in?

Lung cancer is mostly prevalent in older ages, above 60 years old. But of course people of any age can get lung cancer.

What are the different treatment options for lung cancer patients?

We treat lung cancer according to the stage it has reached. In case of early detection, we treat it with surgery. If it is stage 2, we must add chemotherapy after the surgery to prevent recurrence and to prolong the life of the patient. In more advanced stages, we mainly do not resort to surgery. We use radiotherapy and chemotherapy. In the metastatic or extremely advanced stage, we use mainly chemotherapy and keep radiotherapy for areas of metastasis.

What new developments and therapies can you tell us about?

In the last decade, a new medical model called “personalized therapy” appeared. We use personalized therapy in advanced cases of lung cancer. Personalized medicine is used to learn about a person’s genetic makeup and how their tumor grows. We perform biological tests on the tumor to determine a personalized tailored type of treatment; chemotherapy, targeted therapy or immunotherapy.

Immunotherapy is also a recent breakthrough in cancer treatment that directs the body’s own immune system to fight cancer cells. To explain this therapy very simply, we must know that usually tumors send messages to the immune system that they are part of the body so the immune system does not fight them. This therapy acts upon the immune system making it recognize that the tumor is a strange foreign body that must be fought.

Are lung cancer rates high in Egypt?

Lung cancer rates are high in Egypt. I must point out that lung cancer is much more prevalent amongst Egyptian men than women. This is due to the fact that some cultural traditions in Egypt and the Middle East still look down upon women smoking. Less smoking amongst women has resulted in fewer women lung cancer patients. Six percent of all cancer patients in Egypt have lung cancer. However, if we look at the male population alone, then around 10% of all male cancer patients in Egypt have lung cancer.

However, I do believe that the ratio between men and women lung cancer patients in Egypt will change again soon because of the shisha. Shisha smoking amongst women and teens is much more socially accepted than before and is becoming part of the social outing custom. The number of lung cancer cases amongst women is increasing.

What are the survival rates amongst lung cancer patients?

As I said earlier, early detection is crucial in lung cancer. General numbers show that lung cancer survival rate is 20%. Survival rates amongst early-detected patients reach around 70 – 80%. However, in advanced stages, survival rates become less than 5%.

How harmful is second-hand smoking?

Being exposed to second-hand smoke is harmful in many ways especially to children. Non-smokers who breathe in second-hand smoke take in nicotine and other toxic chemicals just like smokers do. However, we don’t have exact numbers regarding how many people got lung cancer from second-hand smoke. It is hard to differentiate if someone got cancer from second-hand smoke or pollution. Smoking must be completely eliminated to decrease the threat of cancer. I am very supportive of all procedures taken to prohibit smoking in public areas. People should not be allowed to harm others.

Can our diet help us prevent cancer?

Of course. Eating healthy reduces your risk of cancer.  Drink green tea. Eat cruciferous vegetables like broccoli, cabbage, cauliflower and Brussels sprouts. All anti-oxidants in general help decrease cancer risk. Avoid artificial coloring, overly burned food, and used oil especially the overly-used oil in many falafel shops in Egypt. Generally, It’s not a good idea to use oil more than once. Also, do not put hot food in plastic containers.

Is lung cancer easily preventable?

It now should be clear that lung cancer is one of the most preventable types of cancer taking into consideration that 85% of lung cancer patients got it as a result of smoking. My advice is to stop smoking. Please stop any type of smoking immediately!


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