When Debra Montague goes to the doctor's, the first thing she says is: 'I am a non-smoker, I've never smoked.'
Debra, 54, has advanced lung cancer — despite never picking up a cigarette in her life — and, as she says: 'I still feel I have to tell doctors, nurses, anyone I meet for the first time that I've never smoked, because unless I say it first, I feel judged or blamed; that the cancer is somehow my fault.
'Of course, it's wrong to judge smokers who have cancer, too. But I still feel I have to explain myself. People think of lung cancer as something only smokers get.'
In fact, while smoking is the biggest risk factor for lung cancer (due to more than 60 cancer-causing chemicals in tobacco) and is responsible for 85 per cent of cases, research suggests lung cancer in non-smokers is on the rise.
Debra Montague, 54, has advanced lung cancer — despite never picking up a cigarette in her life (stock image)
Cases have doubled in the past seven years, according to a recent study led by Eric Lim, a consultant thoracic surgeon at Royal Brompton Hospital and Harefield NHS Trust in London, published in the European Journal of Cancer.
Non-smoking lung cancer accounts for a third of patients undergoing surgery at the Royal Brompton Hospital and worryingly, Mr Lim says, non-smokers may have more difficulty getting diagnosed, meaning their cancer is spotted at a later stage when it's harder to treat.
'In general, patients with lung cancer present late because there are no symptoms such as pain or a cough when the cancer is small,' he says. 'When there is a cough, for non-smoking lung cancer the problem is compounded as they are considered low risk — a persistent cough in a smoker and non-smoker will be managed very differently, with doctors less likely to send non-smoking patients for lung scans.'
Debra, a former marketing manager from Guildford, Surrey, was fit and otherwise healthy when she returned from holiday with a cough, in the summer of 2016.
'It wasn't a normal throaty or chesty cough,' recalls Debra. 'It was from low down — a deep, strong cough. It resonated through my bones.' She had no other symptoms and otherwise felt fine. 'My colleagues started jokingly leaving cough sweets on my desk because it was so irritating. It's thanks to them I eventually decided to see the GP.'
This was eight weeks after the cough first appeared.
'The GP listened to my chest and said it sounded clear and that, because I'd never smoked, there was no risk of anything sinister,' says Debra. 'But she sent me for blood tests and an X-ray to be on the safe side.' A few days later her GP rang with the results — the blood tests were normal but the X-ray was 'inconclusive'.
Non-smoking lung cancer accounts for a third of patients undergoing surgery at the Royal Brompton Hospital (stock image)
Debra had private health insurance through her work at a pharmaceutical company so went to a private respiratory consultant to be seen sooner. Another X-ray showed one lung was clear but the other looked 'snowy' and the consultant recommended further scans, including CT (a form of X-ray that produces a cross section image of the body).
Again Debra was reassured it would 'not be lung cancer' and so returned for the results a week later on her own after work. 'I'd been told several times I wasn't at high risk so I wasn't nervous,' she says.
At first, her consultant said he wasn't sure what the scan showed but she pushed him. 'I could tell he was being kind, holding back,' she says. 'I asked: "Is it cancer?" and he replied it was most likely cancer.'
Debra, who is divorced, has a