Q and A

Question

Can you provide a perspective on the risk of lung cancer?

My partner of 18 months gave up smoking several months ago but developed a cough that he can’t seem to shift (no other symptom and is working and incredibly active). He is 46 and has been on meds for the last seven years which have worked well maintaining a high cd4 and undetectable VL. He has been to see his doctor and is due a chest x-ray in the next week.

Both of us are very anxious about the results of the x-ray and are finding it difficult not to think about the worst.

Despite trying not to we have read up about the disease and in particular how it affects HIV+ people and have read that the risk of lung cancer can be 8 times higher in HIV+ people compared to HIV- people.

I just wondered if you could give some perspective to this, how prevalent is lung cancer in the general population and how does this compare with the HIV+ community?

Any information you can provide would be really appreciated.

Answer

Most people who have x-ray will not have lung cancer – so you really need the results of the x-ray before getting worried about the possible causes.  This is probably the most important information to know this week – though I haven’t got figures for this.

I know it is difficult not to worry but your partner sounds like he has done everything he can to look after his health. He has already stopped smoking and has had such a good response to HIV treatment.

A quick look at the studies looking at the increased risk relating to HIV are not the 8 times (700%) higher that you have heard. Some only refer to being 2-3 times higher but one only reported rates that were 70% higher (ie 0.7 times higher). Most of these studies find current smoking is a much higher risk than HIV and so it is good that your partner has already been able to quit. Given you may already be very worried about a worst case that is far from certain, I’m not sure including these links to these studies will help but I can send them if you’d like them.

The relative risk of something happening can often seem much worse that the absolute risk and you are right to be focused on these differences. If the absolute risk is 1 in 1000 over a certain period (0.1%) then a 100% higher risk is only 2 in 1000 and for most people this would still be low in absolute terms.

However, I’m not sure that trying to provide absolute risks would be helpful because these are so affected by individual circumstances such as his age, how much your partner smoked and for how long etc. Perhaps more helpful for your current concerns it that also smoking clearly increases the risk of lung cancer most smokers don’t die of lung cancer. According to Cancer Research UK, the lifetime risk in the UK is about 15% risk by the age of 75 for a lifelong smoker.

Having said this, being able to stop smoking dramatically improves the health for HIV positive people and this should be a major focus for most people.

I hope things go well with the x-ray – please let me know if I can help with more information afterwards.

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