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Eddie Low, who is medically considered a non-smoker, has lung adenocarcinoma, which is the predominant subtype of lung cancer in men and women in Singapore, 2 November 2024. The Straits Times/Asia News Network
SINGAPORE — At Mr Eddie Low’s routine medical check-up in 2017, the doctor found something suspicious in his liver and one of his lungs. Further tests showed he had liver cancer and lung cancer.
They were both primary cancers, meaning cancer did not spread from one organ to the other.
Article continues after this advertisementThat year, he underwent keyhole surgery for his liver and lung simultaneously to remove the tumors. One lobe in his right lung was also removed.
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A year later, Mr Low found out he had primary cancer in his prostate. Around the same time, the cancer in his lung had spread to the lymph node within his thorax. He had to go for chemotherapy and radiation therapy.
Article continues after this advertisementEight months later, he found out that the cancer in his liver had relapsed.
Article continues after this advertisementBefore Mr Low found out about his three primary cancers, he had no symptoms.
Article continues after this advertisement“I didn’t feel like something was wrong. If I didn’t go for a medical screening, I would have probably found out much later,” says the 66-year-old retiree, who used to work in a church. He is married to 64-year-old Angela Low, who works in the education sector, and they have a 34-year-old daughter.
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Article continues after this advertisementDealing with the cancers has not been easy.“When one cancer appears to be contained, another flares up,” he says.
November marks Lung Cancer Awareness month, which highlights the importance of early detection and education around a disease that remains a significant health threat in Singapore.
Lung cancer is the third most common cancer in men and women in Singapore.It is the leading cause of cancer death among men and third most common cause of cancer death in women here.
According to a 2024 study published in Nature Reviews Clinical Oncology journal, lung cancer in people who have never smoked is estimated to be the fifth most common cause of cancer-related deaths worldwide in 2023, occurring more in women and Asian populations.
More women, younger adults have lung cancerAssociate Professor Sewa Duu Wen is head and senior consultant at Singapore General Hospital’s department of respiratory and critical care medicine. He says that since the 1980s, the incidence and mortality rates of lung cancer in Singapore have steadily declined, particularly in men, largely owing to measures that reduce smoking.
“As smoking prevalence in Singapore has declined, the proportion of lung cancers occurring in people who have never smoked has increased, particularly among women and those in younger age groups,” he adds.
Some of his patients are in their 20s and, increasingly, they are below age 50.
The reasons for the increase in lung cancer among women and younger adults are not entirely clear. Possible contributing factors include prenatal exposure, environmental toxins and lifestyle factors like diet and obesity, notes Prof Sewa.
Prenatal exposure refers to harmful substances or environmental factors that a foetus is exposed to in the womb, such as maternal smoking, air pollution or chemicals.
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As for diagnoses in women, Prof Sewa says: “They started smoking in the years when filtered cigarettes were most common. Filtered cigarettes increase the risk of adenocarcinoma lung cancer due to the way tobacco smoke is distributed to the outer parts of the lungs.”
Women may also have different genetic risk factors for lung cancer compared with men, such as not being able to repair damaged DNA or having abnormal genes related to cancer development.
When Mr Low first found out he had lung cancer, he was shocked.
“I thought, how could this happen, when I hardly smoke,” he says. He would smoke three to four times a year when he was with his friends.
In the medical field, he is known as a never-smoker or non-smoker. This refers to an adult who has never smoked, or has smoked less than 100 cigarettes in his or her lifetime.
Mr Low has lung adenocarcinoma, which Dr Poh Kai Chin, a consultant at Sengkang General Hospital’s department of respiratory medicine, says is the predominant subtype of lung cancer in men and women in Singapore.
Not just a smoker’s diseaseDr Patricia Kho is medical director of Icon Cancer Centre at Mount Alvernia Hospital. She says non-smokers are also susceptible to lung cancer due to factors such as exposure to second- or third-hand smoke, other hazardous chemicals, as well as first-degree family history of lung cancer.
Mr Low did not know that breathing second-hand smoke – from burning tobacco or exhaled by a smoker – around his friends, whom he often met, could lead to the disease.
“Now, it bothers me when I’m surrounded by people who are smoking, so I move away,” he says.
Dr Kho says non-smokers exposed to second-hand smoke – which can linger in a room for up to five hours – at home or at work can increase their risk of developing lung cancer by 20 to 30 percent.
Second-hand smoke contains harmful carcinogens found in cigarettes and tobacco, such as formaldehyde, benzene, ammonia, arsenic and aromatic hydrocarbons, says Dr Poh. The concentration of these chemicals in second-hand smoke is higher than that inhaled by smokers, he adds.
Third-hand smoke – the residue from cigarettes left on surfaces after smoking – is also potentially carcinogenic and can linger for many months, says Dr Poh.
Prolonged or extended exposure to this can increase the risk of cancer by 20 to 30 percent, he adds.
To minimize exposure, non-smokers can advocate for smoke-free environments, use air purifiers in homes and maintain good ventilation in enclosed spaces, advises Prof Sewa.
Non-smokers shocked by diagnosisSome 30 to 50 percent of Dr Poh’s lung cancer patients are non-smokers. He also observes that the percentage of non-smokers with the disease is higher among women.
Prof Sewa says 40 to 50 percent of his patients diagnosed with lung cancer are non-smokers.
The majority of Dr Poh’s non-smoker patients are usually shocked by the diagnosis, as they had not considered themselves at risk.
Prof Sewa’s non-smoker patients are similarly stunned. He says: “They often quote examples of their friends or relatives who are smokers and had lung cancer and contrast their ‘healthier’ lifestyles with them. Their initial reaction may be to deny they have lung cancer, continue to attribute their symptoms to other conditions or insist that a diagnostic error has been made.”
He often has to spend more time explaining the results to them before they can accept the diagnosis and discuss treatment options.
Majority diagnosed at advanced stageMost lung cancer cases, Dr Kho says, are still being diagnosed at an advanced stage.
About 61.5 per cent of men and 60.9 per cent of women who were diagnosed between 2018 and 2021 discovered their condition only at stage four, according to the latest report from the Singapore Cancer Registry.
This could be because most people with lung cancer do not have obvious symptoms in the early stages, says Dr Kho.
People in roles like construction work or shipyard repair, where they are exposed to hazardous materials like silica and asbestos, may face an increased risk of developing lung diseases such as silicosis or asbestosis. This can raise their risk of lung cancer, says Prof Sewa.
Those who have had pulmonary tuberculosis have also been reported as having a higher incidence of cancer, he notes.
People who have parents and siblings with lung cancer are also at higher risk.
Cancer has taken a heavy toll on Mr Low’s family. His father died of liver cancer, his mother from colon cancer, and three of his siblings from various forms of the disease – lung, kidney and breast cancer. One sibling remains cancer-free.
Mr Low is candid about how tough the fight has been, physically and mentally. “Sometimes, I wake up in the middle of the night and wonder, ‘What’s happening?’ I’m stable now, but it keeps coming back. I get tired, but I move on,” he says.
Found comfort in football club’s anthemStill, he remains positive.
A Liverpool Football Club fan since he was a child, Mr Low found a strong connection between his struggles and the club’s iconic anthem, You’ll Never Walk Alone.
The song’s message of perseverance and unity was a source of comfort during his cancer journey.
“I drew strength from the idea that I, too, am never alone in my fight. My faith, family, church friends and support groups provided the same sense of companionship and hope that the song promises,” says Mr Low.
He has leaned on support groups, including counseling through 365 Cancer Prevention Society and the Singapore Cancer Society.
“I had to prepare for the end at some point, and the emotional support from my wife, daughter and friends has been vital. My wife has been my main caregiver, and my daughter, even though she works, is always there for key medical decisions,” he says.
Mr Low does not just receive support. He gives it too.
He is a patient ambassador for the Singapore Cancer Society and offers guidance to others going through similar struggles.One of the people he is journeying with is a 26-year-old non-smoker with stage four lung cancer.
Treatment options include surgery, radiation therapy and systemic therapy, as well as new therapies such as immunotherapy and targeted therapy.
When lung cancer is detected early – such as in stage one, when the cancer has not spread – treatment can be effective, says Dr Kho.
The five-year survival rate for stage one lung cancer patients can be as high as 92 per cent. But the five-year survival rate for stage four lung cancer patients is significantly lower at 10 per cent, she says.
Even in the later stages, treatment can still be effective with newer options like immunotherapy and antibody-drug conjugates, notes Dr Kho.
Antibody-drug conjugates are monoclonal antibodies attached to chemotherapy drugs that then attach themselves to receptor proteins on the cancer cells, thus bringing the drugs directly to the cancer cells, she says.
After Mr Low’s cancer diagnosis, he started working on a bucket list.
In 2018, after being cleared by his doctor to travel, he visited Mont Blanc, the highest mountain in the Alps and western Europe that spans France, Italy and Switzerland.
He took a cable car up to 3,005 meters, but decided to stop there as it was getting difficult to breathe at the high altitude.
Mr Low says his lung cancer is not in remission. He still requires close monitoring and lives with side effects from treatment, such as breathlessness and numbness in his feet.
A scan in September showed progression of lesions on his liver. He will have to decide on treatment options.
Though his prostate cancer is in remission, he lives with side effects like incontinence.
The three cancers have forced him to reflect on his purpose in life.
“I’ve asked myself, ‘Why do I want to live?’ Of course for my family, my loved ones. But beyond that, it’s about helping others. I want to be there for those who need support, so they don’t have to walk alone in their journey.”
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I didn’t feel like something was wrong. If I didn’t go for a medical screening, I would have probably found out much later.Mr Eddie Lowrich711, 66, who had no symptoms before a 2017 check-up led to tests that showed he had liver cancer and lung cancer
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