See Through the Symptoms is a campaign that helps healthcare professionals recognise lung cancer in people who have never smoked or who don’t fit the expected picture. It was created in 2021 by EGFR Positive UK, ALK Positive UK and the Ruth Strauss Foundation. It is now the healthcare professional strand of All You Need Is Lungs.
Why See Through the Symptoms was created
Lung cancer is the leading cause of cancer death in the UK, and around 15% of people diagnosed have never smoked. Because lung cancer is so closely linked with smoking, people who have never smoked are often not seen as at risk, by themselves or by the healthcare professionals they see.
That can mean symptoms are put down to something else, such as a chest infection, asthma, a pulled muscle or stress. By the time lung cancer is diagnosed, it has often spread.
The charities wanted lung cancer to be considered when someone has symptoms, whatever their age or smoking history, and for a chest X-ray or scan to be requested.
The campaign launched during the Covid-19 pandemic. Many lung cancer symptoms were similar to Covid-19, more appointments were remote, and urgent suspected lung cancer referrals had fallen.
How three charities came together
EGFR Positive UK set out what the campaign needed to do, with the support of ALK Positive UK. Together they approached the Ruth Strauss Foundation, set up by Sir Andrew Strauss in memory of his wife Ruth, who died in 2018 aged 46 from a type of lung cancer that affects people who have never smoked.
The charities then worked with communications agency The Engine Group, research organisation Syneos Health, production company Smoke and Mirrors, photographer Rankin and media agency Wavemaker.
Everyone involved worked pro bono. The media campaign was funded through charity funding, crowdfunding and a charity grant.
Nine people and their real chest X-rays
EGFR Positive UK and ALK Positive UK asked their communities for volunteers to be the faces of the campaign. The charities felt it was essential that the people in it were real.
Nine people took part: Faye, Brenda, Jaber, Mark, Amelie, Debbie, Pete, Razia and Cameron. They were aged 26 to 64, and all had been diagnosed with stage 4 lung cancer. Eight had never smoked.
Rankin photographed each of them holding their own chest X-ray, in black and white, with their cancer highlighted in red. The images were designed to make healthcare professionals think again about who can get lung cancer.
The campaign focused on symptoms that should prompt healthcare professionals to think about lung cancer, whatever someone’s age or smoking history:
a cough that won’t go away, with or without pain
breathlessness
wheezing
chest, shoulder or back pain
other bone pain
a hoarse voice
weight loss
“It remains crucial to remain vigilant to the possibility of lung cancer in non and never-smokers, particularly adenocarcinoma which can occur due to genetic mutations. Early diagnosis with imaging such as CXR and low dose CT is pivotal to good outcomes and cure.” Dr Sam Hare, Consultant Chest Radiologist, British Society of Thoracic Imaging, 2021
What the See Through the Symptoms campaign achieved
The campaign ran in May 2021, featuring four of the nine people, and again in October 2021, ahead of Lung Cancer Awareness Month, with the other five. Adverts appeared on platforms healthcare professionals use, including GP Online, Practice Nurse and the British Journal of General Practice, as well as LinkedIn, Twitter and Facebook. Posters and a website with resources for healthcare professionals were also created.
The campaign was consistent with NICE guidelines and was supported by the British Thoracic Oncology Group, the British Lung Foundation, the Taskforce for Lung Health, Macmillan Cancer Support, GatewayC and the Primary Care Respiratory Society.
Across the two runs in 2021:
5.2 million impressions
there were more than 27,000 clicks
videos were viewed more than 400,000 times
73% found the diagnoses based on these symptoms surprising
81% learnt something new from the website
The campaign was covered by The Guardian, ITV News and the BMJ blog. In 2022, it won Public Health Initiative of the Year.
“I see too many patients who have never smoked present with late-stage lung cancers. It is really important that we raise awareness amongst all healthcare professionals that people who have never smoked can get lung cancer too.” Professor Sanjay Popat, Consultant Thoracic Medical Oncologist, Royal Marsden Hospital, 2021
Remembering Jenny Abbott
See Through the Symptoms would not have happened without Jenny Abbott, co-founder of EGFR Positive UK. Jenny worked tirelessly to support other people with lung cancer until her death in late 2021. The campaign is part of her legacy.
Why See Through the Symptoms is still needed
Since 2023, See Through the Symptoms has been part of All You Need Is Lungs. It now reaches GPs, nurses, pharmacists, paramedics, physiotherapists and other healthcare professionals involved in early diagnosis.
The message hasn’t changed. Debra Montague of ALK Positive UK says:
“People like me were told we were too young, too healthy, too unlikely to have lung cancer. But it happens, and when it’s missed, it costs lives. This campaign is about making sure we’re seen, taken seriously, and diagnosed earlier.”
Finding lung cancer early makes a huge difference. Almost 65% of people diagnosed at stage 1 survive for five years or more, compared with around 5% at stage 4.
Healthcare professionals can find resources, posters and real stories at seethroughthesymptoms.uk.
All You Need Is Lungs is a joint campaign from ALK Positive UK, EGFR+ Lung Cancer UK and the Ruth Strauss Foundation.
