Spotting lung cancer early is crucial. Here’s what you should know

This article was first published at Spectator Health on 17 December 2015.

Britain tends to lag behind other European countries in terms of its cancer survival rates. A few years ago this was most definitely the case with lung cancer. In 2005 only nine per cent of patients survived for five years after diagnosis. Now, after a remarkable jump in progress, it is predicted that for those diagnosed in 2013 the rate will be 16 per cent — still low, but actually only slightly behind world-leading rates such as Sweden’s or North America’s.

The reason, says Dr Mick Peake, clinical lead for the National Cancer Intelligence Network, is a massive increase in specialist surgeons — up from 40 to more than 80. Previously about half of lung operations had been performed by heart surgeons.

This greater expertise means that surgery is much more commonly a treatment. And, for lung cancer patients, surgery is by far the best option. If caught early enough the tumour can simply be cut out — vastly preferable to gruelling rounds of chemo and radiotherapy.

Dr Peake cites two other factors in the improvement in Britain’s rates. One is data. From 2004 data was collected on hospitals’ performance on lung cancer. (Some hospitals’ results were alarmingly poor, says Dr Peake.) The other is more surgeons joining multidisciplinary teams to assess patients’ treatment. An expert surgeon is then well-placed to decide if surgery might be possible.

For lung cancer, even more so than for most other cancers, early diagnosis is crucial. Four in 10 cases are spotted during some sort of emergency hospital admission. In these cases the survival rate is very low – 12 or 13 per cent are alive after a year. But if you are diagnosed after a GP referral your chances of surviving go up to nearly 50 per cent.

These figures are undeniably bleak. But to improve our odds of beating lung cancer, and to lower the death rate generally, there are two things we should know — what the early symptoms are and whether we are likely to be at risk.

So, risk. About 85 per cent of cases are caused by smoking. The other biggest cause is a natural gas called radon, which is present in higher levels in Cornwall, Wales and the north of England. (An interactive map is here.) A small percentage of cases is explained by second-hand smoking and air pollution.

Symptoms, unfortunately, aren’t easy to spot. An advertising campaign had the line: ‘Been coughing for three weeks? Tell your doctor.’ Actually, says Dr Peake, it’s not that simple. Most smokers have some kind of permanent cough — so often the warning sign is when that cough changes.

Dr Peake explains: ‘It becomes more persistent, or more frequent, and it might start disturbing your sleep. You often produce more phlegm or the phlegm alters in some way, becomes slightly discoloured or green or has blood in it. Or sometimes it might hurt a bit when you cough, or you have might chest pain.’

Most people, Dr Peake suggests, are aware that something has changed. ‘They might say “I had a cough for six weeks” – actually they had a cough for five years,’ he says, but its character altered six weeks ago.

For some, though, there is not even a cough. In that case, what to look out for is ‘any new symptoms — breathlessness, weight loss, chest pain — that do not go away’.

The threshold for concern should be very low, Dr Peake says. ‘A lot of people are very reticent about disturbing their GP,’ he says. But most lung cancers will be picked up by a single chest X-ray, so there is no downside to a check-up.

The latest figures have been compiled by the UK Lung Cancer Coalition, an alliance set up to raise survival rates. They were released in its report Ten Years On: The Changing Landscape of the UK’s Biggest Cancer Killer.

‘I’ve had a beautiful life’

Patrick Reyntiens is one of the greatest stained-glass artists of our age. As he prepares to turn 90 he reflects on nannies, guardian angels and the faith that drives him

This article was first published in the Catholic Herald on 15 May 2015.

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Patrick Reyntiens writes for the Catholic Herald thanks to his guardian angel. On a dark winter’s morning 15 years ago, an angel visited him and said he would live until he was 96. But there was a catch. “You’ll have to work for it,” the angel told him. Reyntiens, who turns 90 this year, took the advice to heart. He is prodigiously active: he still paints, writes, travels and gives talks. His angel has not appeared since. “One didn’t know if one was having a dream or if it was true,” he says. “But I shall not forget it.”

Reyntiens has written for the Herald since the 1990s. Before that, as you may know, he was Britain’s leading stainedglass artist of the 20th century. For 35 years he worked with the painter John Piper, turning his basic designs into finished stained glass. Their biggest projects, at Coventry Cathedral and Liverpool Metropolitan Cathedral, were completed during a revival of the art form in the 1950s and 1960s.

I visit Reyntiens at his house in Ilminster, Somerset, in the hope of discovering more about his life’s work. Unfortunately, this proves to be more difficult than I had imagined. What he really wants to talk about is books. In his library he has 16,000. He gives me a tour and I quickly realise I am out of my depth. He has sections for art, architecture, the classics, French literature, 1930s literature… He points to a Balzac shelf and admits that he’s “only read about five” of them. I keep quiet about how many I’ve read. “I don’t know who’s going to inherit all this,” he says. “I may sell the lot.”

Reyntiens is an extremely generous host and apologises for not offering sherry – he says he’s given up alcohol for Lent. “Still, we’ll have a little wine for lunch,” he adds.

Our conversation is propelled by his enthusiasms. His range of interests is enormous. He talks about everything from Somerset’s medieval wool trade and underground Catholicism in Scotland to how humans underestimate animals – geese in particular.

His love of books began with his nanny, Violet Grey, who used to read Dickens to him for half an hour every night before bed. His family sound like a pretty cultured lot: his grandmother, Flora, was a friend of John Singer Sargent. She played piano with him and bought his house when he died.

Reyntiens has no fond memories of Flora – he recalls her shouting “Idiot!” at him as a toddler – but her taste for fine objects seems to have partly inspired his career as an artist. Growing up, he says, he was surrounded by beautiful artefacts and pictures. “[It was] an amazing feeling of being in this place and I just wanted to draw and then I wanted to paint,” he says. He has his family’s furniture still – a cabinet from the 1740s, a dining table sculpted in the 1870s and statues of St Francis, St Joseph and St Teresa of Avila bought by Flora in 1920s Portugal. “I never want to buy another piece of furniture in my life,” he says.

Read the rest of the article here.

Easter prayer of Iraq’s embattled Christians: ‘give us back our land’

Assyrian Christians in the Nineveh Plains are forming an army to fight for their ancient community against Isis invaders

This article was first published in the Times on 4 April 2015.

As Christians around the world celebrate the most important feast in their liturgical calendar tomorrow and Pope Francis delivers his message of peace, Christian soldiers will be preparing to fight Isis.

In the remaining Christian-held territory in the Ninevah Plains in northern Iraq, many of the newly trained Christian militiamen are volunteers who have arrived to fight for their brethren and try to avoid a repeat of the night of August 6 when 125,000 Christians fled their homes as Islamic State stood poised to invade. That evening, a Kurdish commander warned Christian leaders that his forces were retreating. By morning whole cities and towns, including Bakhdida and Bartella, had been abandoned and Christians evacuated into Kurdish territories in Iraq such as Ankawa, an Assyrian Christian suburb of the city of Arbil, and the city of Dohuk, where there is also a big Assyrian population.

Staying in their homes would have entailed either converting to Islam, paying extortion money or being murdered. In the Isis-controlled city of Mosul, some 30 miles away, many Christians had already fled in June 2014 after Isis took over. Churches were burnt, statues destroyed, and the Arabic letter for “N” (“Nazarene”) was daubed on the doors of Christian properties.

In the past decade Iraqi Christians have suffered a series of atrocities perpetrated by Sunni and Shia extremists. These attacks have driven most Christians out of the country. In 2003 there were 1.2 million in Iraq; now there are thought to be about 300,000. Many of those displaced say that Christianity in Iraq is finished. If so, this would bring an end to a rich heritage; Christians have been established in the area since the second century AD.

One group of Christians, however, would rather fight than leave — and has started to build its own army. The Assyrians, a distinct ethnic group, have set up a force called the Nineveh Plains protection units. Their aim is to defend the towns and villages they still have and eventually push Isis out of their homeland.

A fundraising appeal has been launched and supporters are mostly drawn from a worldwide Assyrian diaspora of two or three million. The money will fund equipment and training for 3,000 or so volunteers. The militia already has weapons inherited from an insurgency against Saddam Hussein in the 1980s and the organisers say that more than £150,000 has been raised in the past three months. The appeal’s website, restoreninevehnow.org, argues that Assyrians can no longer rely on the Kurds or the Iraqi army to protect them. In the face of Isis, both forces withdrew, leaving Assyrians “with no choice but to flee for their lives”.

A private company of American military veterans has so far trained 500 soldiers. Athra Kado, 25, is one of them. Last August he was employed as a youth worker in Germany. Once he learnt that his family had fled their home he returned to Iraq and volunteered to fight. He argues that a militia is the only choice if Assyrians want to stay in Iraq. “Nobody is helping us,” he says. “The whole world is watching and they are not doing anything.”

Its soldiers patrol the Assyrian Christian town of Alqosh and the village of Sharafiya, less than an hour’s drive from Isis-controlled areas farther south. Two smaller Assyrian militias, working under Kurdish command, are present in the area too. It is hoped that, with the creation of the militias, the Iraqi government will step in and provide funding and equipment.

John Michael, a British-Assyrian who runs an IT company in Ealing, west London, is a supporter of the militia. He is passionate about his people’s history — a collection of artefacts in his office includes a 400-year-old Bible and a statue of Ashur, an ancient Assyrian god. (Assyrians follow the Church of the East, which split from the Western churches in the 4th century, but trace their heritage back to the Assyrian empire, dating from about 2,500 BC).

Between the fifth and 13th centuries Europeans did not even know the Church of the East existed. The church developed independently under a succession of Islamic and Mongol empires. Its liturgy, though composed of the same basic steps, differs significantly from that of Western churches.

“Since the seventh-century AD our people have suffered one massacre after another,” says Michael. The 20th century was particularly deadly, with an estimated half a million killed in the Armenian genocide in 1915 and another 5,000 or so slaughtered by the Iraqi military in 1933. Yet the West pays little attention, he says.

Read the rest of the article here.

The Sistine Chapel shouldn’t be a tourist hell

The site of Michelangelo’s famous fresco is both the pope’s private chapel and a lucrative, overcrowded attraction. This conflict could be resolved in a flash – if the Vatican dared

This article was first published in the Catholic Herald on 27 March 2015.

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The Sistine Chapel takes you by surprise. You turn into a narrow, nondescript doorway, and suddenly the world’s most famous fresco looms above you. Taken as a whole it is a breathtaking sight. For the individual scenes you wish you had binoculars. The world it depicts seems to be in 3D – male nudes sit on plinths in the foreground as the story of Genesis unfolds behind them. You stare, mouth open, neck craned, trying to fathom how it works.

Michelangelo took four years to paint the ceiling and, once completed, it won instant renown. His biographer Giorgio Vasari wrote: “When the work was thrown open, the whole world could be heard running up to see it.” Artists such as Titian and Raphael immediately imitated the new style. Prints and drawings of the various scenes circulated in Europe. Two centuries later, Sir Joshua Reynolds, urging students to copy the fresco, called it the “language of the gods”.

The Church proved harder to please. Pope Julius II, who commissioned the work, liked it, but nine years later Adrian VI threatened to have it chiselled off, saying it was more suited to a bath house than a church. Michelangelo’s second fresco, The Last Judgment, painted 25 years later on the altar wall, provoked more controversy. The chief objection was all the flesh on display: the figures being lifted up to heaven and dragged down to hell were mostly naked. During his lifetime, Michelangelo was eminent enough to have his way, but once he died the most explicit details were painted over with loincloths, breeches and bits of flowing drapery.

Adrian VI, who reigned for only 18 months, has been much derided for his dislike of the fresco. But he had a point. Michelangelo was enraptured by the human body. Sensual, muscular figures dominate the chapel. No wonder they caused alarm among Vatican officials. Even today Catholics may wonder if they are not perhaps entirely suitable.

These days, of course, Michelangelo’s artistic triumph is as celebrated as ever. His Sistine Chapel ceiling, which depicts the finger-tip creation of Adam, is regarded as the high point of the Renaissance. Waldemar Januszczak, the Sunday Times critic, calls Michelangelo the “Everest” of the art world. “By most modern measures of such matters,” he writes, “he qualifies as the Adam of his species and was the first artist.”

Thanks to better arts education and cheaper travel, the popularity of the Sistine Chapel has continued to grow. Last year nearly six million tourists flocked to it – three times the number 30 years earlier.

But the chapel is not just a place of secular pilgrimage. It is also the pope’s private chapel. It is where the pope is elected, where he celebrates his first Mass, and, in a tradition started by St Pope John Paul II, where he welcomes newborns into the Church through baptism every January.

The chapel’s two roles – as a tourist spot and a sacred space for Mass – are in conflict. This is especially so when it comes to money. The chapel generates a lot of revenue for the Vatican. Technically, there is no entrance fee. Yet everyone who steps inside it has paid €16 (£12) to get into the Vatican Museums. And most of the tourists who pay that fee aren’t interested in the sculpture, the 16th-century maps or the porphyry (incredible though they are): they are there simply to see the Sistine Chapel.

According to Fortune magazine, the Vatican Museums are the “only branch of the Vatican run like a true business”. They generate £88 million a year. Fortune’s Shawn Tully claims that, along with the Vatican Bank, the museums have been identified as an area for future financial growth, with the Vatican’s financial tsar Cardinal George Pell hoping to increase revenue through marketing and exhibitions.

The museums are already heading in this direction, with administrators happily wringing funds out of the rich and famous. Justin Bieber, for instance, was reported to have paid £15,000 for a private tour, shelling out extra to see the Apostolic Palace, the pope’s official residence. Last October Porsche effectively hired the Sistine Chapel, putting on a concert there for members of its travel club. (The proceeds went to charities working with the poor and homeless.)

If the use of the pope’s chapel to make money is one scandal, the poor treatment of its visitors is another. Unlike at other popular sites, tourist numbers are not capped in any meaningful way. This means that every summer the crush is horrendous. Tour guides report visitors fainting from the heat and parents losing their children in the fray. One irate critic complains on TripAdvisor that they “just push everyone in and take their money”. Another says it is worse than the Tokyo underground. “Are the Musei any good? Don’t know, didn’t see anything!”

Calls for the Vatican to limit numbers are nothing new. In 2012 the Italian writer Pietro Citati caused a furore by describing the Sistine Chapel as an “unimaginable disaster” ruined by tourists resembling “drunken herds”. In an article for the Corriere della Sera, an Italian daily, he complained: “These monstrous conditions are intolerable.”

In response Antonio Paolucci, the director of the museums, accused Citati of being elitist. “The days when only Russian grand dukes and English lords or Bernard Berenson [an American art expert] could gain access to the great masterpieces are definitely over,” he wrote. “Limiting numbers is unthinkable.” Such a sentiment is laudable. But it seems highly convenient, too, given that wider access comes with much greater revenue.

Last autumn Paolucci finally relented, saying visitor numbers would be limited to the current annual figure of six million.

That will not fix the problem. He must go further: a timed entry system and evening opening hours would be a start. In London, where museums and galleries are under pressure to innovate due to shrinking state funding, this is now commonplace.

The Sistine Chapel’s other problems can be solved at a single stroke: by ending its use as a sacred place. That way the chapel can be admired by the world’s art lovers and shore up Vatican finances without causing any scandal. The process would be simple: the pope would issue a decree recognising the church’s new status and the Masses celebrated there would be moved elsewhere. For conclaves there would be no shortage of other venues. If Michelangelo frescoes are a requirement, the elections could take place in the splendid Pauline Chapel, which is slightly older than the Sistine Chapel and just across the hall.

The change may bring relief to papal masters of ceremonies. One contemporary critic of Michelangelo was the pope’s MC, Biagio da Cesena, who thought the nakedness of the figures in The Last Judgment was shameful. In revenge, Michelangelo painted his likeness into the features of Minos, a goat-eared demon. An end to Masses in the chapel would mean future MCs no longer having a predecessor staring out at them from hell.

Right now the Vatican Museums hardly seem poised for dramatic change. Paolucci, the director, and Mgr Paolo Nicolini, the administrative head, have been in their posts since the early days of Benedict XVI’s pontificate. Pope Francis’s attention is elsewhere. But the Sistine Chapel is one of the only points of contact many people around the world have with the Catholic Church.

Francis is trying to reform Vatican finances because he sees the Church’s credibility being damaged by it. The present state of the Sistine Chapel is having the same effect – if only he could reform that too.

Rise early to see the Vatican at its best

‘Before hours’ tours show you the masterpieces without the crowds – and they’re not that expensive

This article was first published in the Spectator on 28 March 2015.

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The sun has only just risen in Rome and we are standing bleary-eyed in a short queue outside the Vatican. Our guide, Tonia, takes us through security, and within minutes we are in a nearly empty Sistine Chapel. In an hour it will be crammed with tourists — sweating, gawping, getting in each other’s way. Vatican officials will be shushing and clapping to quieten the chatter. Now, though, we are free to contemplate Michelangelo’s swirl of naked bodies in peace.

Michelangelo claimed that he painted the ceiling entirely on his own. In fact, Tonia explains, he started off with 15 helpers, though he got rid of them all along the way. He ‘fought everyone’, she says. ‘On the one hand he was amazing but in human relationships, no.’ He was brave, she says, in accepting the job from Pope Julius II in the first place: Julius was a ‘dreadful pope’ who ‘hit Michelangelo with a stick’.

After the Sistine Chapel we are taken around the rest of the Vatican museums, but there is a great risk of aesthetic overload. There are the famous Raphaels and Caravaggios, of course, as well as ancient Roman sculptures. But forget to look up and you will miss dazzling Mannerist and Baroque frescoes. Even the floor you are stepping on is a second-century mosaic.

Read the rest of the article here.