Julie, at 49, had been a moderate smoker – 15 a day – since she was 15. She had tried to give it up for years, but couldn’t, though the new rules about smoking in public places had forced her to smoke fewer cigarettes.

She had what she called a ‘smoker’s cough’ but had got used to it. For the last month, she had noticed a niggling pain in her right shoulder, that wasn’t related to anything she was lifting, didn’t go away when she rested at night, and didn’t actually stop her from moving her shoulder in any direction.

She wasn’t more breathless than usual, but wasn’t ‘her usual self’. She took aspirins for her pain, but they hadn’t helped, so she eventually decided to see her doctor. Shoulder pain without any evidence of arthritis or other joint problems can come from inside the chest, and the doctor wasn’t happy with the sounds in her chest when he listened with the stethoscope. So he ordered an urgent chest X-ray.

He also weighed her, and found that she had lost about half a stone since a well woman visit a year before. Julie hadn’t noticed the weight loss.

The X-ray was done that afternoon, and Julie was called in the next morning for the result. It wasn’t good. She had cancer in the top section of her right lung. The pain in the shoulder was due to the cancer putting pressure on the nerves to the shoulder – a condition we call Pancoast syndrome after the doctor who first recognised the connection between shoulder pain and lung cancer.

Julie has had radiotherapy and chemotherapy for the tumour, and the shoulder pain has gone as the tumour responded by shrinking to a fraction of what it was.

But she isn’t completely out of the woods. Her long-term outlook is still in some doubt, as the tumour had spread into the tissues beyond the lung. But we hope that she will enjoy some years of reasonable health.

That will only happen, however, if she gives up smoking completely. Even after all this has happened to her, she is still smoking. And that is a disaster in the making for her.