The symptoms of lung cancer frequently go unrecognized in the early stages of the disease, experts say. Lung cancer typically makes itself known through coughing, breathlessness and weight loss, said Professor Dieter Koehler, president of the German Society for Pneumology and Respiratory Medicine in Werne, North Rhine Westphalia. Further symptoms are pains in the chest and swollen fingertips, the so-called clubbed finger. An X-ray, an endoscopic examination of the lungs or an analysis of the mucus the patient coughs up are ways of determining whether the patient has lung cancer, said Michael Barczok of the German Federal Association of Pneumologists in Heideheim. People at greatest risk of lung cancer are current and former smokers, as well as people whose relatives have already developed lung cancer or chronic obstructive lung diseases, experts say. The risk of getting a bronchial cancer is two to three times greater among people who have a biological relative who had lung cancer, Koehler said. The disease usually begins at a younger age among people with a genetic disposition, according to Koehler. "They become ill at age 50 as opposed to age 70," he said. The earlier the disease is detected, the better the survival rate. Only 15 percent of the people age 70 or older who are diagnosed with the disease are still alive five years later. Lung cancer is the cause of death for more than 40,000 people annually in Germany, making it one of the most common malignancies.