Dr Prasad Narayan, Senior Consultant & Director-Medical Oncology, Hemato Oncology, and BMT, Cytecare Cancer Hospitals highlights that despite the upward trend prediction, it is possible to arrest the growth of lung cancer in the country. We need to get past multiple barriers including those around false positives in the case of populations with high incidences of Tuberculosis (TB) to drive greater adoption and timely treatment
November is lung cancer awareness month. According to a recent study published by the Indian Council of Medical Research (ICMR), by 2025, India is expected to see a seven-fold rise in lung cancer cases as compared to a decade ago. Control over external factors like air pollution and exposure to tobacco remains slow and complex. However, early detection and diagnosis can be effective ways to safeguard our population in the growing crisis.
Changing realities
Traditionally, in India, the incidence of lung cancer has been much higher among men than women, particularly in the case of those exposed to tobacco or harsh work environments with pollutants. However, this is fast changing. Lung cancer among women in India has increased by a staggering 61 per cent over a 20-year period, as per the National Cancer Registry Programme (NCRP). More than 80 per cent of these women patients were non-smokers. Such evolving clinical epidemiology hints at the urgency of pan-demographic screening and diagnosis.
Moreover, common signs of lung cancer-coughing and breathlessness are easy to confuse as age-related conditions or lifestyle diseases, especially among non-smokers. This demands a shift in how everyone, including the age group most susceptible to the disease – 65+ years – arrive at testing and screening decisions.
According to the American Lung Cancer Association, the five-year survival rate for patients who get diagnosed in advanced stages is 5 per cent as compared to 56 per cent for those who get diagnosed in the early stages. Yet, currently, only a fraction of cases get diagnosed before the cancer spreads to other parts – globally, this stands at 16 per cent. The numbers are likely to be much lower for India, and significantly so beyond the tier I cities.
Addressing the causes
Studies have well established the causal link between tobacco consumption and lung cancer. Globally, India is the second largest consumer of tobacco. Nearly 29 per cent of adults (15 years and above) in India are users of tobacco, as per the last Global Adult Tobacco Survey India.
However, the new patient demographics showcase that there are various other contributing factors that also need to be addressed. Extensive exposure to secondary smoke and rapid environmental pollution are translating into high-risk factors. This is especially a cause of concern in semi-urban and rural areas which offer limited access to public awareness and timely detection.
As seen in the West, better awareness with regards to lifestyle and early detection can reverse the trend over a long-term period. Similarly, at the policy level, India needs to adopt enhanced environmental and tobacco-related regulations.
Building a healthy future
Despite the upward trend prediction, it is possible to arrest the growth of lung cancer in the country. We need to get past multiple barriers including those around false positives in the case of populations with high incidences of Tuberculosis (TB) to drive greater adoption and timely treatment. What India needs today is greater collaboration among policymakers, healthcare providers and the insurance sector to win the battle against lung cancer.
When it comes to patients, the need of the hour is to create more awareness about highly-effective diagnostic technologies. For instance, the low-dose computed tomography (LDCT), a low-radiation exposure CT scan is emerging as a promising catalyst. Unlike technologies in the past, which could not be linked to an impact on mortality, LDCT showed 20 per cent reduction in mortality vis-à-vis lung cancer, as per the National Lung Screening Trial (NLST).
While advanced lung cancer and high mortality pose a social and economic risk in the years to come, we can prevent this from becoming a national crisis. This calls for a change in how Indians view lung cancer from a smoker’s disease to an epidemic accelerated by harsh environments. By addressing this reality, we can collectively work towards creating greater awareness and action for timely, cost-effective detection and treatment during the early stages
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