World Cancer Day 2022: Rising Incidence Of Lung Cancer In India

Lung cancer is becoming a major healthcare problem in India and it is predicted that there will be more than 1 lakh new lung cancer cases in the next 5 years in India. It is more common among males (around 70% cases of lung cancer), but over the past decade the incidence among women is slowly on the rise too. The incidence is highest between the ages of 55-70 years. Due to lack of public awareness and screening programs in our country, majority (50%) of the patients are diagnosed with lung cancer when it has already spread to other parts of the body. 

Risk Factors 

There are several risk factors for lung cancer, the primary risk factor being cigarette smoking accounting for 90% of lung cancer cases. The association between smoking and lung cancer was first suggested way back in 1912, but till date it still remains to be a public menace. It has been reported that around 10-15% people in India have exposure to tobacco. This in on-par with western population, however the number of people smoking has been decreasing steadily among western countries with public awareness and healthy lifestyle habits, but the trend of smoking in India is on the rise which is alarming. Smokers have a 30 times higher likelihood of developing lung cancer in their lifetime as compared to never smokers and the risk increases with the number of cigarettes smoked and the duration of smoking. Apart from this the degree of smoke inhalation, frequency of the puffs, nicotine content and use of unfiltered cigarettes also increase the risk of lung cancer. Off late there has been a rise of lung cancer in India among people who do-not smoke, this can be attributed to several other factors like family history and exposure asbestos, radon gas, radiation therapy, air pollution and indoor pollution (in the form of burning wood for cooking purposes).

Screening

Most of the patients with lung cancer are detected late in their disease course. 90% of the patients survive five years, if detected at an early stage whereas only 10-15% patients survive five years when detected at an advanced stage. This highlights the importance of identifying the cancer at an early stage in order to increase the chances of survival. Low dose computed tomography (CT) scan of chest is a method which is used for screening patients to detect lung cancer at an early stage. Not all benefit with screening and there are a set of high risk people for whom it is beneficial. These include persons aged 55 to 78 years and with atleast 20 pack years of smoking, current smokers or people who have quit smoking within past 15 years. Screening such high risk people resulted in 20% reduction in lung cancer mortality.

Treatment Options 

Coming to the treatment options for lung cancer, they vary based on the stage of the disease. For early stage disease with good lung function, surgery is the mainstay of treatment. With advancement of science, minimally invasive surgical procedures like video assisted thoracoscopic surgery (VATS) and which have faster recovery times have gained precedence over historically more invasive surgeries which are usually associated with more complications. For patients who are not fit for surgery a newer modality of treatment called radiosurgery is preferred. It is completely non-invasive procedure where the tumor in burnt with the help of photon rays. For locally advanced disease a single method of treatment is usually not sufficient and two or more treatment modalities like chemotherapy, immunotherapy and radiotherapy combinations are used. When the disease has already to spread to various parts of the body, then chemotherapy, immunotherapy and precision targeted therapy are the main treatment options.

Lung cancer is one disease where genomic based treatments came into lime light and has been a game changer. In patients with advanced stage lung cancer harboring  genetic mutations there are effective pills which help controlling the cancer for years. And these medicines have lesser side effects than traditional chemotherapy. Another revolutionary advancement for lung cancer patients is the discovery of immunotherapy. These medicines help to remove the breaks of one's own immune system which helps the immune cells to identify cancer cells and kill them. With such great advancement in science even advanced stage lung cancer patients have been able to lead and good quality of life for years. 

During the COVID-19 pandemic, there has been an increased use of CT scan of chest in India, this in turn has resulted in identifying more lung cancers at an early stage. There is also more awareness among general public regarding CT scans and this has helped in more adaptability to the test. This may over the course of years after post-covid era may help detecting lung cancers at an early stage and saving more lives.

(Dr Saadvik Raghuram, Sr. Consultant Medical Oncologist, Medicover Cancer Institute, Hitech City, Hyderabad)

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