Lung cancer incidence increasing alarmingly

Dr Rajkumar Bikramjeet Singh *

Lung CA seen on CXR :: Pix - Wikipedia/James Heilman, MD

o The incidence of lung cancer has risen by up to 15% as compared to 10 years back

o Pollutants in cigarettes called polycyclic aromatic hydrocarbons can cause genetic damage in minutes; Smokers experience one mutation to their DNA for every 15 cigarettes they smoke, the accumulation of which may result in lung cancer.

Lung cancer is the leading cause of cancer-related deaths across the world, characterized by low survival rates. In India, lung cancer constitutes 6.9 per cent of all new cancer cases and 9.3 per cent of all cancer related death. Northeast India has the highest reported incidences of lung cancer in India, in both males and females.

The overall 5-year survival rate of lung cancer is dismal with approximately 15 per cent in developed countries and 5 per cent in developing countries.

As we observe Lung Cancer Awareness Month, Dr Rajkumar Bikramjit Singh, Asst Prof, Dept of Medicine, RIMS, Imphal says great emphasis need to be paid on the importance of educating people about the disease, the need to minimize risk factors and ensure early seeking of medical attention in case of symptoms like persistent cough accompanied by weight loss and fever.

"The past few years have witnessed a spike in numbers of lung cancer patients in India. The incidence has risen at an alarming rate of up to 15% over the past decade. While there is no clear evidence of the exact cause of this rise, we take into account high prevalence of smoking aided by factors such as increasing environmental pollution and increasing exposure to chemical substances as the plausible causes.

Another trend characteristic to India is the disease's prevalence in relatively younger men and women as compared to western countries. While the average age of lung cancer patients in the west is the mid 60s, in India this is much lower. In fact a lot of patients are being diagnosed in their early 50s," says Dr Rajkumar Bikramjit Singh.

Unfortunately, late diagnosis remains a norm rather than exception in India where people often hesitate to visit doctors.

"Smoking doesn't just harm the smoker himself. It harms the environment around him, causing many people to inhale the dangerous fumes emanating from his cigarette butt. Pollutants in cigarettes called PAHs (polycyclic aromatic hydrocarbons) can cause genetic damage in minutes. Smokers experience one mutation to their DNA for every 15 cigarettes they smoke. The accumulation of such mutations gives rise to lung cancer. Besides myocardial infarction (heart attack) and lung cancer, smoking also increases the risk of cancer of throat, pancrease and even urinary bladder," says Dr Singh.

Ban on public smoking, and pictorial warnings have been the right measures initiated in recent years in India. More steps are needed to nail home the point among youngsters that smoking is 'NOT COOL'. Unfortunately, even as mass campaigns are being initiated against cigarette smoking, the repackaging and revival of the hookah culture among urban Indians is a worrying trend. The mushrooming of hookah parlors and bars across our urban landscape neutralizes all successes made against the cigarette.

Apart from taking radical steps to reduce prevalence of smoking – cigarettes, cigars as well as hookahs, steps also need to be taken to improve diagnosis and early intervention.

Due to rampant prevalence of tuberculosis in India, cases of lung cancer often get mistaken for tuberculosis and even treated for the same in initial days. Most lung cancer cases are detected in late stages by the time it is too late for treatment and cure.

"Another importance aspect is the steady increase in numbers of non-smokers falling prey to lung cancer, once considered an exclusive ailment of smoke addicts. A large share of non-smoking patients are women who might have had exposure to second hand smoke all their lives at home or even no exposure at all in some cases," adds Dr Singh.

With symptoms such as fever, cough, weight loss and anorexia common to both tuberculosis and lung cancer, it is equally important for both patients and medical practitioners to stay alert to other indicators such as age of patient, history of smoking, or hoarseness in the voice. These indicators can point to the possibility of lung cancer.

How to Minimize Risk:

Say No to Smoking: Survival rates of lung cancer patients remain low in India as also across the world. Most lung cancers remain asymptomatic during the early stages, and by the time they become symptomatic, they are already advanced. In such circumstances, minimizing risk remains the main option. And quitting smoke – all kinds of smoke be it cigarette, hookah or cigars — is the primary risk reducing method.

Reduce exposure to polluted air: Wear masks on the roads to minimize inhaling of dangerous chemicals and particulate material. Also, select low pollution phases of the day such as early morning for activities like walking and exercising outdoor.

Keep Alert for Symptoms: Early diagnosis can go a long way in saving or prolonging life of patients. Symptoms such as shortness of breath accompanied by fever, cough, bronchitis or hoarseness of voice should never be ignored, especially if it is of long duration. In India these symptoms are often mistaken and treated for tuberculosis. This calls for greater alertness and awareness.