Lung Cancer is one of the most common cancers of India. According to GLOBOCAN 2022 data, Lung cancer is the 4th most common cancer while it is the second most common cancer among males. There are estimated 81000 new cases of lung cancer diagnosed every year. It is also a associated with a high incidence of mortality. Annually, approximately 75000 deaths can be attributed to lung cancer which indicates its fatal nature. One of the reasons for its high mortality is because it is often diagnosed in an advanced stage. According to one of the largest data published from AIIMS in 2017, approximately 2/3 rd of all lung cancer cases are diagnosed when the cancer has already metastasized to other organ (stage 4). Additional 20% of the cases are diagnosed in stage III where majority of the cases are not operable. Less than 10-15% of cases are diagnosed in stage I and 2 where a realistic chance of cure is possible.
Dr. Abhishek Raj, Senior Consultant & Head (Unit I) Medical Oncology, Haematology & BMT, Cancer Care, Genomic Oncology, Paediatric Oncology, Sarvodaya Hospital, Faridabad, says, “This underscores the need for early diagnosis and screening to detect lung cancer early where it can be cured. Screening is a test which can detect the presence of disease before the symptoms appear. Screening is usually done in healthy and asymptomatic individuals. Various screening tests are well established in different cancers and they are known to detect cancer early and prevent mortality.”
Examples include Mammography (breast cancer), PAP smear and HPV DNA testing (Cervical cancer), colonoscopy (colon cancer), PSA levels (prostate cancer). Screening in lung cancer is tricky because of two reasons. First, the screening involves using computed tomography scan (CT scan) which in itself is associated with exposure to radiation beams and it is not a single time procedure. If the first scan comes is negative, it needs to be repeated at a regular interval (usually annually). “To counter this, various trials have successfully used a low-dose CT (LDCT) scan for lung cancer screening which uses significantly less radiation exposure to conventional diagnostic CT scan of the chest. Various studies from the west have shown that annual LDCT scan chest in individuals with significant history of smoking (> 20-30 pack years of active smoking or quit recently not > 15 years ago) in age group 50-80 have shown to detect lung cancer early and also led to significant reduction in lung cancer mortality,” adds Dr Raj.
Dr Raj explains the second problem with screening is overdiagnosis and over-investigation. Sometimes a small nodule detected on a screening LDCT scan will necessitate the individual to undergo a further array of other investigations like biopsy, bronchoscopy to prove the nature of abnormality detected on CT scan. In a country like India where lung infections like tuberculosis and more recently COVID are so common, often a benign lung nodule due to past infections can be interpreted as suspicious for cancer and can lead to over investigations leading to anxiety, mental stress and burden on healthcare system and family. So, every person who are more than 50 years of age with significant history of smoking should meet with experts to help them take an informed decision making on doing annual low dose CT scan of chest to screen for lung cancer.
Diagnosis of lung cancer is made by various modalities like CT scan of chest, Bronchoscopy and guided needle aspirations and biopsies. PET-CT scan is another modality that is used to determine the extent and spread of lung cancer. PET-CT scan is often done after the diagnosis of lung cancer is established. The common signs and symptoms of lung cancer are a dry or productive cough that is not going away, chest pain, blood in sputum, shortness of breath at rest or at exertion, weight loss and a recent change in voice. “Some of these symptoms are non-specific and can be seen in other lung and heart conditions as well. People with a history of smoking with these symptoms should not ignore it and meet their physicians at the earliest to arrive at the correct diagnosis,” shares Dr Raj.
Tobacco smoking in its various forms like cigarette, bidi, hukkah etc. is one of the most common causes of lung cancer. 80-85% of all lung cancer could be attributed to smoking. Other less common risk factors are exposure to second hand smoke, asbestos dust and radon gas exposure, air pollution and rarely genetic predisposition. The risk of lung cancer increases with both the number of cigarettes smoked as well as the duration of exposure to smoking.
We are all aware that prevention is better than cure; sensitizing the masses to the ill effects of smoking and the impact it causes on their physical, mental and financial health. Besides various types of cancer, smoking also increases the risk of cardiovascular disease, hypertension, diabetes, migraine, mental health problems etc. It is important to target the youths and adolescents as this is the age where smoking habits usually develop.
Seeking professional help with counselling and medications can be really helpful in smoking cessation. Nicotine which is common component of cigarette smoke which causes physical and mental dependence is not itself a carcinogen but your cigarette smoke contains 70 other different carcinogens. Nicotine causes craving for one to smoke and eventually exposing to other carcinogens contained in smoke. There are nicotine patches and gums available to reduce the craving for smoking.
Sensitizing the masses about the harmful effects of second-hand smoking is also important. When a person smokes, the fumes of the smokes inhaled by the persons around them are also at increased risk. It has been shown in various studies that second hand smoking is an established risk factor for lung cancer.
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