Representational image (Photo: Towfiqu Barbhuiya via Unsplash)
In yet more evidence of the growing hazard of air pollution in Indian cities, an analysis by a leading hospital in the National Capital Region has found that nearly 50 percent of the lung cancer patients diagnosed over the past decade were non-smokers.
The analysis by Medanta hospital in Gurugram, on 304 patients from various states who underwent treatment at the facility between March 2012 and November 2022, also showed that nearly 30 percent of the patients were women and a more aggressive form of lung cancer, adenocarcinoma, was increasingly being seen in a majority of the patients.
“The trends that have emerged from the demographic analysis are startling and shocking,” said Dr Arvind Kumar, who led the analysis. “These changes can be directly linked with the growing menace of air pollution as earlier just about 10 percent of the non-smokers used to have lung cancer and its incidence in women was very low.”
The worrying findings have emerged even as the abysmally poor air quality in Delhi-NCR and other cities in India has become a regular feature every winter.
The report, which will be presented to professional organisations of doctors, said that nearly 20 percent of patients were less than 50 years of age.
“The trend showed lung cancer developing in Indians about a decade earlier than their western counterparts,” it said. Also, about 10 percent of all patients were less than 40 years old with 2.6 percent in their 20s.
Lung cancer has one of the lowest five-year survival rates and in India, nearly 63,000 such cases are detected every year, though this figure is believed to be grossly under-reported.
As per Globocan 2020, a global cancer observatory, lung cancer is responsible for the largest number of deaths due to any cancer in India.
Analysis highlights
The study included analysis of 304 patients retrospectively based on their age at presentation, gender, smoking status, stage of disease at the time of diagnosis and type of lung cancer, besides other parameters.
It noted an overall increase in the incidence of lung cancer in both men and women and the results also showed that the incidence of lung cancer was found to be rising in women, who accounted for 30 percent of the patient load and all were non-smokers, and all patients under 30 years were non-smokers.
Also, the disease was at an advanced stage in more than 80 percent of patients where complete remission is not possible, and treatment is restricted to palliative care, and in nearly 30 percent of the cases, the patient’s condition was initially misdiagnosed as tuberculosis, leading to delay in treatment.
It was also seen that the majority of patients presented with adenocarcinoma against squamous carcinoma that dominated earlier reports.
Adenocarcinoma forms when cells lining the outside of the lungs become cancerous, whereas squamous carcinoma impacts the cells that line the surface of airways. The former is known to have relatively poorer outcomes.
Public health implications
Based on the results, doctors have inferred that in the coming decade we are very likely to see an increase in the number of non-smoking lung cancer patients of the female gender in the younger age group.
“The current trend shows that majority cases are likely to be diagnosed late when adequate treatment is not possible, resulting in high mortality due to lung cancer,” the report said and warned that a lung cancer epidemic is foreseeable in near future.
The findings prompted doctors, including Dr Kumar who has been associated with the All India Institute of Medical Sciences in Delhi in the past, to recommend urgently raising awareness about the risks of the specific type of cancer.
“Effective measures to reduce tobacco consumption and control air pollution will help in controlling the rising graph of lung cancer cases,” said the report.
A report on pollution and health published in the Lancet Planetary Health journal this year said that air pollution was responsible for 16.7 lakh deaths in India in 2019, which was 17.8 percent of all deaths in the country that year.
Some reports have also suggested that air pollution may be cutting life spans of Indians by up to five years.
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