Study has shown nearly 50% of lung cancer patients across the country are non-smokers. Experts say pollution plays a big role in people falling prey to cancer. TOI analyses the effects of pollution on health
There was a time when smoking would be associated with lung cancer and whenever we would see our loved ones light up cigarettes, we would immediately urge them to give up the harmful habit, fearing that they may be affected with the terminal disease.Even cigarette packets carry a ‘smoking kills’ sign in a perhaps feeble attempt to dissuade people from smoking and possibly protect them from the disease. But does not consuming tobacco shield you from lung cancer? Not anymore as per studies that show 40-50% of lung cancer patients in India are non-smokers.
Air we breathe
The World Health Organisation (WHO) has added second-hand smoke and air pollution as risk factors for lung cancer, along with consuming tobacco. Air pollution, especially particulate matter (PM2.5), is believed to be a risk factor for lung cancer in non-smokers. It has become a major concern in urban areas, as per a recent study published in The Lancet.
The study stated that exposure to asbestos, chromium, cadmium, arsenic and coal products at the workplace can be a potential cause of lung cancer. “Factors like genetic susceptibility, hormonal status and pre-existing lung diseases have also been implicated in the rising incidence of lung cancer in non-smokers,” read the study’s analysis conceived and designed by Dr Vanita Noronha and Dr Kumar Prabhash of Tata Memorial Hospital, Mumbai.
Dr Tarini P Sahoo, a native of Odisha who works in a Bhopal-based hospital and is among the 36 authors of the study, said, “Lung cancer cases are increasing among non-smokers, perhaps due to passive smoking. Pollution will lead to chronic lung diseases and some studies have proven that lung cancers are more common in patients with pre-existing lung diseases.”
Dr Sourav Mishra, associate professor of medical oncology department at AIIMS Bhubaneswar, said, “We have conducted a survey of 100 lung cancer patients and of them, over 30% were non-smokers.”
He added, “Pollution is an unknown killer. There is data about the harmful effects of smoking cigarettes, cigars and other tobacco-based products and the contents the smokers inhale through them, but more extensive studies are required to know about the pollutants people inhale daily. We need to know if it directly causes lung cancer and if so, to what extent.”
Disease status
The rate of lung cancer – the symptoms of which include persistent cough, chest pain and shortness of breath – in the country has increased from 6.62 per one lakh population in 1990 to 7.7 per one lakh population in 2019.
Cases in metropolitan cities are expected to rise significantly by 2025, as per the study published in The Lancet. The study says that in India, lung cancer tends to manifest around 10 years sooner than in Western nations, with a mean age of diagnosis being between 54 and 70 years. Studies have shown that over two-thirds of the lung cancer patients in India are men, and 42.4% men and 14.2% women consume tobacco.
“Three of every 10 adults who work indoors have been exposed to second-hand smoke at the workplace,” read the report.
Traditionally, lung cancer was more common in older adults, usually diagnosed in those over 65.
However, there has been an increase in cases among younger individuals, some even in their 30s and 40s.
This could be due to earlier detection, genetic factors, or environmental exposures, said earlier studies.
“We need to conduct a detailed study regarding the relation between pollution and lung cancer,” Bhubaneswar-based pulmonologist Dr Sourav Mishra said.
He added, “There is a higher detection rate of specific genetic mutations, such as EGFR (epidermal growth factor receptor) mutations and ALK (anaplastic lymphoma kinase) rearrangements, particularly in non-smokers and young patients. Our cells in the body grow in a regulated way, but the EGFRs are getting dis-regulated and function in an autonomous way. Targeted therapy is being used to treat lung cancer patients with these mutated genes. EGFR mutation is around 30-40% in Southeast Asia and in the Indian population.”
Dr Sarat Kumar Behera, a city-based pulmonary medicine specialist, said there are a lot of causes behind lung cancer and pollution could be a likely cause of it. “Pollution causes respiratory disease, chronic obstructive pulmonary disease and other related ailments. The pre-existing diseases in lungs may cause lung cancer in future,” he added.
“There is no doubt that smoking is a major risk factor for lung cancer, but so is pollution nowadays,” Dr Deepak Rautray, director of Acharya Harihar PG Institute of Cancer, Cuttack, said, while advocating for early diagnosis for timely treatment of the disease.
“The cornerstone of cancer cure and treatment is early detection. If you miss that bus, then you are fighting a lost battle. The chances of cure and survival increases with early detection,” he added.
Gouranga Mohapatra, a health activist in Bhubaneswar, said the govt should start lung cancer screening of citizens for early detection.
Highlights:
–According to the Indian Council of Medical Research-National Cancer Registry Programme (ICMR-NCRP), cancer cases are on the rise in Odisha.
–In 2020, the state had reported 50,692 cancer cases, while it had reported 51,829 in 2021. This number was 52,960 in 2022 and 54,856 last year.
–In Odisha, mortality in cancer cases was 28,024 in 2020, as many as 28,656 in 2021, a total of 29,287 in 2022 and 30,147 last year.
–In national level, the country had reported 13.92 lakh cases in 2020, more than 14.26 lakh in 2021 and over 14.61 lakh in 2022 and 14.97 lakh last year.
–In India, mortality in cancer cases was 7.7 lakh in 2020, over 7.89 lakh in 2021 and 8.08 lakh in 2022 and around 9 lakh last year.
Lung Cancer in Odisha:
There was a time when smoking would be associated with lung cancer and whenever we would see our loved ones light up cigarettes, we would immediately urge them to give up the harmful habit, fearing that they may be affected with the terminal disease.Even cigarette packets carry a ‘smoking kills’ sign in a perhaps feeble attempt to dissuade people from smoking and possibly protect them from the disease. But does not consuming tobacco shield you from lung cancer? Not anymore as per studies that show 40-50% of lung cancer patients in India are non-smokers.
Air we breathe
The World Health Organisation (WHO) has added second-hand smoke and air pollution as risk factors for lung cancer, along with consuming tobacco. Air pollution, especially particulate matter (PM2.5), is believed to be a risk factor for lung cancer in non-smokers. It has become a major concern in urban areas, as per a recent study published in The Lancet.
The study stated that exposure to asbestos, chromium, cadmium, arsenic and coal products at the workplace can be a potential cause of lung cancer. “Factors like genetic susceptibility, hormonal status and pre-existing lung diseases have also been implicated in the rising incidence of lung cancer in non-smokers,” read the study’s analysis conceived and designed by Dr Vanita Noronha and Dr Kumar Prabhash of Tata Memorial Hospital, Mumbai.
Dr Tarini P Sahoo, a native of Odisha who works in a Bhopal-based hospital and is among the 36 authors of the study, said, “Lung cancer cases are increasing among non-smokers, perhaps due to passive smoking. Pollution will lead to chronic lung diseases and some studies have proven that lung cancers are more common in patients with pre-existing lung diseases.”
Dr Sourav Mishra, associate professor of medical oncology department at AIIMS Bhubaneswar, said, “We have conducted a survey of 100 lung cancer patients and of them, over 30% were non-smokers.”
He added, “Pollution is an unknown killer. There is data about the harmful effects of smoking cigarettes, cigars and other tobacco-based products and the contents the smokers inhale through them, but more extensive studies are required to know about the pollutants people inhale daily. We need to know if it directly causes lung cancer and if so, to what extent.”
Disease status
The rate of lung cancer – the symptoms of which include persistent cough, chest pain and shortness of breath – in the country has increased from 6.62 per one lakh population in 1990 to 7.7 per one lakh population in 2019.
Cases in metropolitan cities are expected to rise significantly by 2025, as per the study published in The Lancet. The study says that in India, lung cancer tends to manifest around 10 years sooner than in Western nations, with a mean age of diagnosis being between 54 and 70 years. Studies have shown that over two-thirds of the lung cancer patients in India are men, and 42.4% men and 14.2% women consume tobacco.
“Three of every 10 adults who work indoors have been exposed to second-hand smoke at the workplace,” read the report.
Traditionally, lung cancer was more common in older adults, usually diagnosed in those over 65.
However, there has been an increase in cases among younger individuals, some even in their 30s and 40s.
This could be due to earlier detection, genetic factors, or environmental exposures, said earlier studies.
“We need to conduct a detailed study regarding the relation between pollution and lung cancer,” Bhubaneswar-based pulmonologist Dr Sourav Mishra said.
He added, “There is a higher detection rate of specific genetic mutations, such as EGFR (epidermal growth factor receptor) mutations and ALK (anaplastic lymphoma kinase) rearrangements, particularly in non-smokers and young patients. Our cells in the body grow in a regulated way, but the EGFRs are getting dis-regulated and function in an autonomous way. Targeted therapy is being used to treat lung cancer patients with these mutated genes. EGFR mutation is around 30-40% in Southeast Asia and in the Indian population.”
Dr Sarat Kumar Behera, a city-based pulmonary medicine specialist, said there are a lot of causes behind lung cancer and pollution could be a likely cause of it. “Pollution causes respiratory disease, chronic obstructive pulmonary disease and other related ailments. The pre-existing diseases in lungs may cause lung cancer in future,” he added.
“There is no doubt that smoking is a major risk factor for lung cancer, but so is pollution nowadays,” Dr Deepak Rautray, director of Acharya Harihar PG Institute of Cancer, Cuttack, said, while advocating for early diagnosis for timely treatment of the disease.
“The cornerstone of cancer cure and treatment is early detection. If you miss that bus, then you are fighting a lost battle. The chances of cure and survival increases with early detection,” he added.
Gouranga Mohapatra, a health activist in Bhubaneswar, said the govt should start lung cancer screening of citizens for early detection.
Highlights:
–According to the Indian Council of Medical Research-National Cancer Registry Programme (ICMR-NCRP), cancer cases are on the rise in Odisha.
–In 2020, the state had reported 50,692 cancer cases, while it had reported 51,829 in 2021. This number was 52,960 in 2022 and 54,856 last year.
–In Odisha, mortality in cancer cases was 28,024 in 2020, as many as 28,656 in 2021, a total of 29,287 in 2022 and 30,147 last year.
–In national level, the country had reported 13.92 lakh cases in 2020, more than 14.26 lakh in 2021 and over 14.61 lakh in 2022 and 14.97 lakh last year.
–In India, mortality in cancer cases was 7.7 lakh in 2020, over 7.89 lakh in 2021 and 8.08 lakh in 2022 and around 9 lakh last year.
Lung Cancer in Odisha:
(Collected mostly from govt hospitals)
