• Lung cancer cases among non-smokers in India are rising, with air pollution being a major factor.
• Non-smokers, especially women, are diagnosed with lung cancer about 10 years earlier than in Western countries.
• Environmental pollutants, radon exposure, indoor cooking fumes, and second-hand smoke are key risk factors.
• Despite advancements in lung cancer therapies, early detection is crucial for improving survival rates.

A recent revelation that has alarmed the medical fraternity is the significant rise in lung cancer cases among non-smokers in India. Traditionally, lung cancer has been strongly associated with smoking, but a shift is being witnessed, especially in urban populations. This shift is raising concerns among health experts who attribute the increased exposure to air pollution as the major reason behind this trend.

A study published in the Lancet's eClinical Medicine Journal showed that a majority of lung cancer patients in India are non-smokers. The study also noted that lung cancer cases are manifesting in India about 10 years earlier as compared to Western countries. Dr. Prasad Adusumilli, a Thoracic Surgeon and Cellular Therapist at the Memorial Sloan Kettering Cancer Center (MSK), US, highlighted that India's lung cancer demographic presents a unique and concerning picture, with a rising incidence among younger individuals and an increasing number of cases occurring in non-smokers.

Non-smokers, particularly women, are increasingly diagnosed with lung cancer around 10 years earlier than their Western counterparts, often with no history of smoking. This may be linked to various risk factors, including exposure to environmental pollutants, genetic predisposition, and lifestyle factors.

Air Pollution and Lung Cancer

Lung cancer is also the leading cause of cancer-related deaths globally, with increasing cases among non-smokers, especially women and Asian populations. India reports about 75,000 new cases every year. Worryingly, a considerable number of lung cancer patients are diagnosed at advanced stages in the country. Non-smoker lung cancer (LCINS) mainly presents as adenocarcinoma, affecting peripheral lung tissues. Key risk factors include air pollution, radon exposure, indoor cooking fumes, and second-hand smoke.

Environmental pollutants like fine particulate matter (PM2.5) in urban areas and radon in homes significantly contribute to risk. Poor indoor air quality from cooking with solid fuels in poorly ventilated spaces also poses a danger, especially in developing regions. Passive smoking further elevates risks, particularly in areas with high smoking rates among men.

In terms of treatment, there have been significant advancements in lung cancer therapies. Minimally invasive surgical approaches and radiation therapies are offering patients a less invasive, more targeted approach, resulting in reduced recovery times and fewer side effects.

The Global Perspective

Despite the slight improvement seen in Delhi, several air monitoring stations across the national capital still recorded AQI levels above 400, which is categorised as severe, according to the Central Pollution Control Board (CPCB). The agency said that Jahangirpuri and Wazirpur saw the highest readings at 437, Bawana at 419, and Ashok Vihar and Mundka registered 416.

The potential impact of the COVID-19 pandemic on cancer diagnosis, treatment, or survival as the data in the report preceded the emergence of the novel coronavirus. Persistent cough, chest pain, shortness of breath, weight loss, fatigue, coughing up blood, and recurrent infections (like bronchitis or pneumonia) are some of the symptoms of lung cancer. Targeted Therapy and Immunotherapy: Focuses on specific genetic mutations and helps the immune system recognise and attack cancer cells. The five-year survival rate varies based on stage, type, and region, generally low due to late-stage diagnoses. Survival rates are better in high-income countries with better healthcare infrastructure.

From 2020 to 2021, the average life expectancy for males in the United States fell from 74.2 to 73.5 years-the lowest it has been since 1998. By 2022, the downward trend started to reverse, increasing to 74.8 years. Even so, it was still well below the high-water mark in 2019 when the average life expectancy was 76.3 years. Experts attribute the decline to the COVID pandemic, during which the virus was the third leading cause of death in males in 2020 and 2021 and the fourth leading cause in 2022. By 2023, with increased vaccinations and better medical treatments, COVID-19 has fallen to the 10th leading cause of death overall.