Lung Cancer Incidence in India: Regular Screening Tests Can Help Find Cancers Early, Save Lives

India’s lung cancer burden is estimated to increase further to 1.57 million cases in 2025, from 1.46 million cases in 2022.

“An investment in knowledge pays the best interest“, Benjamin Franklin. This is certainly true when it comes to cancer. By investing in knowledge about cancer, we can make the best possible choices for our health. This could mean not only staying healthy ourselves but also keeping the people we care about healthy. The lung cancer incidence in India continues to increase ranking as the 4^th leading cause of cancer related death in the country¹. It is likely to increase further from 1.46 million cases in 2022 to 1.57 million cases in 2025².

With ~50% of cancers being still detected at an advanced stage, the emphasis on the need for early diagnosis (e.g., knowledge of warning signs) and responding to cancer symptoms can help to identify cancer before it has spread³. Early signs of lung cancer are not always detectable, and most people with lung cancer don’t have symptoms until the cancer is advanced. As the old dictum goes “prevention is better than cure”, preventable risk factors such as active and passive smoking, occupational exposure to carcinogens [e.g., Asbestos] should be kept in check⁴.

Risk factors of lung cancer

‘My relative never smoked, but he was diagnosed with lungcancer.’ Among those newly diagnosed, it is estimated that about 80% 90% are either current or former smokers; and the remaining 10% 20% are non smokers⁵. Passive smoking should also be actively enquired. Avoiding smoking, making your home and car smokefree and adopting health and safety guidelines in the workplace are a few important measures. 1/3^rd of cancer deaths globally can be avoided by reducing exposure to the key known risk factors⁶. In addition to improvement in survival for patients with cancer who quit smoking, smoking cessation was noted to have health benefits at any age resulting in an improved quality of life and adding up to 10 years to the lifespan⁷.

Screening tests for cancers

Screening [checking for disease when there are no symptoms] is an established modality for early detection⁸. Examples of commonly used screening tests for cancers are mammograms for breast cancer and PAP smear for cervical cancer⁸. On similar lines, low-dose computed tomography (LDCT) scan has proven to be effective among individuals considered to be at high risk. According to research, people who underwent LDCT had a 16% lower risk of dying from the disease. The US Preventive Services Task Force (USPSTF) recommends annual screening with LDCT in adults who are aged 50 to 80 years, have a 20 pack-year [1 pack a day for 20 years] smoking history and currently smoke or have quit within the past 15 years⁹. However, implementation of this is challenging due to reasons such infrastructure, trained human resource and the psychological trauma awaiting the diagnosis¹⁰. If you feel that you may have been exposed to other risk factors of lung cancer (family history, occupational exposure) you may choose to discuss the possibility of screening with your doctor.

Common symptoms of lung cancer

Eating a healthy diet and exercising regularly can help maintain a healthy weight and reduce risk of developing cancers. Eating 500 grams of fruits and vegetables per day and exercising for 30 minutes at least 3 times a week are good goals to aim for. In addition to physical health, lifestyle modification can also help improve mental health and psychological well-being in cancer survivors. Regular meditation can help clear the mind, improve the immune system, and promote body functionality¹¹.

Visit your doctor if you experience any of the following common symptoms of lung cancer¹²:

B Blood when you cough or spit

R Recurring respiratory infections

E Enduring cough that is new or different

A Ache or pain in shoulder, back or chest

T Trouble breathing

H Hoarseness or wheezing

E Exhaustion, weakness or loss of appetite

Types of cancer treatments

Lung Cancer is not a death sentence, THERE IS HOPE. Better treatments, especially the approval and use of targeted therapies, are the main reasons why fewer people are dying from lung cancer and the overall impact of the disease is decreasing^13,14. Targeted therapy and immunotherapy are two types of cancer treatments. Targeted therapy uses drugs to block the growth and spread of cancer cells, while immunotherapy helps the immune system fight cancer. Targeted therapy is personalized to the specific cancer type; therefore, it may require certain tests (biomarker tests) before utilization. Immunotherapy works by blocking ‘checkpoint proteins’ that cancer cells use to avoid being attacked by the immune system, hence these drugs are also known as checkpoint inhibitors¹⁵.

Lastly, cancer mortality is reduced when cases are detected and treated early. So let us all be aware and help save lives. We can all make a difference in the fight against lung cancer.

The article is contributed by Dr. Raja Dhar, Director and Head of Department, Department of Pulmonology, C K Birla Hospitals.

References:

Cancer (IARC) TIA for R on. Global Cancer Observatory [Internet]. [cited 2023 Aug 8]. Available from: https://gco.iarc.fr/
Sathishkumar K, Chaturvedi M, Das P, Stephen S, Mathur P. Cancer incidence estimates for 2022 & projection for 2025: Result from National Cancer Registry Programme, India. Indian J Med Res. 2022;156(4 5):598 607.
Crosby D, Bhatia S, Brindle KM, Coussens LM, Dive C, Emberton M, et al. Early detection of cancer. Science. 2022 Mar 18;375(6586):eaay9040.
Diet, nutrition, physical activity and lung cancer. 2017; (Accessed 8 Aug 2023)
Lung Cancer Causes | Lung Cancer in Non-Smokers [Internet]. [cited 2023 Aug 8]. Available from: https://www.cancer.org/cancer/types/lung-cancer/causes-risks-prevention/what-causes.html
Cancer prevention [Internet]. [cited 2023 Aug 8]. Available from: https://www.who.int/europe/news-room/fact-sheets/item/cancer-prevention
Benefits of Quitting [Internet]. Centers for Disease Control and Prevention. 2022 [cited 2023 Aug 8]. Available from: https://www.cdc.gov/tobacco/quit_smoking/how_to_quit/benefits/index.htm
Cancer Screening – NCI [Internet]. 2021 [cited 2023 Aug 8]. Available from: https://www.cancer.gov/about-cancer/screening
Lam DCL, Liam CK, Andarini S, Park S, Tan DSW, Singh N, et al. Lung Cancer Screening in Asia: An Expert Consensus Report. J Thorac Oncol [Internet]. 2023 Jun 28 [cited 2023 Aug 8]; Available from: https://www.sciencedirect.com/science/article/pii/S1556086423006354
Shankar A, Saini D, Dubey A, Roy S, Bharati SJ, Singh N, et al. Feasibility of lung cancer screening in developing countries: challenges, opportunities and way forward. Transl Lung Cancer Res. 2019 May;8(Suppl 1):S106 21.
5 Do’s and Don’ts of Cancer Care [Internet]. [cited 2023 Aug 8]. Available from: https://www.wattanosothcancerhospital.com/en/all-about-cancer/5-dos-and-don-ts-of-cancer-care
Lung Cancer Facts 2023 [Internet]. Lung Cancer Research Foundation. [cited 2023 Aug 8]. Available from: https://www.lungcancerresearchfoundation.org/lung-cancer-facts/
Rudolfsen JH, Hjorts MD, Pedersen MH, Pilgaard T, P hl M. Impact of new cancer medicine real-world evidence from Danish register study of lung cancer patients. Acta Oncol. 2023 Mar 4;62(3):253 60.
Howlader N, Forjaz G, Mooradian MJ, Meza R, Kong CY, Cronin KA, et al. The Effect of Advances in Lung-Cancer Treatment on Population Mortality. N Engl J Med. 2020 Aug 13;383(7):640 9.
Types of Cancer Treatment – NCI [Internet]. 2017 [cited 2023 Aug 8]. Available from: