Lung cancer is increasingly becoming a significant health concern in India, with reports suggesting it was the second most common cancer in Indian males in 2020. It was the leading cause of cancer-related deaths worldwide in both high Human Development Index (HDI) and low HDI countries. Over the course of the last decade, the number of lung cancer cases diagnosed each year in India has risen, attributable to a confluence of several factors.
The COVID-19 pandemic made matters worse by delaying diagnosis and treatment. Between March 1 and May 31, 2020, there was a 54% reduction in the number of new cancer patients registered, and nearly half the patients were lost to follow-up in many centers in India. With the increasing burden and changing trends of lung cancer, the understanding of its biology and the science of its treatment has also evolved.
In western nations, the widespread availability of newer diagnostic techniques and optimization of existing treatment as well as newer modalities have led to the improvement in survival of patients with lung cancer. However, limited access to these new treatment modalities in India is still a matter of concern.
Changing Trends, Awareness and Air Pollution
As the number of people smoking has decreased in many countries, a change in patterns and a parallel rise in lung cancer among non-smokers has been observed. Adenocarcinoma, a type of lung cancer, is now the most common type, with an increasing number of non-smokers and women being diagnosed with it. Indoor fuel use-related and traffic-related air pollution has been linked to a higher risk of lung cancer among non-smokers. Worsening air quality in India and prolonged exposure to polluted air could partially contribute to this changing trend.
Despite recent advances in cutting-edge diagnostics and therapeutics, patients with lung cancer in India are mostly diagnosed at an advanced stage, where a complete cure is rarely possible. This could be attributed in part to poor awareness of the disease in both patients and healthcare workers as well as misdiagnosis in a proportion.
As an example, even today, many patients are diagnosed with tuberculosis and administered anti-tuberculosis therapy based solely on symptoms and chest X-ray findings, without confirmation of tuberculosis in a microbiology lab. In a study done in Bihar, one in three patients were initially erroneously diagnosed with tuberculosis and were treated empirically for 1 to 6 months before they were diagnosed with lung cancer.
