Non-smoker lung cancer cases are rising: Doctor explains battle of young Ghaziabad woman

On National Cancer Awareness Day, know how early diagnosis is the only way to battle lung cancer in India’s polluted cities

A biopsy confirmed stage 2 lung cancer, a treatable window. (Source: Pixels)

A 31-year-old woman from Ghaziabad, who had never smoked in her life, first coughed up blood, which subsided with some drugs that her neighbourhood doctor had prescribed. But then she felt a left-sided chest pain. Fearing a lung infection, she walked into the clinic of Dr Arvind Kumar, chairman, Lung Transplant, Chest Surgery/Oncosurgery, at Medanta, Gurugram, because she worked at an office nearby. “An X-ray showed a mass in the upper part of her left lung. A biopsy confirmed stage 2 lung cancer, a treatable window. She is disease-free and has returned to work but her case shows a disturbing trend,” he says.

Typically, lung cancer is associated with smokers, usually over 50, and men. But Dr Kumar has been seeing that profile change in his OPD. “Younger non-smokers are being diagnosed. And there are as many women as men. This indicates that lung cancer is no longer a smoker’s but a breather’s disease. While we talk of particulate matter, the ambient air in the urban environment is full of carcinogenic gases. And this is emerging as a real threat to everybody,” he says. Compounding all of this is a late diagnosis, which in lung cancer, complicates the patient’s chances of survival. “Luckily my patient had made the right call at the first stop. Most patients don’t,” he says.

Why lung cancer is often detected in later stages

That has to do with tuberculosis (TB), an infectious disease caused by bacteria that most often affects the lungs. “Unfortunately, TB is widespread in our country. Unfortunately, its symptoms of long-standing cough, blood in the sputum, pain and fatigue, overlap with those of lung cancer. Often the opaque patch of the lung in the X-ray is misconstrued as caused by TB. Most young patients are immediately put on TB therapy. Meanwhile the cancer lurking behind that patch grows and progresses. Confounding symptoms are the reason that 90 per cent of lung cancer patients in India present themselves at stage 4,” says Dr Kumar.

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That is why, he insists upon a detailed diagnosis protocol for TB as per the National TB Elimination Programme (NTEP) guidelines. “Once that rules out TB, get tested for possible cancer growth,” he advises. “My patient got diagnosed at a stage where surgery was possible,” he says.

Was pollution a trigger?

Ghaziabad is one of India’s most polluted cities and this case highlights the potential link between the environment and lung cancer. “People talk about prevention and wearing masks in public places. We breathe 25,000 times a day, which makes it difficult to wear a mask all day. Besides, a mask only stops particulate matter, which is minor protection considering that carcinogens come in gaseous form. Be it benzene, ethylene oxide, radon, ozone, all are triggers,” says Dr Kumar. Studies have shown that PM2. 5 (PM less than 2.5 µm) from various sources carries different toxic substances, such as sulphates, organic compounds, polycyclic aromatic hydrocarbons and heavy metals, which are considered major carcinogens that increase lung cancer risk.

Which surgery is best for therapy

Dr Kumar chose keyhole surgery, which is kinder on the patients, who do better during recovery protocols. “Since one of her lobes was affected and localised, we chose this minimally invasive method. Her biopsy revealed her cancer to be moderately aggressive, so we followed it up with chemotherapy, which kills any hidden and remnant cancer cells. She was given up to six cycles. Over the years, data has shown that about 30 to 55 per cent of lung cancer patients die because of recurrence post-surgery. That’s why now we consider lung cancer to be a widespread disease from Day 1. And recommend post-surgery chemotherapy,” says Dr Kumar.

The woman went back to work after three to four weeks. With physiotherapy and a high-calorie, high-protein diet, she recovered fast. Her breath-holding time exceeded 40 seconds. Subsequent tests showed that all her six lymph nodes were safe and the cancer had not spread. She got saved by an early diagnosis.