Written by: Gayatri Thomas
4 min readAug 1, 2024 05:44 PM IST
First published on: Aug 1, 2024 at 03:52 PM IST
When 35-year-old Arun Mathai was diagnosed with lung cancer, it was in the advanced stage. Having never smoked in his life, he thought he had some severe lung infection because of Delhi’s polluted air. Yet many young people like him are at risk.
According to a study in The Lancet eClinical Medicine Journal, most lung cancer patients in India are non-smokers and develop the disease about a decade earlier than in Western countries.
What’s behind the higher incidence of lung cancer among young non-smokers?
Dr Arvind Kumar from Medanta, Gurugram, has mapped a pattern over decades. “I did a comparison of my data during my stint at AIIMS Delhi in 1988 and at Gangaram Hospital in 2018. In 1988, 90 per cent of my patients were smokers. In 2018, I found that over 50 per cent were non-smokers. In 1988, the peak age of occurrence was the 50s and 60s. Now, the peak age is 40. So it’s down by a decade and a half. In 1988, there were hardly any women patients. And now, 40 per cent of the patients are women. And 90 per cent of the patients present are beyond the scope of surgery by the time they present, which means they are in advanced stage three or stage four,” he says.
He attributes this to the presence of carcinogens in the air. “If you start smoking in the early 20s, you would take about 30 years of exposure to the 70 carcinogens in cigarettes to develop lung cancer. You would get it in your 50s. Unfortunately, air pollution exposure begins at birth. The average AQI in Delhi on non-rainy days equals about ten cigarettes. So, a newborn becomes a smoker from the first breath of life. By the time they are 30 or 40, they have actually been smokers for that much time. That explains it,” he says. The WHO has called air pollution the second smoking epidemic.
What are components of air pollution?
There could be exposure to industrial substances like arsenic, asbestos and heavy metals. Then there is exposure to second-hand smoke in shared spaces. But what Dr Jyoti Bajpai from Apollo Cancer Centre warns of is indoor pollution from radon gas which infiltrates buildings from soil contaminated by heavy metals. “Building materials, the water supply and natural gas can all be sources of radon in the home. This radioactive gas is invisible and doesn’t have a smell. Even exposure to diesel fumes is risky,” she says.
Why aren’t symptoms easily identifiable?
Dr Bajpai says the real challenge of early detection is overlapping of symptoms. “Respiratory symptoms like cough, chest pain, and at times, a blood clot are not specific and can occur in various infections, including tuberculosis. Because of this, it can be confusing for both patients and primary care practitioners to identify the cause. Sometimes, people ignore these symptoms, and even when they seek medical help, they may be prescribed antibiotics for suspected infection. This delays diagnosis.” The best way one can sense red flags is when there are unusual changes in your body like body weight, skin discoloration, or unusual behaviour changes like extreme thirst and a sudden intolerance to smoking, she explains.
What impact does early detection have on treatment outcomes and patient survival?
If you detect cancer at stage one, you have something like 95 per cent five-year survival. If you detect it late, survival drops to around 10 per cent in stage four, according to Dr Kumar. Likewise, stages two and three are placed in between. If there are suggestive symptoms, and you have a family history, then get investigated, advises Dr Kumar.
Any tech advances in screening procedures?
Molecular profiling can identify changes in cell DNA. Then there’s a low-dose CT scan, which can detect lung cancers even before they become symptomatic. “These detect abnormalities that mimic the spots seen in lung cancer. Still, you need to do a biopsy to confirm it is lung cancer,” he adds.
Most lung cancer patients in India are non-smokers and develop the disease about a decade earlier than in Western countries. (Photo Credit: Freepik/File) 
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