Why are young non-smokers too getting a deadlier form of lung cancer?

Says Dr Kumar, “What disturbed me most was the fact that unlike the West, where lung cancers are mostly reported among people above 60, the incidence of lung cancer in India is about two decades earlier. Nearly 10 per cent of all patients were less than 40 years of age with 2.6 per cent in their 20s. I have checked data from various OPDs and found that there is almost an equal distribution of lung cancers among smokers and non-smokers, with younger women getting most affected.”

He was also worried about the manifestation of lung cancer and the tumour changing its character. “Adenocarcinoma forms when cells lining the lungs from the outside become cancerous whereas Squamous Carcinoma impacts the cells that line the surface of airways. The former is known to have a relatively poorer outcome and forms 60 per cent of all cancers diagnosed among young people,” says Dr Kumar. He is also concerned that diagnosis is happening in Stage 3 and Stage 4 when the disease is almost intractable. But as existing research shows young patients in these stages are able to physically perform at 85 per cent of their activities. “Besides, most of them lose time because of misdiagnosis. I have had patients who say they had been wrongly treated for tuberculosis,” adds Dr Kumar.

Agrees Dr Pramod Kumar Julka, Principal Director, Cancer Care, Max Speciality Hospital, Saket, “Over 45 years, there has been a 20 to 30 per cent increase in lung cancers among young people. In the 1980s, I have never seen young people contracting lung cancer. It is only after the 90s that cases have begun spiralling and keep going higher and higher from 2000 onwards.”

WHAT ARE THE TRIGGERS FOR LUNG CANCER?

Now that the line between smokers and non-smokers are almost blurred, Dr Kumar sees air pollution as the biggest threat and trigger. “The WHO has already called air pollution as a second tobacco epidemic. Given Delhi’s poor air quality index (AQI), where PM 2.5 hovers between 140 to 160 on an average and goes up to 500 in winter, with the figures getting repeated in other metro cities, most citizens are actually smoking seven to ten cigarettes in 24 hours. Consider that new-borns are also smoking the same air. It takes 25 years for tissues to become cancerous after exposure to PM 2.5. So now you can imagine the extent of lung damage, considering most babies born today are being exposed to these levels at birth,” says Dr Kumar.

Explains Dr Julka, “We are living in a furnace. PM2.5 has a capacity to penetrate the alveoli (tiny branches of air tubes in the lungs). This can be a trigger for genotoxic stress. The P53, or the tumour suppressive gene, can then mutate and the onco genes take over,” he says.

HOW CAN WE PREVENT AN EPIDEMIC

Both Dr Kumar and Dr Julka agree that primary prevention to reduce tobacco consumption and control air pollution will help in controlling the rising graph of lung cancer cases. Dr Julka advocates that as part of the National Cancer Control programme, trained healthcare professionals should encourage people at rural primary healthcare centres (PHCs) to strictly launch a campaign against smoking tobacco as beedi or consumption of tobacco-related products. “Concerted efforts to screen lung cancer using low-dose CT scan in the at-risk population (i.e., age above 55 years with more than 25-year history of smoking) has been able to reduce lung cancer mortality by 20 per cent in the United States. Now, there is a need to apply this approach in our country for better screening and diagnosing more cases at an early stage which offers improved outcomes and decreased mortality. We need tissue confirmation. If a person with symptoms of TB is not diagnosed as such, then go for biopsy. It is better to be over-cautious than sorry. If detected early, then we can have 70 per cent surgeries as key-hole procedures (VATS or robotic), which are more patient-friendly and have improved long-term outcomes,” says Dr Kumar.

Dr Julka, while recommending early screening in younger years, recommends a low-dose CT scan of the lungs in suspect case besides molecular studies. “This means micro-RNAs can be investigated as a prevention strategy. Targetted therapies work well after we do a genetic and molecular profile of the patient. While oral, surgery, chemotherapy and radiation continue to be treatments, targetted therapies have increased the survival prospects of Stage 4 cases, some of whom are living for more than five years now,” he adds.