Increase in Lung Cancer Cases Among Indian Women and Non-Smokers

A persistent cough could indicate something far more serious than asthma, as revealed by the case of a 50-year-old woman who sought a second opinion from Dr Sachin Kumar, a pulmonologist in Bengaluru. Initially diagnosed with asthma, her condition deteriorated, culminating in the discovery of advanced lung cancer during an X-ray. Dr Kumar notes, "Not every cough or episode of breathlessness is asthma. When symptoms persist, they warrant re-evaluation." This underscores a growing trend in India, where lung cancer is increasingly found in women and non-smokers. Historically viewed as a disease mainly affecting older male smokers, lung cancer in India is now the leading cause of cancer-related deaths, surpassing all other malignancies. The latest statistics from Globocan 2024 show that India recorded over 112,000 new lung cancer cases last year, marking it as the third most frequently diagnosed cancer. However, it also accounted for nearly 99,000 deaths, translating to more than 10% of total cancer-related fatalities in the country. The grim reality persists that lung cancer diagnoses often occur at advanced stages, significantly complicating treatment. Dr Kumar has observed a stark rise in cases within his practice, with approximately 40% of recent diagnoses involving women or individuals with no smoking history. The annual rate of lung cancers in India has doubled since 2004, from about 55,000 cases to over 112,000. Notably, the proportion of women diagnosed has escalated from 20% to nearly 30% in two decades. This is puzzling for oncologists, particularly as studies indicate that 15% to 35% of lung cancer patients have never smoked. Among Indian women, a staggering 60% to 85% diagnosed with lung cancer report no history of smoking. Dr Vijay Kumar Srinivasalu, an oncologist at Sakra World Hospital, suggests multiple factors, including environmental and genetic influences, may contribute to this unsettling trend. Dr Srinivasalu cites indoor air pollution, outdoor air quality, and genetic mutations as some of the factors leading to increased vulnerability among women. The lethargic growth of lung cancer is another area of concern; its symptoms often mimic more benign respiratory issues. Many patients experience chronic cough, breathlessness, or chest discomfort, leading to misdiagnoses. By the time lung cancer is accurately diagnosed, it is frequently at an advanced stage. Dr Vijay highlighted that early-stage lung cancer can be asymptomatic or present symptoms resembling those of common ailments, making diagnosis challenging. This delay is compounded by overlapping symptoms with tuberculosis, especially in a country like India where tuberculosis is prevalent. The extensive capacity of the lungs allows tumours to grow unnoticed for extended periods before clear symptoms manifest. The difficulty in early detection is underscored by studies revealing that fewer than 10% of lung cancer patients in India are diagnosed early enough for surgical options, which offer the greatest chance of survival. Dr Kumar Prabhash of the Tata Memorial Centre emphasised that misconceptions around lung cancer being a smokers’ disease keep non-smokers from seeking help. With diminishing smoking rates, it is critical to acknowledge that lung cancer is increasingly affecting non-smokers, and awareness around environmental risk factors is essential. Experts, including Dr Prabhash, highlight that long-term exposure to indoor pollution from cooking and outdoor air pollution is likely contributors to rising case numbers. These concerns warrant urgent attention as they may shape future lung cancer risk profiles in India. For effective cancer management, doctors advise that persistent respiratory symptoms should never be overlooked. Education on the significance of early detection, along with improved access to screening technologies like low-dose computed tomography (LDCT), can make a difference. Overall, stakeholders must work together to shed light on this evolving landscape of lung cancer in India and develop appropriate strategies for risk mitigation and early detection.