Lung cancer: time to kick the butt

Irrespective of the gender, every sixth person per one lakh population in India is diagnosed to have lung cancer. Lung cancer ranks third in cancer-related deaths next to breast cancer and cervical cancer in the country. It is one of the most common causes of cancer-related deaths and is the most common cancer diagnosed worldwide.

For people who are into smoking, the best way to avoid getting lung cancer is to not smoke. Smokers who quit for more than 15 years have an 80% to 90% reduction in their risk of lung cancer compared with people who continue to smoke.

The odds of developing cancer increases proportionately with the duration and amount of smoking. Starting to smoke at a young age further aggravates the risk. Both beedis and cigarettes pose the risk for cancer. Though it is assumed that filtered and low-tar cigarettes might not compound the problem so much, by taking more deeper puffs or smoking more cigarettes most smokers inch closer to developing cancer. However, as soon as you stop smoking, your chances of developing lung cancer decreases. Sitting with people who smoke in front of you also adds to the risk.

Though smoking tobacco is the main risk factor for causation of lung cancer, there is a large portion of people who get lung cancer despite being non-smokers. The surprising fact is that the number of deaths due to lung cancer among non-smokers is much more common among women when compared to men. This emerging trend suggests that there could be other factors at play, such as biomass fuel exposure.

Risk factors which come from workplace exposures can also pose a serious threat. Construction and shipyard workers, firefighters, power plant workers etc are exposed to asbestos, which is harmful to the lungs. People working in metal industries, painting and rubber industry, glassware production, solder manufacturing, on the other hand, are exposed to arsenic and chromium, which again is a cause of the disease.

Wearing protective devices in industries which have a significant amount of toxic exhaust is highly recommended to avoid complications. Replacing asbestos with less toxic elements can also be an option to reduce the impact on the body.

Overexposure to diesel engine exhaust, too, can be a contributor in the long run. Regular emission tests for vehicles, scrapping much older engines and ensuring entrapping of particulate matter from the vehicles may help reduce the number of toxic substances released into the environment.

Preventive checks

The symptoms of lung cancer may be very non-specific, and one may not be able to differentiate it from other respiratory disorders. Nevertheless, it is always recommended to meet a specialist if you develop symptoms such as chest pain, coughing up blood, shortness of breath, wheezing, hoarseness of voice, loss of weight and appetite and cough which does not respond to treatment.

Anyone with a first-degree relative (parent, brother, sister) with lung cancer has a slightly higher risk of developing the condition themselves.Additionally, pre-placement examination for people who are already at risk of developing cancer should be done before placing them in occupations which pose a greater threat.

For people over 55 years of age who have a long history of smoking, screening for lung cancer with low-dose computed tomography (CT) scan has been shown to decrease the risk of death.

The emergence of interventional pulmonology in the last decade has led to a change in the scene of lung cancer diagnostics. Earlier while the diagnosis of lung cancer was deemed a death sentence, tremendous advancements in skills and technology have made it possible to diagnose lung cancers at a much earlier stage.

Bronchoscopy and bronchoscopy guided ultrasound have revolutionised the approach to lung cancer. Small tumours which were inaccessible earlier, hence delaying the diagnosis, are now easily approached using endobronchial ultrasound-guided biopsies.

Another major cause of delay in diagnosis was when patients presented with fluid around the lungs, a condition called as pleural effusions. Most patients were treated with anti-tuberculosis treatment as there were not many tools or tests available to confirm the diagnosis. Today, the procedure of medical thoracoscopy aids in procuring biopsies under vision and helps confirm the diagnosis.

(Dr Tousheed is consultant pulmonologist and Dr Hibare is con-
sultant interventional pulmonologist, Narayana Health City)