Lung cancer incidence has gone up and this has been noticed especially more in women
The month of November is internationally observed as Lung Cancer Awareness month. The last release of the GLOBOCAN database (September 2018) includes estimates of the incidence of, mortality and prevalence from 36 types of cancer and for all cancers combined in 185 countries of the world. As per the report, Lung cancer was fourth on the list with a 6.45 percent rise in cases from 2012 to 2018.
Dr. Tejinder Singh, Medical Oncologist, Apollo Hospitals Navi Mumbai says, “Lung cancer incidence has gone up and this has been noticed especially more so in females. We don’t know the exact cause behind the increase but some factors that could be contributing to the increase are indoor pollution, i.e. exposure to cooking gases within the kitchen as well as increase in smoking among females.” The primary causes of lung cancer are smoking, exposure to asbestos and other hazardous materials. Air pollution does have a role to play in increasing the risk of lung cancer but no direct correlation has been found yet.
However the survival rate for lung cancer patients has improved which is a good sign of the advances in lung cancer treatment. Dr. Tejinder Singh states, “Today treatment has become more personalized – which means that doctors today detect specific mutations within the tumour , based on which a treatment course is planned out. Unlike chemotherapy where the patient had to regularly visit the hospital to receive doses of the medicine, there has been more focus on ‘Targeted Therapy’.”
Through mutation testing, patients are prescribed certain types of medicines (tablets) that specifically target those mutations. Unlike chemotherapy, this treatment does not have any side-effects and has faster recovery. Patients can also take this treatment at home instead of visiting the hospital. Another example of treatment is Immunotherapy which has also been showing very good results in those patients who opt for it.
“Diagnostics have also improved – more patients can afford to go for CT scans rather than regular X-Rays, through which it is much easier to detect lesions within the lungs. However we are still facing an issue with early detection – still, about 80 percent of patients come when they are at advanced stages,” adds Dr. Tejinder Singh.
The Future of Lung Cancer Treatment
Treatment options will move towards Targeted Therapy and Chemotherapy will slowly become a thing of the past. Today we are able to detect about 40-50 percent of mutations in the patients through we can prescribe personalized therapy, however this number is expected to improve to about 70-80 percent in the future.
Says Dr. Tejinder Singh, “There is also research ongoing in genetic testing which help us detect those patients in which cancer is more likely to happen. For example, patients with the P53 mutation are more prone to developing certain kinds of cancer – there are more developments happening in this arena as well.”
Dr. Muzammil Shaikh , Consultant Medical Oncology at Hinduja Healthcare Surgical says, ’There is an increase incidence of lung cancer in India; the latest GLOBOCAN data 2018 justifies the increase of lung cancer incidence in India more so in women and also in nonsmokers, which is something that needs to be understood more. Also, many of these women are non-smokers. But still they develop lung cancer at younger age.
Our population registry reporting system is not fool proof so many a times we are not reporting it accurately and possibly under reporting the incidence of lung cancer. However, the fact remains that there is definite increase and projected that there will be more increase in the coming decade and this follows the smoking pattern.
Talking about the causes Dr. Muzammil Shaikh says that there is no defined factor as such, whether it is some micro environment, or it is the nutrients which we are taking, or it is just the pollution outside or inside which we are dealing with causing an increase in the incidence in non- smokers as well.
Risk factors for lung cancer
When it comes to risk factors, the most defined and the most important risk factor is smoking in all forms, whether it is cigarette, biri or hookah or active or passive, these are great risk factors for developing lung cancer, and of these smoking is the most important, most talked about and at the same time avoidable.
The type of cancer that we have seen has also changed from last thirty or forty years because of the smoking pattern. We are using filter cigarettes and other things, which actually have not reduced the incidence of lung cancer. But these habits are changing the type of lung cancer which are seen. We are witnessing more of adenocarcinomas now than squamous cell carcinoma, these are the two sub types of carcinomas. But the actual number has increased. Therefore, thinking that taking a filter etc might be safe is just a myth.
Role of air pollution in lung cancer incidence
Another risk factor is pollution, air pollution has got a role to play when it comes to risk factors. There is definite increase in incidence of lung cancer in people having exposure to air pollution.
Air pollutants should be considered on two parameters - one is outdoor air pollution, and another is indoor air pollution. In outdoor air pollution the absolute risk may be small for each individual patient. For example each individual person who is exposed to air pollution in Mumbai, the risk may be small, but the number of people getting exposed to this risk is very important because if everyone is exposed to that amount of pollution, the risk may be small but the number is huge.
Regarding indoor air pollutions, as there is still use of kachha chulhas in India to make food and also burning wood in winters; these indoor pollutions affect a large population of India. And to add to these there is indoor pollution like passive smoking which is harmful especially for kids in urban areas as well, which increases the risk of developing lung cancer when they grow up. These are few reasons for non-smokers who develop lung cancer in young adults especially in females.
Prevention of lung cancer
The most important preventive measure is to stop smoking and using tobacco in all forms. It not only prevents lung cancer but other health related issues also like-cardiac risks, strokes etc.
Other measures are to prevent outdoor pollution, we should encourage people to take active modes of transport, may be walking, and cycling for small distances. So, that we are not using vehicle and developing carbon footprint behind us. The chemical exposure in the industries should be controlled and try that the employees are not in direct contact with chemicals, like- toxic fumes which can increase the incidence of lung cancer. Staying healthy, exercise and eating balanced nutritious diet to make the immune system better are the few more measures to prevent lung cancer or any other cancer.
Recent Advances in Lung Cancer research and treatment
Considering recent advances, definitely lung cancer has made a lot of advances that have occurred. Since we better understand biology now, so we are moving from the era of chemotherapy to targeted therapy and many of these have given great responses and patients have been benefited with it and recently in last 7 years we have immunotherapy which is approved for lung cancer, many patients do get benefited by using immunotherapy. These are the two new big additions which are there in recent advances.
Apart from chemo and other treatments, there is also immunotherapy. Based on certain tests which can tell you that in which patients we can avoid chemo therapy and directly do immunotherapy, currently though the percentage of patient actually using Immunotherapy is small, but is a US FDA approved treatment. There are cases where most of patients still require chemo therapy to begin with but now we have an option that some patients can directly go for immunotherapy, if the report says so. And immunotherapy is always there as a second option if chemotherapy doesn’t work. And it can be significantly effective in some patients.
Immunotherapy can be standalone therapy, and in combination as well. Only those patients whose PD- L1 testing report shows more than 50 percent positivity, then one can avoid chemo therapy and can directly give the patient immunotherapy as a frontline drug.