ECHO India

Author: Dr. Sandeep Bhalla, Associate Vice President, ECHO India

According to the World Health Organization (WHO), cancer is among the leading causes of death across the globe. In 2020, cancer accounted for over 10 million deaths, of which 1.80 million were attributed to lung cancer alone. [1]

Lung cancer is a type of cancer that originates from an unfettered division of cells in one’s lungs, gradually resulting in tumour growth. It can cause various health concerns, such as shortness of breath, respiratory infections, rapid weight loss, swollen lymph nodes, prolonged cough, fatigue, pneumonia, and more.

In India, lung cancer has emerged as one of the top 5 common cancers affecting the country’s population. The Indian Journal of Medical Research stated that by 2025, the number of lung cancer cases in India is set to cross 81,219 and 30,109 for males and females, respectively [2]. Additionally, Aizawl District in Mizoram had the highest incidence rate of lung cancer in both genders, largely owing to the prevalence of smoking and tobacco use in the state. [3]

As November is recognised as Lung Cancer Awareness Month, it is crucial to understand the epidemiology of the life-threatening disease, which continues to differ based on geographic barriers, ethnicity, and lifestyle habits, especially smoking.

What Causes Lung Cancer?

Although there are several possible causes of lung cancer, tobacco smoking tops the list in most countries, including India. Similarly, inhalation of secondhand smoke, also commonly known as passive smoking, can also increase one’s chances of developing lung cancer. Other risk factors include tobacco use, such as cigars, pipes, kreteks, and bidis, as well as exposure to harmful substances like chromium, benzene, nickel, and other carcinogens.

Additionally, one is also likely to contract lung cancer if there is an existing family history of the disease. As per the American Cancer Society, one can inherit an abnormal gene that may cause cancer; however, so far, only up to 10% of all cancer types have been linked to genetic defects. [4]

The Nexus Between Lung Cancer and Air Pollution in India

While tobacco consumption is a leading cause of lung cancer, the rising incidences can be attributed to other factors, including the alarming increase in air pollution [5]. As a rapidly developing country, India is experiencing unprecedented urbanization and industrialization; however, this comes at a cost - deteriorating air quality, with vehicular emissions, construction activities, and climate change only adding to the challenge.

Prolonged exposure to Particulate Matter (PM2.5 and PM10) [6] and hazardous gases present in the air can penetrate into the lungs, damaging lung tissues and causing chronic inflammation. The situation is particularly grim in urban cities like Delhi and Mumbai, which often face severe air quality issues, leading to a spike in respiratory illnesses, including lung cancer.

This necessitates urgent and comprehensive measures to combat air pollution, such as stricter emission norms for vehicles, regulating industrial emissions, and encouraging clean energy sources. Additionally, it is critical to raise awareness about the adverse effects of air pollution, promote the use of public transportation, and underscore the importance of wearing face masks in polluted areas.

What Are the Common Symptoms of Lung Cancer?

In lung cancer cases, timely diagnosis and treatment are crucial in preventing unprecedented fatalities. The foremost step to combat this is to raise awareness around the common symptoms of lung cancer, some of which include:

Persistent cough
Shortness of breath
Chest pain
Coughing up blood
Loss of appetite
Sudden weight loss
Fatigue
Swollen lymph nodes

Is Lung Cancer Preventable?

While several factors can lead to a lung cancer diagnosis, certain lifestyle habits can go a long way in preventing the chronic disease. These include avoiding smoking, frequently exercising, following a healthy diet, and staying away from secondhand smoke. Another thing to keep in mind is to avoid exposure to carcinogens, such as asbestos, nickel, benzene, and cadmium [7]. Moreover, it is important to get tested regularly. This includes blood tests, chest X-rays, as well as CT scans, PET scans, and screenings if one presents any of the above-mentioned symptoms.

In essence, the fight against lung cancer is intrinsically linked with the battle against air pollution, but there are often other factors at play. By tackling the root causes of pollution and embracing sustainable practices, India can significantly reduce the incidence of lung cancer, safeguard public health, and create a healthier environment.

National Cancer Grid’s Virtual Tumour Board (VTB): A Collaborative Initiative Between Tata Memorial Hospital and ECHO India

The Virtual Tumour Board (VTB) is a pivotal initiative by the National Cancer Grid (NCG) established under Tata Memorial Hospital, which is committed to providing standardized cancer care to patients across the country. The platform integrates over 250 cancer treatment facilities affiliated with NCG, fostering virtual and collaborative discussions on oncology cases.

As a step towards combating and managing lung cancer, ECHO India is supporting the Thoracic Disease Management Group (DMG) VTB run by Tata Memorial Hospital. During these sessions, cases involving various types of thoracic cavity cancers, primarily including lung cancer, are presented by participants. Following a case-based learning approach, oncologists, pathologists, and other healthcare professionals offer their recommendations, treatment plans, and other insights, enabling participants to effectively treat and manage patients’ symptoms. Additionally, the cases presented are followed up in subsequent Virtual Tumour Boards (VTBs) to evaluate the outcomes.

Within Tata Memorial Hospital, a total of ten Disease Management Groups (DMGs) have been set up, each focusing on specific cancer sites and comprising 20 to 40 members, including surgical oncologists, medical oncologists, radiation oncologists, and pathologists. Each cancer site also boasts a pool of 1,000 to 1,800 potential participants from the 270 NCG centres across India.

A collaborative effort between TMH and ECHO India, it ensures a comprehensive and collective approach to cancer management, leveraging expertise from diverse sources within the National Cancer Grid (NCG) network.