A Lancet Regional Health Southeast Aisa Journal study reveals found that a 'substantial portion' of lung cancer patients in India have never smoked and that there is the involvement of unique’ environmental and genetic risk factors among others.

Impact of Air Pollution on Lung Cancer Patients

Given this, the experts demanded region-centric research, claiming that some climatic variables, such as air pollution and other cancer-causing environmental elements, directly cause lung cancer. The essay "Uniqueness of lung cancer in Southeast Asia," which was written by a group of doctors, mostly from Tata Memorial Centre in Mumbai, said that a "substantial proportion of patients" with lung cancer are not smokers.

lung cancer patients
Image Source: Drugwatch.com

The researchers, who included specialists from Tata Memorial Hospital, found that the ratio of Indian lung cancer research production to worldwide research output is 0.51. The research, which was published in the eClinical Medicine Journal of The Lancet, also revealed that lung cancer age appears in India 10 years earlier than in Western nations, where the diagnostic age is between 54 and 70.

Genetic Factors and Lung Cancer

"Although several guidelines exist, we require a set of dynamic guidelines which change with changing science, and are region-centric, which are developed from data generated in Southeast Asia rather than based on global data," the authors wrote.

The reason for this might be because India's median age is 28.2 years, but the USA and China have median ages of 38 and 39 years, respectively. The study draws attention to common geographical characteristics like genetic mutations and air pollution that are important. From 6.62 per 1,000 people in 1990 to 7.7 per 1,000 people in 2019, there has been a notable increase in the risk of lung cancer expected in urban areas by 2025.

A World Air Quality Report 2023 by Swiss organization IQAir states that around 1.33 billion people, or 96 percent of India’s population, are exposed to PM2.5 levels over seven times the WHO’s annual guideline of 5 micrograms per cubic meter. The study's authors noted that certain geographical risk factors like genetic abnormalities and air pollution also have an impact.

"As climate change continues to unfold, it magnifies the burden of lung cancer which is already a significant public health challenge in Asia," the authors wrote.

Lung cancer incidence climbed from 6.62 per 1,000 people in 1990 to 7.7 per 1,000 people in 2019, with notable increases predicted in metropolitan areas by 2025. The male-to-female ratio of lung cancer cases also shows that males consume tobacco at greater rates than women do (42.4% vs. 14.2%). Researchers from the All India Institute of Medical Sciences (AIIMS), New Delhi, among others, examined the effect of climate change on lung cancer in Asia in a different work from the same series.

According to the researchers, China, India, Indonesia, the Philippines, and Thailand have been the most severely affected by national catastrophes in Asia. In 2020, these nations accounted for nearly 9.65 lakh new cases of lung cancer. According to the study, there may be a connection between the increased prevalence of lung cancer among never-smokers and variables such as genetic predisposition, pre-existing lung illness, and hormone state.

According to a PubMed study, nonsmokers with lung cancer are more likely to have mutations in genes like EGFR (epidermal growth factor receptor). Independent of outside variables like smoking, these genetic defects can result in unchecked cell proliferation and tumor formation, according to research from the National Cancer Institute.

The Times of India was informed by Dr. Kumar Prabhash, one of the writers from the medical oncology department of Tata Medical Centre, that although the percentage of cancer cases in India is lower than in the West, the country's size makes the total number still noteworthy. He also explained that a unique aspect of India’s lung cancer issue is the high incidence of tuberculosis (TB).

He stated, “Diagnosis often gets delayed because of TB as both conditions mimic each other.” The authors of the study noted the difficulty in accessing new treatment modalities and molecules, saying, “Most treatments are developed abroad, and importing them adds to the cost.” The primary challenge, they emphasized, is early identification and initiation of treatment.

The study reinforces Prabash’s argument, stating, “Inequities in socioeconomic status and access to healthcare contribute to the differences in the lung cancer burden and mortality in low- and middle-income countries.” Additionally, Dr. Prabash pointed out, “Barely 5 percent of lung cancer patients seek help in time for surgical help. We need to increase this number to at least 20 percent like in the West.”

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