Lobar or Sublobar Resection for Peripheral Stage IA Non–Small-Cell Lung Cancer

Experts Link Lung Cancer Risks To Air Pollution, Passive Smoking

Lung cancer leads to global cancer-related mortality rates, affecting both men and women. The World Health Organisation attributes 85% of cases to tobacco use and air pollution, highlighting these as the primary risk factors.

In 2022 alone, 20 million new cancer cases were reported globally, with 9.7 million deaths—one in five individuals develop cancer during their lifetime, with mortality rates of one in nine for men and one in 12 for women.

Read Also: Why lung cancer cases are rising among women and youth

To gain insights into lung cancer detection, management and treatment, we spoke with leading oncologists: Dr Ankur Bahl, Senior Director of Medical Oncology at Fortis Memorial Research Institute; Dr Devavrat Arya, Oncologist at Max Hospital Saket; Dr Sajjan Rajpurohit, Senior Director of Medical Oncology at BLK-Max Super Speciality Hospital; and Dr Pooja Babbar, Consultant of Medical Oncology at C K Birla Hospital.

Excerpts

Air pollution increases lung cancer risk

Dr Bahl: A study by The Lancet found that air pollution causes 1.67 million deaths in India every year, including cancer-related deaths. Exposure to fine particulate matter (PM2.5), industrial emissions, vehicular exhaust, and other pollutants can lead to chronic inflammation and oxidative stress, increasing lung cancer risk. Recent studies have shown that long-term exposure to high levels of air pollution can be as detrimental as smoking in terms of lung cancer risk. The alarming rise in air pollution levels, particularly in urban areas highlights the need for stricter environmental regulations and collective efforts to minimise exposure such as using air purifiers and wearing protective masks.

Passive smoking and cancer link

Dr Arya: Second-hand smoke (SHS) is a serious but often underestimated threat to non-smokers, playing a critical role in lung cancer development. Exposure of non-smokers to dangerous chemicals through second-hand smoke, which includes carcinogens, can result in lung cancer. Research suggests that there is a 25-30% increased risk of lung cancer due to second-hand smoke exposure. Also, according to the Indian Council of Medical Research (ICMR), approximately 1 million Indians die each year due to smoking-related diseases, while the impact of second-hand smoke exposure on non-smokers cannot go unnoticed.  It is also important to note that vulnerable groups, including children and pregnant women, face heightened risks.

Role of lifestyle changes in reducing lung cancer risk

Dr Ankur Bahl: Reducing the risk of lung cancer involves a combination of lifestyle changes, regular health check-ups and awareness. Here are some adjustments that can help lower your risk:

Quit smoking: The most effective way to reduce lung cancer risk is to quit smoking and avoid exposure to tobacco smoke.

Healthy diet: A diet rich in fruits, vegetables, and whole grains, while low in processed foods and red meat, can support overall lung health.

Regular exercise: Engaging in moderate physical activity can strengthen your immune system and improve lung function.

Limit exposure to pollutants: Minimize exposure to air pollution and occupational hazards (like asbestos) by using protective gear and ensuring proper ventilation.

Avoid radon: Test your home for radon levels, especially if you live in an area known for high radon emissions, as it's a leading cause of lung cancer after smoking.

Steps to lower your risk of lung cancer

Dr Babbar: To lower your risk of lung cancer, consider these proactive steps: Quit smoking and avoid second-hand smoke, as these are the primary risk factors. Maintain a healthy diet rich in fruits, vegetables, and whole grains. Engage in regular physical activity to boost overall health. Minimise exposure to air pollution and radon gas. If you have a family history of lung cancer or are a heavy smoker, consult your doctor about screening options like low-dose CT scans.

Small cell and non-small cell lung cancer

Dr Rajpurohit: Lung cancer is generally divided into two main types: small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). These two types differ significantly in terms of their growth patterns, treatment, and outcomes.

Small cell lung cancer (SCLC) accounts for about 15% of lung cancers and tends to grow and spread very quickly. This cancer type is often linked to smoking and is typically more aggressive, meaning it spreads to other parts of the body faster. Due to its rapid growth, SCLC is usually treated with chemotherapy and, sometimes, radiation to control its spread. Surgery is less common because the cancer often spreads before it's detected.

Non-small cell lung cancer (NSCLC), on the other hand, makes up about 85% of lung cancer cases. This group includes subtypes like adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. NSCLC grows more slowly than SCLC, so if detected early, it may be treated with surgery, chemotherapy, radiation, and newer targeted therapies or immunotherapy.

Modern technologies of lung cancer diagnosis and treatment

Dr Bahl: Advancements in medical technology have significantly improved the diagnosis and treatment of lung cancer. Some of the modern diagnostic tools include:

Low-dose CT scans: These are more effective than standard X-rays for detecting early-stage lung cancer, especially in high-risk individuals.

PET-CT scans: These provide detailed images that help determine the extent of cancer and guide treatment planning.

Biomarker testing and liquid biopsies: These can identify genetic mutations and other biomarkers, allowing for personalized treatment plans.

For treatment, modern options include:

Targeted therapy: Drugs that target specific genetic mutations in cancer cells.

Immunotherapy: Treatments that boost the body's immune system to fight cancer.

Robotic-assisted surgery: Minimally invasive procedures that reduce recovery time and improve outcomes.

Radiotherapy with stereotactic techniques: Highly focused radiation treatments that minimise damage to surrounding tissues.

Read Also: World's First Lung Cancer Vaccine Trial Begins

Signs and symptoms of lung cancer

Dr Babbar: Early signs of lung cancer can be subtle and often mistaken for other illnesses. Common symptoms include a persistent cough that worsens or doesn't go away, coughing up blood, chest pain, shortness of breath, hoarseness, and unexplained weight loss or fatigue.

End of Article

With Smoking Rates Declining, So Too Are Lung Cancer Deaths. For Nonsmokers, The Numbers Tell A Different Story.

Lung cancer rates and deaths have fallen precipitously in recent decades overall — but diagnoses are rising for nonsmokers. (Getty Images)

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November is Lung Cancer Awareness Month, which brings both good news and bad. On the one hand, overall rates of the disease — and deaths from it — have declined precipitously as smoking rates have plummeted. But, on the other hand, diagnoses are climbing among people who have never smoked.

The lung cancer landscape in the U.S. Has shifted considerably since the first surgeon general's report linking the disease to smoking was published 60 years ago last January, so we've broken down emerging trends with the help of three charts. Here's what to know about lung cancer in 2024.

Lung cancer diagnoses are less common and less fatal

It's hard to overstate the progress the U.S. Has made against lung cancer. The disease's mortality rate has declined by 35% for men and 26% for women over the past 10 years, according to the American Lung Association (lung cancer rates have always been, and still are, considerably higher among men, which partially explains why mortality has fallen more steeply among males). And the rate of new cases has fallen over the past decade too, by 23% for men and 11% for women.

Much of this encouraging shift is thanks to a parallel trend: Smoking rates have declined too. Undoubtedly, better screening and innovative treatments have saved or prolonged many lives. But smoking is linked to between 80% and 90% of lung cancer deaths in the U.S., the Centers for Disease Control and Prevention estimates. If cigarettes were as popular now as they were in the '60s, even the most cutting-edge treatments would struggle to put a dent in the mortality rate.

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However, not everyone who smokes develops lung cancer, and not everyone who is diagnosed with lung cancer has smoked, ever or heavily. "Lung cancer is different in people who never smoked," Dr. Heather Wakelee, a Stanford University professor of oncology who specializes in lung cancer, tells Yahoo Life. "But the people who have smoked start to feel like they're being blamed" for the disease, she says.

Lung cancer in people who haven't smoked is stubbornly high

The CDC estimates that between 10% and 20% of people who develop lung cancer in the U.S. Don't have a history of smoking. "It's hard to tease out" precisely what causes these cases, Zach Jump, director of research, epidemiology and statistics at the American Lung Association, tells Yahoo Life. Likely contributors include air pollution, genetics and radon gas (which the Environmental Protection Agency has blamed for as many as 21,000 lung cancer deaths, though experts say that's likely an overestimate). "But right now, there are more questions than answers," says Jump.

Whatever the case may be, there has been little change in the deadliness of the disease for people who don't have a history of smoking. Lung cancer was responsible for more than 25,000 deaths that couldn't be attributed to smoking in 1990, according to a study published in the Journal of the National Cancer Institute. In 2018 that figure was stable at 27,000 (accounting for population growth). As smoking rates have fallen, lung cancers in people without a history of smoking account for a growing proportion of annual diagnoses.

Different kinds of lung cancer tend to strike those who haven't smoked

There are two broad groups of lung cancers, as well as subgroups:

Small-cell lung cancer, which is diagnosed overwhelmingly among people who have smoked, per Cleveland Clinic. These tumors grow more quickly and typically originate from cells in the bronchi or windpipe.

Non-small-cell lung cancer (NSCLC) is much more common, accounting for about 85% of lung cancers and originating in the lung tissue. It has several subtypes:

Adenocarcinoma is the most common subtype of lung cancer among people who have and haven't smoked alike, but it's the form most often seen in people without a smoking history. It begins around the outside of the lungs.

Squamous cell carcinoma originates in the lining of the lungs and is the second most common form of lung cancer. It's more closely linked to smoking than other forms of NSCLC.

Large-cell carcinoma, the least common subtype, grows and spreads more aggressively than other forms of lung cancer. Smoking is thought to be its predominant cause.

Why are rates staying higher for people who never smoked?

Asian heritage has emerged as a major risk factor for developing lung cancer despite never having smoked. People with Asian ancestry are more likely than other groups to be diagnosed with tumors that have a mutation to a protein called epidermal growth factor receptor. "About 50% of nonsmoker Asians have this mutation, compared with less than 20% of non-Hispanic white people" with lung cancer, Dr. Bryant Lin, a professor of primary care at Stanford Medicine and co-founder of the school's Center for Asian Health Research and Education, tells Yahoo Life. (Lin was diagnosed with this form of lung cancer himself.) What's not clear yet is why this occurs.

Wakelee (who is also Lin's oncologist) is among the leading researchers working on that very question, looking at other sources of indoor smoke, like cooking oils, as possible contributors. And, we now have quite "clear data that air pollution is playing some role," she says. Some of the best data on lung cancer, smoking and pollution comes from Taiwan. "Women in Taiwan almost never smoke, and rates of smoking in men have come way down, but when you look at lung cancer there ... Squamous [a type closely linked to smoking] rates are way down and rates of adenocarcinoma [the form nonsmokers tend to get] are way up," Wakelee explains.

The U.S. Has less and lower-quality data on smoking, she says. But similar trends are apparent. Even as rates of other forms of lung cancer (and deaths due to them) have come down, adenocarcinoma rates have remained persistently higher.

What you can do

First and foremost, not taking up smoking, or trying to quit if you already smoke, is the No. 1 thing you can do to reduce your risk (and improve your overall health), experts say. If you don't know if your home was radon-tested, it's worth having that done, as the radioactive gas is a carcinogen known to raise risks of lung cancer. That's especially true if you live in certain parts of the country, like the northern Midwest and Mountain West, says Wakelee. States where radon is more prevalent include Montana, Pennsylvania and South Dakota. And while pollution in your vicinity isn't under your direct control, Wakelee says it's worth advocating for better air quality in your community and with your vote.

Finally, don't ignore symptoms or avoid or delay screening, Jump urges. Signs of the disease include a new and persistent cough, shortness of breath, coughing up blood and, in some cases, chest or upper back pain. But one of the problems of lung cancer is that signs often develop only at the disease's later stages. That's why screening — which is recommended between ages 50 and 80 for those who smoked one pack a day for 20 years or two a day for 10 years, or who have been a smoker in the past 15 years — is so crucial. "Formerly, it was a death sentence, so people don't want to know; if they think they'll be at risk they want to put their head in the sand," Jump explains. "But screening offers incredible hope." Now surgery for lung cancer that hasn't spread can be "essentially curative," he explains. And, for those diagnosed in later stages, treatments have come an incredibly long way.

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