Lung Cancer – Smoking away our concerns

The month of November is observed every year not only as the Lung cancer awareness month / National cancer awareness day but also as the Pancreatic cancer awareness month and No shave November to highlight the need for awareness against male related cancers like prostate & testicular cancer.

Lung cancer is the most common type of cancer & the leading cause of cancer related deaths globally, whereas in India, it is the 4th most common among both men & women and 2nd most common among men – related to the higher incidence of smoking / tobacco related cancers among men.

About 1 in 15 men have a lifetime risk of developing lung cancer which is higher among smokers as opposed to non-smokers.

Anyone who has consumed more than 100 cigarettes in their lifetime, by definition, becomes a smoker. Among smokers, there is a 20-25% risk of developing lung cancer. Among people diagnosed with lung cancer, 80% would have had a history of tobacco consumption including smokeless tobacco – gutkha, paan, betel nut, khaini, etc

Second-hand smoking (passive smoking) is another important risk factor. E-cigarettes (concept of vaping – only vapours – tobacco free) are not safe alternatives and should only be used as part of nicotine replacement therapy for tobacco cessation strategies.

         Can non-smokers develop lung cancer ?

Yes, the impact of environmental pollution / occupational exposure can also lead to lung cancer. Delhi is also the lung cancer capital of India because of the incidence of smog (smoke + fog) and the particulate matter concentration of air being very high.

Any respiratory symptom like cough / breathlessness / blood stained sputum which persists for more than 2 weeks needs further evaluation and prompt referral to a specialist.

Screening can lead to early detection of lung cancer especially in the high risk population which refers to smokers (30 pack years) / people with underlying respiratory disorders and between the age of 55 – 74 years with a low dose CT scan of the chest at 1,3 & 5.5 years.

About 90% of people diagnosed with lung cancer in India have metastatic disease (Stage 4) at presentation, which again emphasizes the need for screening & early detection.

Treatment options depend on the stage at presentation. Only around 6-8% of people with lung cancer actually undergo surgery in India. The other treatment options for Stage 1 – 3 lung cancer include chemo / radiotherapy & concurrent chemo + radiotherapy.

Stage 1 refers to disease confined to the lung.

Stage 2 / 3 refers to disease in the lung which has spread to the regional lymph nodes (commonly – mediastinal lymph nodes)

Stage 4 refers to distant spread to other organs (bone, adrenal, brain, etc)

The mainstay of treatment for stage 4 disease is systemic therapy which includes targeted therapy, chemotherapy & immunotherapy alone or in combination based on molecular tests.

Targeted therapy works only in people who have a particular driver mutation which can be targeted, the incidence of which is higher among non / never smokers.

World No Tobacco Day falls on the 31st of May every year and the theme for this year “Protecting youth from industry manipulation and preventing them from tobacco and nicotine use” highlights the need for tobacco cessation.

Tobacco cessation strategies are the need of the hour, so remind yourself of the 5 A’s & 5 R’s

ASK – about tobacco consumption.

ADVISE – about the ill-effects of tobacco consumption.

ASSESS – the severity of addiction to tobacco related products.

ASSIST – in tobacco cessation strategies.

ARRANGE – for regular follow-up at regular intervals .

RELEVANCE – talk about the relevance of tobacco cessation.

RISK – talk about the ill-effects of tobacco consumption.

REWARD – talk about the benefits of tobacco cessation.

REPETITION – keep driving home the message about tobacco cessation until it sinks in.

ROADBLOCK – identifying roadblocks to successful implementation of tobacco cessation strategies.

Before I conclude, let me highlight on the theme for this World Cancer Day which is “I am & I will” and it’s meaning. I must draw inspiration from the famous “Backstreet Boys” song, which goes “I don’t care who you are / where you are from / what you did, As long as you love me”

So, it really doesn’t matter who we are / where we are from or what we do we can still make an impact in the lives of people with cancer by taking the pledge “I am” a responsible human being & “I will” spread the word about the ill effects of tobacco & create awareness about lung cancer.



– Dr.Krupa Shankar, Consultant Medical Oncologist, NSR CanKure Center, Coimbatore. Contact No. 9894547795, email – (Formerly Assistant Professor at Adyar Cancer Institute,Chennai)

Issued in public interest for general awareness and is not intended or implied to be a substitute for professional medical advice or for treatment/cure for any medical condition. The views expressed are independent opinion based on studies from authentic sources. Please consult your doctors/ a registered medical practitioner before starting any treatment/medicine.