Stop the killer
DR. R. NARASIMHAN
If identified early, lung cancer can be treated. Otherwise, the chances of survival are bleak.
High risk category: Smoking is a primary cause for the disease. Photo: AFP
CANCER is an uncontrolled growth of the tissue. The five most common cancers are colorectal, lung, stomach, breast and cervix, According to the World Health Organisation (WHO) more than 11 million people are diagnosed with cancers every year. It is estimated that there will be 16 million new cases every year by 2020. Cancer causes seven million deaths every year.
Treatment has very little impact on lung cancer cases at an advanced stage, as 90 per cent of such people do not survive. In India, the higher incidence of lung cancer is attributed to the rising trend of smoking. From 32,000 in 1989, the country is burdened with 41,000 new lung cancer cases every year. Individuals who have a close relative suffering from lung cancer are at an increased risk of developing the disease, regardless of whether or not they smoke.
Cause for concern
The divergent smoking trends in the West and developing countries are a cause for concern. While male smoking in the West has hit a plateau because of greater health consciousness, in India and China it is still on the rise. Since female smoking is still fashionable in the West, lung cancer cases are higher among women.
Despite tremendous advancement in the diagnosis and treatment of the disease, chances of survival are very bleak. More than 75 per cent of the cases in India are detected at an advanced stage and despite treatment with chemotherapy and radiotherapy the disease remains incurable. Statistical projections suggest that lung cancer mortality in this decade will continue to rise to a rate of over 50 deaths per year per 100,000 people in the U.S. It is debatable whether the current lung cancer prevention programmes are expected to influence lung cancer death rates.
Environmental and genetic factors are also thought to play a role. It has long been postulated that people may differ in their susceptibility to environmental risk factors and evidence is growing for a familial risk pattern. Other risk factors include exposure to smoking, radiation, asbestos; heavy metals such as arsenic, chromium and nickel.
Very low lung cancer rates are seen in the men of undeveloped regions of India, Africa, and South America. Lung cancer rates also are highest among Maori women and among some black and white populations within the United States.
In addition, Chinese women, many of whom are non-smokers, have very high lung cancer rates. This phenomenon has been associated with exposure to cooking oil vapours and other forms of air pollution in the indoor environments of China.
Lack of awareness
The low incidence of lung cancer observed in underdeveloped countries is due to the lack of awareness and also due to the fact that the priorities were in treating tuberculosis. It is possible that many of the cases of lung cancers could have been treated as "TB treatment failures".
There is, however, an increasing awareness about this dreadful disease. Thanks to various awareness campaigns, people tend to visit doctors at an earlier stage than before. Also due to the availability of the latest diagnostic facilities in many cities there has been an increased incidence of lung cancer referrals from peripheries. Many lung shadows were earlier treated as TB and referred to hospitals only when it did not respond to treatment.
Persons with any of the unusual symptoms should undergo sputum test for cancer cells. If clinical suspicion of lung cancer is high, the pulmonologist will ask for one or more of the following tests: Chest Xray, CT scan of the chest, needle biopsy and bronchoscopy. It is then possible to diagnose whether the disease is advanced or not.
The treatment would depend on the type of cancer and also the extent of spread. If one is careful in identifying symptoms and with the availability of good and reliable advanced investigations it is possible to offer fairly good treatment options and modify the quality of life if not completely cure it.
In Japan the disease is identified at a cellular stage and treatment offered at a much earlier stage. That day is not far off in India.
The writer is a Senior Respiratory Physician based in Chennai. E-mail him at firstname.lastname@example.org
Cough not responding to treatment
Blood stained sputum
Recurrent respiratory infection
Persistent change in voice
Late onset of asthma
Unexplained weight loss
Loss of appetite
Gradually increasing shortness of breath
Unexplained drooping of eyelid
Overgrowth of fingernails
Breast development in men
In 90 per cent of cases, smoking causes lung cancer.
About 10-15 per cent of smokers get lung cancer.
Men who smoke one or more packets of cigarettes daily face 15 to 25 times higher risk than non-smokers.
Of all forms of malignancy, lung cancer is the number one killer in India.
Globally it accounts for 14 per cent of all cancers and 28 per cent of all cancer-related deaths.
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