Driven by air pollution, smoking and exposure to second-hand smoke, lung cancer cases among young Indians are on the rise. Speaking to Kavita Bajeli-Datt, Dr Arvind Kumar says there is a spike in lung transplants in the country since Covid-19 and the trend is likely to continue. Dr Arvind is the chairman at the Institute of Chest Surgery - Chest Onco Surgery and Lung Transplantation, Medanta, Gurugram
What is the current prevalence of lung cancer cases in India compared to the western countries?
Lung cancer cases are sharply rising in India for both genders.
In certain regions, it’s already the primary cancer among men and ranks third for women. Nationally, it’s the second most prevalent type of cancer among men. The primary drivers are smoking and air pollution, with smoking rates increasing, especially among women. Notably, a significant demographic shift has occurred over three decades: from 95% smokers in their 50s-60s in 1988, to equal numbers of smokers and non-smokers today, with 40% being women.
The peak age for cases has shifted to the 40s, a 15-year advancement. This unsettling shift is attributed to air pollution, termed as “second tobacco epidemic” by WHO, exposing individuals from birth. This early exposure also reshapes the age dynamics of lung cancer. In the past, people typically began smoking in their late teens or early twenties, with cancer developing after 20 to 30 years of exposure. Due to lifelong air pollution exposure, children breathe the same polluted air as adults. Thus, by their 20s and 30s, individuals have already encountered decades of exposure, shifting lung cancer’s peak age by 15 years.
What is the current scenario of lung transplants in India?
From a mere couple of centres, a decade ago, the number of accredited lung transplant centres has reached 17, though active procedures occur in around four or five centres. A surge in transplant activity, attributed to heightened awareness among medical professionals and the public, is also evident. Additionally, the pandemic spotlight on lung health, shifting from heart concerns, has prompted greater awareness and consideration of lung transplantation for advanced lung diseases. Although there is no centralized registry, data from centres suggest an annual range of 200 to 250 transplants. We anticipate that this upward trend will continue in the months and years ahead.
Has there been an upsurge in lung transplants after Covid-19?
Lung transplants have markedly surged due to various health concerns, notably influenced by Covid-19. The pandemic has driven this trend in two ways. Firstly, Covid-19 has enlarged the pool of potential recipients. Some fully recovered, while others suffered severe consequences or faced extended struggles with oxygen support. The latter group now forms a significant portion of annual lung transplant candidates. Secondly, COVID-19 has spurred interest in lung health, causing those with pre-existing conditions like interstitial lung disease, bronchiectasis, pulmonary arterial hypertension, and COPD to consider transplants.
Do additional factors like vaping and secondhand smoking contribute to this burden?
Both firsthand and second-hand smoking are equally linked to lung cancer, with the latter even more concerning due to its lack of filtration. Roughly 70 carcinogens identified in cigarette smoke also exist in polluted air, making their impact consistent. Vaping lacks regulation and has shown evidence of severe respiratory damage within 5 to 10 years, initiating changes that can lead to cancer. The evidence-backed connection between air pollution, smoking, and vaping emphasizes the pressing need for preventive measures and awareness.
What are the technological advancements in lung cancer treatment in recent years?
Surgical techniques, including video-assisted thoracic surgery (VATS) and robotic surgery, offer minimally invasive approaches that lower risks and improve outcomes. Radiation therapy has evolved toward precise targeted treatment to spare surrounding tissues, expanding its applicability. A molecular understanding of lung cancer has driven tailored systemic therapies, transforming it from a fatal to a chronic condition.
Distinct subcategories within lung cancer respond to unique molecules based on genetic variations. This progress has led to extended lifespans, turning advanced cases into manageable chronic diseases. Hopeful prospects for emerging molecules suggest improved survival rates in the future. Over the past 5-10 years, significant enhancements have collectively elevated lung cancer patients’ survival prospects across surgery, radiotherapy, and systemic therapy.
What do you foresee as the most significant breakthroughs in managing this disease?
Future breakthroughs in lung cancer management are expected across four key areas. Early diagnosis, a focus of intensive research, could leverage techniques like targeted low-dose CT scans in high-risk populations. For instance, the US targets those with over 15 years of exposure and age 55+, showcasing potential in identifying early-stage cancers for timely intervention and improved cure rates.
Anticipated advancements include shifting the curve to emphasize early detection, thereby enhancing curative measures and survival rates. Additionally, significant strides in surgery, radiotherapy, and systemic therapy hold potential for curative treatments, boosting survival rates for advanced-stage cancers. Simultaneously, addressing the well-established links between lung cancer smoking and air pollution is imperative.