Catch it early, stop it forever: the dual battle against lung cancer

November is Lung Cancer Awareness Month, and we need to work to make both cancer detection and smoking cessation efforts available to everyone.

“I regret not quitting smoking.”,” So confessed Ajay (name changed), a 60-year-old man battling lung cancer. His habit began during his time at the Institute of Technology, where the pressure for excellence was relentless. As time went on, stress from work, relationships, and life's challenges kept him going crazy. Moment of joy — chai Gatherings with friends, reunions, and celebrations blur the harm caused by smoking. Through all the changes in his life, his cigarette remained his constant companion until his oncologist said three shocking words. “You have cancer.” He was in stage IV and had only a few months left to live.

Unfortunately, the majority of lung cancer patients discovered at a later stagewhen the chances of survival plummet and treatment costs soar. There are several issues that contribute to the delay in lung cancer diagnosis. For example, low awareness of lung cancer symptoms can lead to delays between the onset of symptoms and the first visit to the doctor. Early lung cancer symptoms are often mild and may be dismissed as a respiratory problem. Additionally, in India, a country where tuberculosis is endemic, lung cancer is often misdiagnosed as tuberculosis due to overlapping symptoms.

Timely detection of lung cancer requires both effective screening and increased awareness of its symptoms. These include cough, loss of appetite, weight loss, fatigue, chest pain, and hoarseness. Certain symptoms, such as a cough with blood (hemoptysis) or a cough that lasts for more than 6 weeks, are red flags and require immediate referral to a specialist.

lung cancer screening

The World Health Organization emphasizes the importance of screening high-risk people for early detection of lung cancer. However, in low- and middle-income countries like India, health system barriers such as limited access to facilities, lack of trained personnel, and financial constraints prevent effective and equitable lung cancer screening. This hinders implementation and leads to delays in discovery.

Low-dose computed tomography (LDCT) has proven effective for lung cancer screening in high-risk individuals. However, in the Indian context, country-wide LDCT-based lung cancer screening faces several challenges. First, it is radiologically similar to tuberculosis, which increases the false-positive rate. Nevertheless, recent evidence suggests that LDCT may be effective in TB endemic areas. Second, the availability of limited LDCT equipment and trained professionals. Third, the cost of LDCT equipment can reach up to Rs 2 billion, posing a major barrier to setting up such facilities, especially in non-metropolitan cities and rural areas. Fourth, in India, more than half of healthcare costs remain out-of-pocket, so costs of nearly ₹7,000 per test are unaffordable.

Chest X-ray (sensitivity 77-80%) costs up to ₹300 but misses 90% of lung cancer cases. but, AI integration and training It has the potential to improve accuracy and differentiate between lung cancer and tuberculosis. AI-powered portable X-rays can enhance screening in rural India, where survival rates and smoking rates are 70% high (according to NFHS-5), and will help India improve its LDCT infrastructure. This can be a temporary solution.

no smoking

Smoking remains the main preventable cause of lung cancer. However, according to the National Family Health Survey-5, 39% of men and 4% of women in India are smokers. Although lung cancer screening can help with early detection once hurdles are overcome, smoking cessation remains the most effective preventative measure.

The reasons behind smoking initiation, continuation, and failure to quit smoking include personal impulses, peer pressure, weak anti-tobacco policy and the strong pharmacological effects of nicotine. Anyone who has ever smoked knows that quitting smoking is difficult. It takes many attempts to quit, and only a small percentage of users succeed.

Smoking cessation attempts often fail because most attempts are made without behavioral support, which greatly increases success rates. Behavioral support can range from SMS reminders encouraging users to stop to active engagement through individual or group sessions conducted in person or via video conferencing.

Cognitive behavioral therapy (CBT) is one approach that can help individuals recognize and restructure the thought patterns that fuel their smoking habits and ultimately improve their health. Research has shown that combining CBT with other smoking cessation supports, such as nicotine replacement therapy, exercise, and financial incentives, significantly improves success rates. In contrast to CBT, acceptance and commitment therapy is another behavioral approach that focuses on changing how individuals relate to their thoughts, rather than changing the thoughts themselves. Mindfulness-based smoking cessation interventions aim to increase individuals' awareness of their feelings, thoughts, beliefs, and behaviors related to smoking.

Nearly 400 mobile apps, including the WHO app, have been developed to make smoking cessation scalable. but, There are only a few related Provide evidence-based support to users. In India, the National Tobacco Control Program provides free support to quit smoking. The use of mobile apps in parallel with behavioral approaches and nicotine replacement therapy holds promise as a multifaceted strategy for smoking cessation.

Looking to the future

As we conclude Lung Cancer Awareness Month this November, it is important that we continue to discuss this important public health issue. Smoking reduces life expectancy by almost 10 to 11 years. In India, lung cancer is the second leading cause of cancer-related death in men and the fourth leading cause of cancer-related death in women. In addition to cancer, smoking dramatically increases the risk of many other serious health conditions, including stroke and cardiovascular disease. In 2017-18, tobacco use imposed an economic cost of Rs 1.77 billion (1.04% of India's GDP). Smoking accounted for 74% of these costs.

In the absence of available and affordable lung cancer screening and effective anti-tobacco policies, smoking cessation remains the most effective and personally responsible means of preventing lung cancer. And the good news is that by quitting smoking in a timely manner, much of the damage can be reversed. Now is the perfect time to quit and make up for the years lost to smoking.

(Dr. Vid Karmarkar is the founder of Canseva Foundation, an organization whose mission is to reduce the economic harms of cancer treatment. [email protected])