The need to destigmatise lung cancer

In India, over half of lung cancer patients are non-smokers. Air pollution in Indian cities has reached levels where even non-smokers exhibit blackened lungs, similar to those of long-term smokers. This harsh reality demands a shift in our perspective, writes Sigal Atzmon.

Imagine a loved one diagnosed with lung cancer. You see the fear in their eyes, the worry etched on their face. But beneath that fear lies another burden – the weight of societal judgement. In India, lung cancer carries a heavy stigma, often seen as a punishment for smoking. This perception is not only cruel, it's deadly. It delays diagnosis, steals hope, and isolates patients and leaves them without emotional support in their time of greatest need.

In India, the assumptions surrounding lung cancer are particularly dangerous. The truth is, in India, over half of lung cancer patients are non-smokers. And as compared to the West, lung cancer strikes a decade earlier. The culprit? The very air we breathe. While smoking is a major risk factor, air pollution also poses a serious threat to lung health, even for non-smokers. The air in the megacities we call home is choked with pollution, silently ravaging our lungs like a slow-burning fire.

Fine particles, particularly PM2.5, infiltrate deep into the lungs, triggering inflammation, DNA damage, and potentially leading to lung cancer, especially adenocarcinoma. Research suggests several mechanisms at play, including oxidative stress and epigenetic changes. Men and those who've never smoked seem to be at higher risk. Air pollution in Indian cities, especially in Delhi and other metropolitan areas, has reached levels where even non-smokers exhibit blackened lungs, similar to those of long-term smokers. This harsh reality demands a shift in our perspective.

Early detection is our weapon in this fight, yet a mere 15% of lung cancer cases in India are diagnosed early. This isn't just a number – it represents lives lost due to delayed diagnosis. The stigma surrounding the disease, the belief that it is a smoker's punishment, prevents patients from seeking help sooner. Each delayed diagnosis is a stolen breath, a stolen chance at life.

The persistent stigma associating lung cancer solely with smoking unfairly burdens patients with guilt and shame, discouraging them from seeking potentially life-saving screenings. The stigma not only delays diagnosis, it burdens patients with an unnecessary weight of guilt and shame. The patient not only faces the physical consequences of the disease but also the unfair burden of societal judgement. No one deserves to face a health crisis alone, ostracised by a misplaced perception.

As a society, we have the power to change this narrative. We need widespread education campaigns that dispel myths and raise awareness about the environmental factors at play. Our fight for clean air isn't just about aesthetics; it's about protecting the very breath in our loved one's lungs.

Early detection programmes are crucial. Making lung screenings accessible and affordable can save countless lives. But our fight goes beyond medicine. Cancer patients need a support system, a network of empathy and understanding, not judgement. We must work to create a future where lung cancer is diagnosed early, treated effectively and with compassion. Chest X-rays are a common screening, but they aren't always efficient in diagnosing lung cancer early, hence more easily treatable stage X-rays may not be able to find small to medium size lung tumours or cancers that are located behind other structures in the chest.

For medium to high risk patients, the best screening would be low-dose chest CT, which can detect lung cancer at its very beginning. The importance of early detection versus later-stage diagnosis is reflected in years of survival; nearly 65 out of 100 people with stage 1 lung cancer will live for 5 years or more after being diagnosed, so it should not be underestimated.

(The author is a strong advocate of healthcare equity and personalised medical case management.)