Catch it early, quit forever: a dual fight against lung cancer Premium

November is Lung Cancer Awareness month, emphasizing early detection, smoking cessation, and the importance of prevention efforts.

November is Lung Cancer Awareness month, and efforts must be made to ensure both detection of cancer and smoking cessation activities are made available to all.

“I regret I didn’t quit smoking,” confessed Ajay (name changed), a 60-year-old man battling lung cancer. His habit began in engineering college, where the pressure to excel felt relentless. Over time, stress from work, relationships, and life’s challenges kept him hooked. Moments of joy -- chai with friends, reunions, and celebrations -- blurred the harm smoking causes. Through life’s changes, his cigarette remained a constant companion, until his oncologist uttered three devastating words - “You have cancer.” It was stage IV and he had only a few months left.

Unfortunately, the majority of lung cancer patients are detected at a late stage, when chances of survival plummet and treatment costs soar. Several challenges contribute to the diagnostic delay of lung cancer. For example, low awareness of lung cancer symptoms leads to a lag between symptom onset to first visit to a clinician. Often, early lung cancer symptoms could be mild and dismissed as respiratory issues. And in India, which is a tuberculosis-endemic country, the symptom overlap often leads to lung cancer being misdiagnosed as tuberculosis.

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

The World Health Organization highlights the importance of screening high-risk individuals for early lung cancer detection. However, in low- and middle-income countries like India, health system barriers such as limited access to facilities, dearth of trained personnel, and financial constraints hinder implementation of effective and equitable lung cancer screening, leading to late detection.

Low-dose computed tomography (LDCT) is proven effective for lung cancer screening in high risk individuals. However, in the Indian context, nation-wide LDCT-based lung cancer screening is faced with several challenges. First, radiological similarities with tuberculosis lead to high false positive rates. Nevertheless, recent evidence suggests LDCT could be effective in tuberculosis-endemic regions. Second, availability of limited LDCT equipment and trained professionals. Third, an LDCT machine can cost up to ₹2 crore, creating a significant barrier to establishing such facilities, particularly in non-metro cities and rural areas. Fourth, the per test cost of nearly ₹7,000 is unaffordable in India, where half or more of healthcare expenses are still paid out-of-pocket.

Chest X-rays (77-80% sensitivity) cost up to ₹300 but miss 90% of lung cancer cases. However, AI integration and training can potentially improve accuracy and distinguish lung cancer from tuberculosis. Portable AI-powered X-rays can boost screening in rural India, where 70% live and tobacco use is higher (as per NFHS-5), and can be an interim solution until LDCT infrastructure improves in India.