Lung Cancer Screening Challenges in India

Lung Cancer in India - 2024 Overview

Statistics & Trends

• Lung cancer is India's leading cause of cancer deaths, accounting for 10.9% (98,687 deaths) in 2024, up from 75,031 deaths in 2022.
• New lung cancer cases increased from 81,748 (5.8%) in 2022 to 112,000 (7.2%) in 2024, rising from fourth to third in incidence.
• Survival Rates: 93% of cases are diagnosed in advanced stages; 5-year survival rates are only 7% to 18% when diagnosed late, increasing to 80% if detected in the first stage.

Screening Challenges

• Lung cancer screening is largely absent in India's health programs, which primarily screen for breast, oral, and cervical cancers.
• The current screening methods for more common cancers are low-tech and inexpensive, while Low-Dose Computed Tomography (LDCT) screenings for lung cancer are costly.

Government Schemes & Recommendations

• The Indian Council of Medical Research (ICMR) notes that although LDCT is the costliest, it provides significant net monetary benefits and should be considered in national cancer screening programs.
• Institutional efforts need to incorporate lung cancer screening strategies, especially using LDCT.

Criteria for Screening & Population Risk

• Current global screening guidelines primarily focus on smokers aged 50-80, leaving many at-risk individuals (including non-smokers and beedi smokers) unaccounted for.
• Advocates suggest expanding the high-risk category to include:
  • Individuals with a history of bidi smoking.
  • Those exposed to secondhand smoke, biomass fuel, and air pollution.

Environmental Factors

• Ambient air pollution is identified as an emerging risk factor.
• Studies indicate LDCT remains effective in TB-endemic populations, with no significant issues related to false positives due to tuberculosis.

Scientific Studies & Recommendations

• The Indian Lung Screening Trial (ILST) and AIRCARE are generating evidence on the effectiveness and risks associated with lung cancer screening in India.
• Dr. Abhishek Shankar emphasizes the integration of smoking cessation into screening and treatment programs to improve outcomes.

Suggested Public Health Interventions

• Public health messaging should be revised to become more actionable; for example, inform smokers over 60 years old to get screened, rather than simply warning them about smoking risks.

Conclusion

The increasing prevalence and mortality associated with lung cancer in India necessitate a critical assessment of screening protocols and public health strategies. With targeted screening and an integrated approach including smoking cessation efforts, there is potential to significantly reduce lung cancer incidences and improve survival rates.