Lung cancer is one of the most common forms of cancer among men in the Indian subcontinent. Though it is less in the region compared to the western world, the total number of lung cancers present a significant medical problem in India, given its population.

Besides, there is a uniqueness to lung cancers in this region, requiring more specific research.

Data suggests that between 40-50 per cent of lung cancers from the subcontinent are observed in non-smokers. This differs from the west, where 80-90 per cent of lung cancer patients are smokers. Tobacco use, including smoking, has a distinct cultural pattern in our society. Apart from cigarettes, our population also uses beedi, hukkah, chillam, etc.

Besides, most patients present with symptoms similar to tuberculosis. Considering tuberculosis is common in India, this delays the cancer diagnosis. Only 5 per cent of patients in India undergo surgery for lung cancer, compared to around 30 per cent in the western world — highlighting the late stage presentation of lung cancer.

The biology of lung cancer also presents unique features here. Genetic changes seen in our patients differ from the western population. Almost 70 per cent of the lung cancer patients in India have some genetic changes for which there is a targeted therapy. This is estimated at less than 50 per cent in the western population. But the limited testing facilities here impacts our patients.

Adding to this is the changing nature of the type of lung cancers. Earlier adenocarcinoma and squamous cell cancer occurred in similar numbers. Adenocarcinoma is now more common than squamous cell carcinoma, and while the cause is not known, this information helps clinicians plan treatment. Screening is a challenge in India, and is not routinely done for lung cancer. This is because of high infection rates which lead to false positive scans, besides the limited resources. Nevertheless, it is important to increase awareness and encourage people to meet doctors if they have symptoms.

On the treatment side, there has been significant developments — newer techniques in surgery, radiotherapy and systemic therapy has increased the life span of patients. But a lot more still needs to be done to bring better treatments tailored to the needs of local patients and make them accessible. Patient advocacy can help raise concerns involving treatment access but localised research also needs to be part of the plan. And that requires an ecosystem where professionals research treatments for India and make it accessible.

(The writer is Professor Medical Oncology, Tata Memorial Hospital. Views are personal.)

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