One in nine people in India is likely to develop cancer in their lifetime, according to a recent study titled, ‘Cancer incidence estimates for 2022 & projection for 2025: Result from National Cancer Registry Programme, India’, published on Pub Med. The study further quotes that in males leading cases are lung cancer, whereas, for females, it is breast cancer. The incidences are expected to rise by 12.8% by 2025, says the study, throwing a serious challenge to our healthcare system. The best possible intervention to combat this scenario is early screening for cancer detection.
While smokers have always been at a high risk of developing lung cancer, recent Indian newspaper reports suggest that even pollution is a cause of it. However, on the positive side, lung cancer is treatable and preventable. It needs a focussed approach of early screening and timely treatment with some lifestyle changes. In Western countries, there is a recommendation for high-risk patients to undergo screening once a year. In India, though, the awareness is still low. Unless the doctor suggests a screening, an annual health check-up usually does not include lung cancer screening, even for high-risk patients. Let us understand a bit more about lung cancer screening.
What is lung cancer screening?
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Typically, screening is the test done by the doctor before symptoms appear to detect the disease at an early stage. In the case of lung cancer, screening may be an X-Ray, Chest CT scan, lab tests, sputum cytology, etc. The screening objective is to detect lung cancer, especially in the high-risk category of the population. The doctor prescribes screening tests based on family and medical history and other risk factors.
In Western countries, the recommended screening test is a low-dose computed tomography (LDCT) scanning of the chest. The annual health check-ups for those in the high-risk category of developing lung cancer include this screening test. The LDCT screening can detect many abnormalities despite using up to 90 percent less ionizing radiation than a conventional chest CT scan. This aspect makes it a safe screening option.
LDCT can detect even tiny nodules and is fast, painless, and non-invasive, unlike CT scans with contrast. More importantly, it has no side effects and detects early-stage cancers. The early-stage detection helps in early treatment with minimally invasive surgery and fast recovery.
Why lung cancer screening?
According to the UK Lung Cancer Screening Trial (UKLS), early screening can cut deaths due to lung cancer by 16%. People aged 50 to 75 years participated in this study. In the US, a clinical trial by the National Cancer Institute called National Lung Screening Trial (NLST found this percentage was between 15 to 20%. People aged 50 and above, smokers, ex-smokers, etc., who were at high risk of developing lung cancer, participated in this study. Interestingly, the UK study found that 75% of the cancers identified by low-dose computerised tomography (CT) scans are early stage, which makes treatment and recovery possible.
Such clinical trial outcomes prompted governmental health bodies in the UK and the US to come out with new screening recommendations for those at high-risk to bring down the deaths due to lung cancer. They have also enabled insurance reimbursements for such screening to encourage people to get screened. However, some recent newspaper reports suggest that the people have not been so forthcoming in getting the screening done.
In India, tuberculosis is widespread, and there was a need to see if such studies resonate with the findings of Western countries. Even in India, results suggested that LDCT can detect early-stage lung cancers and help save lives. The mean age of the participants with a smoking history in this study was 61 years. The study was performed over a period of 3 years at a private practice centre in Mumbai.
Who are high-risk?
Smokers, ex-smokers, passive smokers, those exposed to cancer-causing substances, those with a family history of lung cancer, those with chronic lung disease, etc., are high-risk categories for developing lung cancer. People in the 55-74 age group are also at high risk of lung cancer, especially males. Not to forget the pollution aspect which has come up now.
The Indian scenario
In India, currently, there is no recommendation for annual LDCT screening, even for high-risk people. Neither do insurance companies cover LDCT as part of their annual health check-up plan. However, in the interest of one’s health and life, it is best to consult a doctor and get this screening done if the doctor considers you a high-risk category. There are a few risks associated with preventive LDCT screening, as there are chances of false positives or negatives. In a few cases, cancer may have advanced, and LDCT may not aid survival. Also, exposure to radiation, even in small doses, increases the cancer risk slightly. All these are considerations that need to be weighed before opting for a LDCT screening and your doctor will be the best judge for that. There is also a cost implication if the insurance does not cover the same.
