A lung story: non-smoking cancers on the rise in TT

The US Lung Cancer Foundation of America has placed lung cancer as having a higher mortality rate than breast, colon and prostate cancer combined.

The Missouri Medicine Journal says lung cancer is the leading cause of cancer deaths worldwide despite it being the third most common form of cancer. It also reported that there is an overall increase in the number of cases for non-smokers being diagnosed with lung cancer.

November was recognised as lung cancer awareness month, and like breast cancer month in October which has its colour theme of pink, lung cancer awareness uses white as the choice of colour.

Oncologist Dr Akash Maniam, who operates out of the Sangre Grande General Hospital and Medical Associates private hospital in St Joseph, confirmed that based on his experience, there is a growing number of lung cancer patients who have no history of smoking.

“Smoking still remains our biggest risk factor but we are seeing an increase in the number of people who are coming in diagnosed with lung cancer who have never smoked or vaped,” he told Sunday Newsday.

Because of poor data collection in TT, the figures overall are not known, but internationally there seems to be an increase of between 15 to 20 per cent of patients saying they have no history of smoking or vaping.

“Nicotine is cancerous, we are likely to see a link to vaping with regards to lung cancer as well,” Maniam said.

Chair of the TT Cancer Society Dr Asante Le Blanc concurred there is a lack of data regarding lung cancer. The data she shared was between 2013 to 2017, and that too was scarce. According to the information she shared, men have an almost two-to-one ratio with women when it comes to being diagnosed with lung cancer, with 716 men and 247 women being diagnosed within. Of the figures shared, Le Blanc said 642 men died from lung cancer during that period as opposed to 206 women.

“In TT lung cancer is the second highest killer among men, the first being prostate cancer, while lung cancer in women is the sixth deadliest cancer.”

The Lung Cancer Foundation of America states that lung cancer is asymptomatic, which means that symptoms of the illness are most likely to appear in the late stages. The foundation adds that 80 per cent of patients are diagnosed at a late stage.

Cancer, Le Blanc said, is a non-communicable disease, which, according to the World Health Organization (WHO), tends to be of long duration and is the result of a combination of genetic, physiological, environmental and behavioural factors.

The WHO lists lung cancer with the highest mortality rate resulting in some 2.09 million cases and 1.76 million deaths annually.

According the Health Ministry’s Strategic Plan for the Prevention and Control of Non-Communicable Disease (NCD), TT has one of the highest cancer mortality rates in the Caribbean. The 2017 to 2021 plan stated that between 2001 and 2008, the annual number of deaths from cancer increased progressively from 1,201 to 1,417.

The ministry’s website said, “In 2008, mortality was shown to be higher for men than women. In the case of the men, prostate cancer was the most prevalent (34 per cent), followed by lung cancer (13 per cent), colorectal cancer (12 per cent), pancreatic cancer (six per cent), and stomach and non-Hodgkin lymphoma cancers (both four per cent). Breast cancer was identified as the leading cause of cancer death among women (23 per cent), followed by cervical and colorectal cancers (each 11 per cent), ovarian cancer (seven per cent), and lung and pancreatic cancers (each five per cent).”

Lung cancer costs TT on average $2 billion to treat and this is because of less cancer patients when compared to other NCDs.

“Cancers also have substantial productivity losses because of the higher proportion of deaths at younger ages. Interventions for prevention and early identification of cancers can have substantial benefits to the economy; a 20 per cent reduction in cancer mortality can reduce productivity losses by about $360 million,” the website said.

Maniam said based on the patients he saw, most of them are amenable to surgery. In the past ten to 15 years, he said, there has been more of an increase in research for lung cancer than any other type.

“Forty per cent of the people in TT have some genetic mutation that cause lung cancer,” he said, adding that targeted treatments is one of the best treatments for the disease.

“With chemotherapy a patient can have a life span of 11 to 14 months if they are diagnosed with stage four lung cancer. With targeted therapy where the mutated gene is identified there is an increase in the life expectancy to four to five years.”

Le Blanc said the fact that cancers are NCDs, lifestyle changes can reduce its risks. She pointed out that while genetics have a crucial role to play in a patient being diagnosed with cancer, that mutation can be triggered by varying things including pollutants in the atmosphere and the food we eat.

She added that her clarion call for greater taxes levelled against the tobacco industry as well as the petrochemical industry has not been answered as she hoped. Those two industries, she said, contributes significantly to lung cancer.

Maniam said some treatments can cost upwards of $10,000 monthly. Drugs such as erlotinib and gefitinib treat cancer on a genetic level and best work once diagnosed earlier. Even with the best treatment and early detection life after being diagnosed with lung cancer is “not amazing.” He called for more research in this cancer.

He said detecting lung cancer is tricky as the screening process is not as efficient as with other types of cancers. The challenge to detect it, he said, stems from people’s unwillingness to come forward to be screened earlier and the fact that it can manifest itself as some other pulmonary ailment.

“We see a lot of people who were diagnosed with stage three and four lung cancer. You will be lucky to pick it up randomly. Some patients say they have subtle chest pains. It’s a lot like ovarian and pancreatic cancers and there is no one size fits all with detecting lung cancer.”

Le Blanc said, “We have seen an increase in non-smokers and non-vapers getting lung cancer but what we need to investigate is why that is happening.”

Sunday Newsday spoke with a 56-year-old woman who was diagnosed with lung cancer in 2016. Now, with a tumour that has spread to her brain and bones, she is taking life one day at a time.

Because of her past job in the petrochemical industry, she did not want to be named. She said although she used to smoke, the biopsy for her tumour was not nicotine-related.

“One day I fell down and I had to get an X-ray done. When I did the tumour showed up. I did a lobectomy and chemo. The next year it came back.

“I am not panicking any more. I am just dealing with it in the best way. I have the full support of my family and I can not stress this enough, I am breaking the rules now,” she chuckled.

Her advice to people is to get tested any time they feel that something is wrong with their bodies. To those already diagnosed, she advises them not to be afraid of the treatment.

The most common symptoms are shortness of breath, unexplained weight loss and a persistent cough. Anyone exhibiting these symptoms, Le Blanc said, should see a doctor. Because people with these symptoms can sometimes be mis-diagnosed with chronic obstructive pulmonary disease (COPD), Maniam advises patients to do a CT scan.