Did you know that even non-smokers and quitters may be at risk for lung cancer?

The annual World No-Tobacco Day initiated by the World Health Organization (WHO) is observed around the world every year on 31 May to raise awareness on the harmful and deadly effects of tobacco use. In honor of this day, Roche Thailand hosted a press conference on the topic “Did you know that even non-smokers and quitters may be at risk for lung cancer?” to alert the public on the dangers and health problems associated with tobacco and smoke, and to enhance knowledge and understanding of prevention, screening and early diagnosis of lung cancer by performing Low Dose Computerized Tomography Scan (Low dose CT Scan). The event was joined by Manoon Leechawengwongs, MD, respiratory and pulmonary specialist, Vichaiyut Hospital, Narinthorn Surasinthon, MD, anti-aging and regenerative medicine specialist, Bumrungrad International Hospital, as well as an early lung cancer patient with a long history of smoking and a caregiver of an early-stage lung cancer patient with no previous history of smoking or exposure to cigarettes.

Statistics1 reveal that in 2020, lung cancer has the second highest incidence and mortality rate when compared with other cancers in Thailand. The number of new lung cancer cases was 23,717, or an average of 65 cases per day. More than 20,395 Thais died of lung cancer, which equates to around 56 cases per day, on average. The severity of the disease in Thailand is ranked 18th highest in the world, as the stage of the lung cancer being treated, directly affects the patient's chances of survival. Thailand scores low in early diagnosis, when compared to other developed countries such as the United States, United Kingdom, France, Spain, Italy, Japan, etc.2, which make use of low dose CT scan as the standard guideline for lung cancer screening. To reduce the mortality rate of lung cancer patients in Thailand, it is imperative to increase general access to standardized diagnostic method like the low dose CT scan, so that patients can receive early diagnosis and early treatment which lead to more satisfactory treatment results overall.

In Thailand, there is still a lack of lung cancer awareness and screening. As a result, most patients are diagnosed with lung cancer at the last stage, with a low survival rate. Manoon Leechawengwongs, MD, respiratory and pulmonary specialist, Vichaiyut Hospital, informed that “If lung cancer is found in Stage 4 or metastatic, patients will have a 5-year survival rate of only 0-10%. If found in Stage 3 or locally advanced stage, patients are likely to have a 5-year survival rate of 13-36%. However, if the cancer is diagnosed at Stage 1 or Stage 2, patients are likely to have a 5-year survival rate of up to 53-92%. Currently, Thailand detects only 15% of early stage lung cancer. Therefore, people with risk factors for lung cancer including exposure to tobacco smoke or carcinogens, family history of lung cancer, or has a history of other cancers or lung diseases should pay close attention to health warning signs and visit a doctor for lung cancer screening. Warning signs to watch out for include but are not limited to hoarseness, changing in voice, chronic cough, coughing up blood or rust-colored sputum, wheezing, constant chest pain, difficulty swallowing (dysphagia) and frequent lung infections.” 

There is a tendency that healthy people may develop lung cancer, as the causes can also be attributed to genetics. Risk groups include people with a history of chronic lung disease, Chronic Obstructive Pulmonary Disease (COPD), and a family history of cancer that may be inherited. In addition, an individual genomic mutation can also result in lung cancer. However, only about 20% of these genetic factors account for the causes of lung cancer, whereas the other 80% is attributed to behavioral and environmental factors. This includes smoking more than 20 pack-years, as well as exposure to industrial carcinogens such as mining, plastic, and insulation manufacturing. Workers have a higher chance to inhale a large amount of asbestos, nickel and chromium. Moreover, everyday exposure to PM 2.5 fine dust by riding a motorcycle, lighting incense, etc., can also put you in the risk groups for lung cancer. Therefore, regular health check-ups and medical consultation for effective screening method is recommended.

The event was also joined by two lung cancer patients, who shared their experiences of early screening and treatment for lung cancer, namely Arun Thepkaew, a 68-year-old male, Stage 2 lung cancer patient with a long history of smoking two packs of cigarettes daily for 13 consecutive years, coupled with alcohol consumption since adolescence. He has been a quitter for 35 years until in 2021 he was diagnosed with lung cancer. Arun recapped his experience that “I went to the doctor with a chronic cough and was later diagnosed with early lung cancer. As we were able to detect the cancer early on, the doctors were able to administer treatment in a timely manner, and the results are satisfactory. Today I can go back to my normal routine and living a normal life. I intend to continue to follow the medical advice and refrain from any risky activities and environment that may lead to the reccurence of cancer.”

Yos Kusonmanosuk, caregiver of his mother Kim Tiang Kusonmanosuk, a 72-year-old female Stage 1 lung cancer patient who has never smoked or been exposed to secondhand smoke before, recapped the journey to discovering lung cancer, “Even though she had never smoked, when my mother was younger, she loved to pray and light incenses. Moreover, she was diagnosed with colon cancer in the advanced stage. In 2021 during her annual health checkup, the doctor recommended my mother to do a Low dose CT scan, as some of her genetic and environmental factors indicate that she might be in the risk group for lung cancer. The result revealed that she developed an early lung cancer, so we immediately proceeded with the treatment. Looking back, I feel very fortunate to have listened to the doctor’s advice, as the treatment process is far more manageable than that of advanced stage colon cancer 10 years back. We are very happy to be able to detect the cancer early on and begin treatment in a timely manner with a higher chance of being cured.”

At the present, there are three different methods of screening for lung cancer: 1) Chest X-ray 2) Computerized Tomography (CT Scan) and 3) Low dose computerized tomography (Low dose CT Scan). Narinthorn Surasinthon, MD, anti-aging and regenerative medicine specialist, Bumrungrad International Hospital, compared the advantages and limitations of each method that, “Chest x-rays, which are very common during the annual health checkup list, is a fast and easy indication. However, it is still not precise enough to screen for small, early-stage lung cancer cells. On the other hand CT scan is much more accurate, but often comes with long queues, as there is limited radiologists and equipment at most hospitals. Apart from this, patients are also exposed to high doses of radiation and reported hot flush sensation throughout their body from the administration of Intravenous Contrast (IVC). Last but not least, the Low dose CT scan is six times more accurate than the chest X-ray, which in turn helps detect early stage lung cancer and reduce mortality rate from lung cancer by 20%3, making Low dose CT scan the standard and effective screening method for lung cancer.”
 

The National Comprehensive Cancer Network (NCCN)4  guideline states that people at high risk of developing lung cancer, including those over 50 and with a history of smoking over 20 pack-years, should undergo annual lung cancer screening with Low dose CT scan. At the same time, those who may be at risk or are health-conscious can also consult a doctor to request for the same type of scan as well. Lung cancer is a silent health threat that can take the lives of you and your loved ones. Therefore, early detection and timely treatment offer the best chance of having satisfactory outcomes, and reduce the likelihood of cancer recurrence.

Reference

1. The Global Cancer Observatory, International Agency for Research on Cancer, WHO (March, 2021) 

2. EpiCast report: NSCLC Epidemiology Forecast to 2025. GlobalData. 2016

3. The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365(5): 395-409.
   

4. NCCN VERSION1.2022

M-TH-00002100