In a recent report, the World Health Organisation (WHO) has warned that there will be a cancer patient in each household in India by 2020.

People with bad eating habits, those who smoke and drink alcohol, and those who are exposed to radioactivity and pollutants should be alert.

The cancer mortality rate is high and growing in India, owing to the poor availability of prevention, diagnosis and treatment. But a lack of awareness among people in India is one of the main contributors to the increase in the number of cancer patients. According to a report published by the Indian Council of Medical Research (ICMR), all types of cancers have been reported in India, including cancers of the skin, lungs, breast, rectum, stomach, prostate, liver, cervix, oesophagus, bladder, blood and mouth.

The causes are both internal (genetics, hormones, poor immune systems) and external (eating habits, industrialisation, overpopulation, and social factors). In India, about 30 lakh people are suffering from cancer and four lakh die each year. Eight lakh people are diagnosed with the disease each year. In West Bengal, about 2.5 lakh are suffering from cancer and 45,000 die each year. About 75,000 new cases are diagnosed annually. These numbers are set to rise.

In India, the number of people suffering from cancer is expected to increase to 40 lakh by 2020, and the number of people dying of it each year is expected to rise to 11.5 lakh.

In West Bengal, the number of people with the disease is expected to rise to 4 lakh, and the number of people dying of it annually is expected to rise to one lakh. The American Cancer Society (ACS) recommends walking, yoga, dancing, swimming, cycling, hiking or rollerblading to prevent the disease.

To prevent breast and cervix cancer for women, the American Society of Clinical Oncology has recommended that they marry between 23 to 27 years, have babies before they reach 30, and breast feed for six months. ACS recommends a calorie intake of 2,800 for working males and 2,200 for working females. Protein intake should be 0.6 grams per kilogram, fat should account for 30 per cent of total calories and carbohydrates for 55 per cent. A person who weighs 60 kilograms must drink at least three litres of water a day to prevent the disease.

Why Does Lung Cancer Occur in Non-Smokers?
Medical Author: Melissa Conrad Stöppler, MD Medical Editor: Jay W. Marks, MD
While cigarette smoking is an undisputed cause of lung cancer, not all cases of lung cancer occur in smokers or former smokers.

Each year, over 170,000 Americans develop lung cancer, and approximately 10% of lung cancers, or 17,000 cases, occur in non-smokers.

Although not every non-smoker suffering from lung cancer will have an identifiable risk factor for development of the disease, a number of conditions and circumstances have been identified that will increase a non-smoker's chance of developing lung cancer.

Passive smoking, or the inhalation of tobacco smoke from other smokers sharing living or working quarters, is an established risk factor for the development of lung cancer.

Non-smokers who reside with a smoker have a 24% increase in risk for developing lung cancer when compared with other non-smokers.

Each year, up to 3,000 lung cancer deaths are estimated to occur in the U.S. that are attributable to passive smoking. For more, please read the Dangers Secondhand Smokearticle.

How common is lung cancer?
Lung cancer is the most common cause of death due to cancer in both men and women throughout the world. The American Cancer Society estimated that 222,520 new cases of lung cancer in the U.S. will be diagnosed and 157,300 deaths due to lung cancer would occur in 2010.

According to the U.S. National Cancer Institute, approximately one out of every 14 men and women in the U.S. will be diagnosed with cancer of the lung at some point in their lifetime. Lung cancer is predominantly a disease of the elderly; almost 70% of people diagnosed with lung cancer are over 65 years of age, while less than 3% of lung cancers occur in people under 45 years of age. Lung cancer was not common prior to the 1930s but increased dramatically over the following decades as tobacco smoking increased.

In many developing countries, the incidence of lung cancer is beginning to fall following public education about the dangers of cigarette smoking and the introduction of effective smoking-cessation programs. Nevertheless, lung cancer remains among the most common types of cancers in both men and women worldwide. In the U.S., lung cancer has surpassed breast cancer as the most common cause of cancer-related deaths in women.

What causes lung cancer?
Smoking
The incidence of lung cancer is strongly correlated with cigarette smoking, with about 90% of lung cancers arising as a result of tobacco use. The risk of lung cancer increases with the number of cigarettes smoked and the time over which smoking has occurred; doctors refer to this risk in terms of pack-years of smoking history (the number of packs of cigarettes smoked per day multiplied by the number of years smoked). For example, a person who has smoked two packs of cigarettes per day for 10 years has a 20 pack-year smoking history. While the risk of lung cancer is increased with even a 10-pack-year smoking history, those with 30-pack-year histories or more are considered to have the greatest risk for the development of lung cancer. Among those who smoke two or more packs of cigarettes per day, one in seven will die of lung cancer.

Pipe and cigar smoking also can cause lung cancer, although the risk is not as high as with cigarette smoking. Thus, while someone who smokes one pack of cigarettes per day has a risk for the development of lung cancer that is 25 times higher than a nonsmoker, pipe and cigar smokers have a risk of lung cancer that is about five times that of a nonsmoker.

Tobacco smoke contains over 4,000 chemical compounds, many of which have been shown to be cancer-causing or carcinogenic. The two primary carcinogens in tobacco smoke are chemicals known as nitrosamines and polycyclic aromatic hydrocarbons. The risk of developing lung cancer decreases each year following smoking cessation as normal cells grow and replace damaged cells in the lung. In former smokers, the risk of developing lung cancer begins to approach that of a nonsmoker about 15 years after cessation of smoking.

Passive smoking
Passive smoking or the inhalation of tobacco smoke by nonsmokers who share living or working quarters with smokers, also is an established risk factor for the development of lung cancer. Research has shown that nonsmokers who reside with a smoker have a 24% increase in risk for developing lung cancer when compared with nonsmokers who do not reside with a smoker. An estimated 3,000 lung cancer deaths that occur each year in the U.S. are attributable to passive smoking.

Asbestos fibers
Asbestos fibers are silicate fibers that can persist for a lifetime in lung tissue following exposure to asbestos. The workplace is a common source of exposure to asbestos fibers, as asbestos was widely used in the past as both thermal and acoustic insulation. Today, asbestos use is limited or banned in many countries, including the U.S. Both lung cancer and mesothelioma (cancer of the pleura of the lung as well as of the lining of the abdominal cavity called the peritoneum) are associated with exposure to asbestos. Cigarette smoking drastically increases the chance of developing an asbestos-related lung cancer in workers exposed to asbestos. Asbestos workers who do not smoke have a five fold greater risk of developing lung cancer than nonsmokers, but asbestos workers who smoke have a risk that is fifty- to ninety fold greater than nonsmokers.

Radon gas
Radon gas is a natural, chemically inert gas that is a natural decay product of uranium. Uranium decays to form products, including radon, that emit a type of ionizing radiation. Radon gas is a known cause of lung cancer, with an estimated 12% of lung-cancer deaths attributable to radon gas, or about 20,000 lung-cancer-related deaths annually in the U.S., making radon the second leading cause of lung cancer in the U.S. As with asbestos exposure, concomitant smoking greatly increases the risk of lung cancer with radon exposure. Radon gas can travel up through soil and enter homes through gaps in the foundation, pipes, drains, or other openings. The U.S. Environmental Protection Agency estimates that one out of every 15 homes in the U.S. contains dangerous levels of radon gas. Radon gas is invisible and odorless, but it can be detected with simple test kits.

Familial predisposition
While the majority of lung cancers are associated with tobacco smoking, the fact that not all smokers eventually develop lung cancer suggests that other factors, such as individual genetic susceptibility, may play a role in the causation of lung cancer. Numerous studies have shown that lung cancer is more likely to occur in both smoking and nonsmoking relatives of those who have had lung cancer than in the general population. Recently, the largest genetic study of lung cancer ever conducted, involving over 10,000 people from 18 countries and led by the International Agency for Research on Cancer (IARC), identified a small region in the genome (DNA) that contains genes that appear to confer an increased susceptibility to lung cancer in smokers. The specific genes, located the q arm of chromosome 15, code for proteins that interact with nicotine and other tobacco toxins (nicotinic acetylcholine receptor genes).

Lung diseases
The presence of certain diseases of the lung, notably chronic obstructive pulmonary disease (COPD), is associated with an increased risk (four- to sixfold the risk of a nonsmoker) for the development of lung cancer even after the effects of concomitant cigarette smoking are excluded.

Prior history of lung cancer
Survivors of lung cancer have a greater risk of developing a second lung cancer than the general population has of developing a first lung cancer. Survivors of non-small cell lung cancers (NSCLCs, see below) have an additive risk of 1%-2% per year for developing a second lung cancer. In survivors of small cell lung cancers (SCLCs, see below), the risk for development of second lung cancers approaches 6% per year.

Air pollution
Air pollution from vehicles, industry, and power plants can raise the likelihood of developing lung cancer in exposed individuals. Up to 1% of lung cancer deaths are attributable to breathing polluted air, and experts believe that prolonged exposure to highly polluted air can carry a risk for the development of lung cancer similar to that of passive smoking.
Reviewed by Jay W. Marks, MD on 1/31/2011

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