For smokers, having a puff or two after a tiring day at work can help them destress. However, as the tar from cigarettes start to build up in the lungs, so do the chances of developing lung cancer.
According to the Malaysian National Cancer Registry Report (MNCR) 2012-2016 by the National Cancer Institute, lung cancer is the second most common type of cancer among men, and the fourth most common among women.
From 2012 to 2016, there were approximately 11,256 cases of lung cancer recorded, equating to roughly six new cases per day. Unsurprisingly, the majority of lung cancer cases in Malaysia were among smokers and former smokers.
Although lung cancer can be caused by other factors such as radon gas, haze and air pollution, ionising radiation, asbestos exposure, or any disease that causes inflammation or scarring of the lungs, consultant cardiothoracic surgeon at Subang Jaya Medical Centre Dr Anand Sachithanandan stresses the importance to quit smoking as it is the only modifiable lifestyle choice linked to the disease.
“Without a shadow of a doubt, the single most preventable risk factor for lung cancer is giving up smoking. The link has been established for over a half a century across the globe. The longer you smoke and the higher your smoking intensity, the more likely it is that you will get lung cancer.”
These dangers also affect non-smokers. Dr Anand comments that currently, one-third of lung cancer patients he treats are non-smokers, mainly women. These patients may have chronic long-term exposure to second- or third-hand smoke from their spouses who are smokers or work in a smoky environment.
Wok cooking at high temperatures has also been implicated, hence Dr Anand advises on the importance of having a well-ventilated kitchen or extractor fan.
He urges smokers to make a deliberate effort to stop smoking immediately. High taxation, health warnings, restrictions and other efforts imposed by the government can only do so much. Smokers themselves need to have the desire and motivation to stop – or better yet, not start at all.
Screening Saves Lives
Because of the high correlation between smoking and lung cancer, Dr Anand says men and women between 45 and 75 years old who have a history of smoking a 20-stick pack a day for at least 20 years should consult a doctor for health screenings.
This is because lung cancer is a silent killer, with 93% to 94% of lung cancer cases here diagnosed only when the cancer is at an advanced incurable stage three or four. This thus leads to one of the lowest survival rates as compared to other cancers.
Dr Anand shares that the five-year survival rate is almost 90% for stage one, and around 5% to 10% for stage four. Surgery is the treatment of choice for early lung cancer (stages one and two) while chemoradiotherapy, immunotherapy, or molecular targeted therapies are the mainstay of treatment for advanced disease.
Besides chronic smokers, other individuals who are advised to undergo screening with a low-dose computed tomography (LDCT) lung scan include those with a family history of premature lung cancer, or personal history of other cancers.
The LDCT scan is quick, painless and one does not require any prior blood test or fasting. Presently, blood tumour markers are not sensitive enough to be used as a screening tool.
The Way Forward
“Lung cancer is a largely preventable cause of death, but we often detect it too late as there are minimal or no symptoms in the early stages of the disease. Awareness and education levels are low not just among the public, but also among doctors,” says Dr Anand.
He comments that the way forward for lung cancer prevention is education, and it has to start as early as at the primary and secondary school levels. Perhaps for adults who are already smoking, reasoning on the basis of financial economic benefit may be more appealing.
“Why not tell them that they can save about RM15 a day if they do not smoke? This adds up to RM450 a month. The money they save can be used for a vacation at the end of the year or spent on household necessities.”
In addition to education and learning, he feels the government can do more to not only better enforce numerous policies and bans to deter people from smoking, but also incentivise people to stop. With continuous efforts in improving enforcement, the number of casual and hardcore smokers will reduce.
At the end of the day, however, all parties need to step up and take responsibility, instead of expecting health regulators alone to solve the problem. Dr Anand opines non-governmental organisations such as the Lung Cancer Network Malaysia have a vital part to play in pushing education and awareness.
There must be meaningful collaboration with all relevant stakeholders leveraging on each other’s expertise and know-how to improve awareness, destigmatise the disease and provide accessible and affordable lung cancer screening for all.
With sustained and coordinated efforts, Dr Anand is confident that, over time, there will be a reduction in the number of deaths from lung cancer as more Malaysians will be diagnosed at an earlier stage.
In the long run, prevention and screening is certainly more cost-effective to society at large as therapy for advanced stage lung cancer is both financially and emotionally distressing for victims and their caregivers.
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