Lung cancer, long known as a smoker’s disease, is fast becoming a more complex public health threat in India, driven by a potent mix of tobacco use, rising air pollution, and environmental exposures such as asbestos and radon. The country witnesses an estimated 58,000 new cases among men each year, according to leading oncologists, and many remain undiagnosed until the disease has reached an advanced stage.
While cigarette smoking remains the most dominant risk factor—linked to approximately 85% of all lung cancer cases—experts warn that even non-smokers are increasingly at risk due to pervasive exposure to hazardous air and carcinogenic particles.
“We’re seeing more and more non-smokers, especially women and urban residents, presenting with late-stage lung cancer,” said Dr. Vishal Rao, a head and neck surgeon and member of the COVID-19 task force in Karnataka. “This points to an urgent need to broaden our public health response.”
The Environmental Equation
In urban centers such as Delhi, Kanpur, and Kolkata—where PM2.5 levels routinely exceed safe limits—the link between air quality and lung health is more than theoretical. Studies have shown that long-term exposure to fine particulate matter can damage lung tissue and trigger carcinogenic mutations similar to those caused by tobacco smoke.
In addition, occupational exposure to substances like asbestos, historically used in construction and shipbuilding, continues to pose risks in India’s unregulated labor sectors. Workers handling insulation, brake linings, and construction debris often do so without adequate protection or awareness.
Radon gas, another known carcinogen, is a hidden threat in certain geological regions such as Kerala and Rajasthan, where naturally occurring uranium in soil and rock releases the radioactive gas. Poor ventilation in homes and offices can trap radon, creating prolonged exposure.
Prevention Begins with Awareness
The good news, according to oncologists, is that many lung cancer cases are preventable through evidence-based interventions. Quitting smoking remains the single most impactful step one can take, and even longtime smokers can significantly reduce their risk within a decade of cessation.
Other prevention strategies include:
- Avoiding secondhand smoke, especially in enclosed spaces;
- Testing homes and workplaces for radon and asbestos;
- Improving air filtration and ventilation indoors;
- Adopting a diet rich in fruits and antioxidants;
- Undergoing regular screening for high-risk individuals.
Low-dose computed tomography (CT) scans, recommended for people over 55 with a long history of smoking, can detect tumors at earlier, more treatable stages. Yet in India, access to such scans remains limited to urban hospitals, and public awareness is low.
“Screening is one of our best weapons, but only a small fraction of eligible individuals are aware of it or can afford it,” said Dr. Dinesh Pendharkar, an oncologist based in Mumbai.
A Missed Opportunity in Policy?
India’s National Cancer Control Programme has included tobacco control as a central pillar for over two decades, but critics argue it has not kept pace with the changing nature of cancer risks. Enforcement of occupational safety norms remains weak, especially in informal industries, and there is no national framework yet for radon monitoring or indoor air quality standards.
While the country has made strides in banning smoking in public places and increasing taxes on tobacco products, air pollution has continued to rise, and lung cancer diagnoses are expected to increase by 10–15% annually if current trends persist.
“We need a 360-degree strategy that includes not just individual behavior change, but systemic reforms in housing, urban planning, and workplace safety,” said Dr. Arvind Kumar, Chairman of the Institute of Chest Surgery, Medanta.
Looking Ahead
With lung cancer continuing to claim tens of thousands of lives in India each year, public health experts are calling for urgent reforms to broaden the scope of prevention efforts. From stricter industrial regulation to universal screening protocols and targeted awareness campaigns, the country stands at a critical juncture in addressing one of its deadliest yet most preventable diseases.
“Lung cancer should no longer be seen as a smoker’s illness alone,” said Dr. Rao. “It’s a mirror reflecting everything from our personal choices to our public policies.”