India

            

                Lung Cancer stands as the second most common form of cancer in India. According to Globocan Report in 2008, there were 51,000 deaths due to lung cancer in India. This figure has double from the last five years (from 2008) accounting for 26,000 lung cancer deaths from few selected urban and rural registry centers. The tobacco related products smoked in India are Bidi (most carcinogenic with most number of consumption), Cigarettes, Hooka and mixed.  Increase consumption of Bidi had been more dangerous to human lungs that increases the number of lung cancer deaths in India, considering tobacco as the major factor of developing a lung cancer.

                There were several factors which make lung cancer more prevalent in their society. One of which is the literacy and illiteracy rate. In India, 75% are literate. The rest 25% are illiterate that pushes for more indulgence in tobacco use and smoking. The most number of lung cancer deaths is from the industry of farmers. Due to lack of wealth and employment, Indians were forces to work at the farm. Without awareness, they had made smoking one of their habit plus the other factor that accounts in the development of lung cancer.

                Apart from tobacco, air pollution has become a threat to human lungs. It contains many known carcinogens and exposure to this has been known to predispose to lung cancer mortality. According to Scientific and Environmental Research Institute, Koltaka the most polluted metropolitan city in India,  had more than 18 person per one lahk that falls into lung cancer per year. The worst contributor of air pollution were drivers that uses ‘kantatel’ – known as a deadly fuel made of kerosene and petrol. The national government can’t prevent these drivers due to the strong trade union and nobody can touch them.

                Other cause is the occupational risk. Exposure to different kinds of harmful chemicals can increase the risk of developing a lung cancer.  Insulation workers and shipyard workers are exposed to asbestos; Smelter workers and vineyard workers are exposed to arsenic; Nickel Refinery workers is more likely to acquire squamous cell carcinoma; Those exposed to Radiation such as Uranium mining can acquire oat cell carcinoma. Lung cancer is also prevalent to those engaging in Haematie mining due to radon exposure; some were due to the exposure to chromium, chloromethyl, ether and mustard gas.  Including farmers relaying heavily on the use of chemical pesticides are prone to the risk of lung cancer. The 85% of its active ingredients is produced annually in crop production in developing countries. All raw materials and labor were produced in developing countries which makes them more prone to lung cancer.

The problems in management of lung cancer are numerous. One of which, accounts for more than 85%, are cases in advanced stages. Around 90% of lung cancers are NSCLC which is known to be aggressive. If it was detected in stage 1, the cure rate is 70%, while in stage 3, rushes down to 20%. But major of the patients were detected to be in stage 4 and chemotherapy is the only treatment option. Another, many are misdiagnosed as tuberculosis. The burden of misdiagnosis and delayed diagnosis on the health care system makes a large number of patients that is incurable.

                The type of Lung Cancer most common in India is the squamous carcinogen which is caused basically by smoking or occupational exposure to harmful chemicals which is rampant in India.

                It has been observed that the tobacco companies are now targeting the developing countries rather than the developed countries. One reason could be that awareness, regulations and societal pressure have resulted in decreased number of smokers in developed nations.

CANCER FACTS & FIGURES WITH FOCUS ON LUNG CANCER IN INDIA

Oncologists available	0.98 per 100,000 population
On-going (all) clinical trials	1.5% of the world’s total41
Number of patients currently undergoing (all) studies	10,00042
Number of LUNG CANCER being detected each year	250,000 to 300,000

                India as compared to developed country has less count of lung cancer, however, because of the sheer size of its population, it is estimated that India adds 1 million new cases of cancer every year. According to D Behera and New Delhi, “for lung cancer, India has been labeled as hub since the widespread use of tobacco products primarily triggers this malignancy”.

                As a respond to the increasing number of cancer cases and deaths in India Central Drugs Standard Control Organization (CDSCO) prepared a National List of Essential Medicines (NLEM) of India in 2011. The NLEM is one of the key instruments that will ensure the balance of health care delivery system for the nation. The first NLEM released in 2003 are 354 medicines only including the 23 anticancer products, on the other hand, it has an additional new 8 oncology drugs in 2011 list – having a total of 348 medicines. The increase of anticancer drugs has emphasized the importance of oncology products in national health due to continuous increase of cancer cases.