Dr Naveed Shah is J&K’s premiere Pulmonologist, Professor & Head Chest Medicine GMC Srinagar who played a leading role in COVID 19 crisis management in the UT.

In an exclusive interview with Rising Kashmir’s Special Correspondent Jahangir Sofi, he talks about the lung cancers in Kashmir with relation to tobacco smoking.

Excerpts:

Tell us something about Lung Cancers and what are it’s symptoms? 

Our lungs are the spongy organs which help in exchange of gasses. Lungs are predisposed to various disease conditions which range from common respiratory infections to life taking lung cancers.

In early stages of lung cancer patients do not show any type of signs and symptoms. Signs and symptoms that are typical in lung cancer develop in later stages of disease which include shortness of breath, chronic cough not resolving with conventional treatment, blood in sputum, chest pain. Change in voice. 

How cigarette smoking plays a role in disease progression?  

The people who smoke have higher chances of developing lung cancer, though there are reports where lung cancer can develop in those who never smoke.

As per hospital-based data from Kashmir valley lung cancer has been found to be second commonest cancer. In the past few decades, the cancer catastrophe has created havoc globally, Kashmir has witnessed rise in cases of lung and breast cancers.

As per the hospital-based data from Kashmir valley males have higher incidence of lung cancer while females fall victim of breast cancers. 

There is a direct relation between length of smoking and number of cigarettes smoked per day. Even if smokers quit smoking there are chances of developing cancer but these chances decrease to a greater extent.

How do you look at the Cigarette smoking trends in the valley?

In Kashmir number of people actively involved in consumption of cigarettes is growing at an alarming rate, as National Family Health Survey (NFHS-4), 38.2 percent of males in Kashmir are indulged in smoking and international survey conducted by Global Adult Tobacco Survey (GATS) put Jammu and Kashmir on serial number 6 among all states and union territories in terms of tobacco smoking.

Owing to its large part of the population involved in tobacco smoking and also exponential increase in smoking population every year in future Jammu and Kashmir will be tagged as smoking capital of India. Recently Indian Council of Medical Research published a report entitled “Health of Nation's States” as per this report J and K has the highest incidence of chronic obstructive pulmonary disorder (COPD) and same report has attributed this to increased smoking population in J and K. In addition to local brands of cigarettes imported cigarettes have become a culture of decency and smartness among youth. 

Are there any researches or studies over the damages caused by smoking?

Researchers working in this field postulate that smoking being full of carcinogenic substances causes drastic changes in the lining of lungs and this change begins immediately when cells lining lungs are exposed to carcinogenic substances present in cigarette smoke.

In early stages our lungs are able to repair this damage, but chronic exposure results in aberrant behaviour of pulmonary cells which eventually results in development of lung cancer.

Pulmonologists divide lung cancers into two broad categories based on the cell types involved in progression of lung cancer; these include small cell lung cancer and non-small cell lung cancer.

Among these two types, small cell lung cancer is extensively found in the heavy smoking population and is very rarely found in non-smoking population. Recently a study was conducted by SKIMS, and they reported that smoking related cancers (lung cancers) have increased drastically in summer capital Srinagar.

In 2014 International agency for research concluded that in addition to active smoking passive smoking of carcinogenic substances can also cause lung cancer. 

Can passive smoke increase the chance of lung cancer? 

Long-term passive exposure of cigarette smoke increases chances of lung cancer and breast cancers, it has been reported that cigarette smoke contains more than 7,000 chemicals among which 70 have been reported to be highly carcinogenic.

 Inhalation of these chemicals’ damages tiny air sacs of lungs called alveoli and over the time cells covering these air sacs undergo DNA mutation and hence development of cancer.   

How is disease diagnosed and treated? 

Commonly used diagnostic tools for diagnosis of lung cancer include CT scan, Bronchoscopy, endobronchial ultrasound and histology.

There are various treatment options available which include surgery for early stages and chemo radiotherapy for advanced stages. Immunotherapy also in eligible cases has shown good promise in the treatment in inoperable cases.

In most of the cases lung cancer gets diagnosed when disease is in stage III or stage IV hence prognosis of lung cancer is poor, but encouraging results have been reported in treatment of lung cancer if diseases are detected early and treated with multiple modality approach.

What about e-cigarettes?

These are an electronic device which mimics the feeling of smoking by producing mist and delivering nicotine.

These products are new in the market and side effects associated with long term use are yet to be established. At present it is not clear whether e-cigarettes are associated with lung cancer, but recently the American Cancer Society has postulated that e-cigarettes also contain carcinogenic substances but less in quality and quantity compared to conventional cigarettes.

A chemical called diacetyl used as a flavouring agent in e-cigarettes causes DNA damage which can act as a prerequisite for progression of lung cancer.

Furthermore, very heavy metals like Lead and Tin have been isolated from smoke of e-cigarettes, which are highly carcinogenic.

What are the other causes of lung cancer?  

Nearly less than 15% of lung cancers are not associated with smoking, so clinicians have identified the following other causes of lung cancer in addition to smoking tobacco.

These include genetic factors (family history), exposure to radioactive substances, National Cancer Institute has identified asbestos in progression of lung cancer, automobile exhaust (Centers for Disease Control and Prevention).

Recently researchers have identified dietary factors for progression of lung cancer, they have reported that smokers who take increased levels of beta-carotene supplement are at increased risk of developing lung cancers. 

What needs to be done for it’s prevention?

At hospital level screening programs can be helpful in early detection of lung cancer. At community level measures for improving air quality should be taken, at individual level efforts are warranted to curtail active and passive smoking.

It is never late to quit smoking, when we quit smoking our body is equipped with a wide spectrum of physiological processes which can undo the damage caused by smoking.