Spotlight on lung cancer disparities in India

In 2020, lung cancer (LC) was the second most frequently diagnosed cancer (11.4% or 2.2 million cases) and the leading cause of cancer-related deaths (18% or 1.8 million).1 Although the incidence and mortality in high-income countries (HICs) are three to four times higher than those in low- and middle-income countries (LMIC), a trend reversal in future is likely, courtesy the evolving tobacco epidemic. In 2016, 80% of individuals age 15 years or older smoking tobacco originated in LMICs, which is projected to increase.2

India is the world's second largest tobacco consumer and the third largest tobacco producer. The Global Adult Tobacco Survey in 2016/2017 noted 267 million tobacco users in India, comprising 42.4% men and 14.2% women.3 Secondhand smoke (SHS) exposure is another major concern, with high prevalence in both workplace and home, among 38.7% and 30.2% of adults, respectively.4 Despite banning public smoking in 2003, SHS exposure is still common among public areas with varying law enforcement, including bus stops and cinema halls, compared with educational or health care settings with stricter compliance.5 LC is a leading cancer among Indian men, with a steady rise among both smokers and nonsmokers. Another concerning trend is the rising incidence among women, with domestic SHS exposure possibly contributing6 (Table 1). This article aims to explore the disparities and challenges in LC care in India and propose potential solutions.