In Delhi, you don’t have to smoke to get lung cancer: New document calls for urgent, coordinated action to address issue

NEW DELHI: Lung Cancer Day on Aug 1 is a warning against the city's chronically hazardous air. A newly released Asia Pacific Lung Cancer Policy Consensus (APAC Consensus) has spotlighted the alarming rise in lung cancer cases linked to air pollution across the region. Indeed, the smog and PM2.5 in Delhi's air could be why doctors are seeing more lung cancer patients — many of them non-smokers — in the city.

Lung cancer is now a significant health concern in Delhi, with increasing incidence and mortality, particularly among men. The city's air quality index routinely exceeds safe limits — often by 8 to 10 times the norm. In 2020, India accounted for 5.9% of all global cancer cases and 8.1% of cancer-related deaths, with a substantial share attributed to lung cancer, according to the Journal of Thoracic Oncology. This national trend mirrors what is being observed in Delhi.


Lung cancer's share of total cancer cases in the capital has been steadily rising. Among men, it rose from 8.4% of all cancers in 1988 to 10. 6% by 2015, according to Delhi Cancer Registry data. Among women — though traditionally less affected — the trend is equally concerning: an increase from 1. 9% in 1988 to 3.4% in 2015.

"The link between air pollution and lung cancer is no longer a suspicion — it's a reality we're living with in Delhi," said Dr Abhishek Shankar, assistant professor, radiation oncology, AIIMS, who represented India in APAC Consensus. Developed by ASPIRE for Lung Cancer and regional stakeholders, the document urges urgent, coordinated action to address non-traditional lung cancer risk factors like air pollution and genetic mutations.

One major sign of the changing profile of lung cancer patients is the sharp rise in diagnoses among non-smokers. A 30-year analysis by chest surgeons at the Centre for Chest Surgery in Sir Ganga Ram Hospital and Lung Care Foundation revealed that 90% of lung cancer surgery patients in 1988 were smokers, but by 2018, that figure had dropped to 50%, indicating a big rise in cases among non-smokers.

Even more alarmingly, the study found that 70% of those under the age of 50 who underwent surgery for lung cancer were non-smokers. In the below-30 age group, none of the patients were smokers. The research was triggered by doctors noticing an increasing number of relatively young or non-smoking patients with lung cancer.

Doctors point to several contributing factors in Delhi's environment, among them prolonged exposure to second-hand smoke, vehicular emissions, industrial pollutants, cooking oil vapours and indoor fuels like coal. Experts are also flagging a possible link between air pollution and oncogenic mutations such as EGFR, which are especially common among Asian patients.

"We're seeing lung cancer in younger people, in women, in those without any history of smoking or family risk. The common thread is the toxic air," said Shankar. "You can't talk about reducing lung cancer in Delhi without first addressing the air we breathe. This isn't just an environmental issue, it's a public health emergency."

The APAC Consensus document calls for expanding lung cancer risk definitions beyond smoking, strengthening environmental regulations, improving access to early screening, reducing stigma — particularly for non-smoker patients — and ensuring equitable access to treatment.

As Delhi braces for another season of bad air, doctors say the connection between pollution and cancer is now impossible to ignore. Breathing, they say, shouldn't come with a cancer warning — but right now, it does.