#HEALTH: Lung cancer on the rise among female non-smokers

LUNG cancer is no longer a smoker's disease.

Data now indicates that an increasing number of non-smokers are getting the disease with women making up a large number in this category.

According to the Global Cancer Observatory (Globocan) 2020 report, over 2.2 million lung cancer cases were reported globally in 2020, with more than 770,000 of them in women.

There has been a 79 per cent increase in global lung cancer cases among women in the last few decades, with the majority of these women being non-smokers.

For the longest time, lung cancer has been viewed as a male smoker's disease. The fact that an increasing number of non-smokers, especially women, are acquiring the disease, shows that this demographic is changing.

In Malaysia, less than 2 per cent of women are smokers, but lung cancer is the fourth most common malignancy among females, says consultant cardiothoracic surgeon and co-founder of Lung Cancer Network Malaysia Dr Anand Sachithanandan.

"There is a genuine lack of awareness amongst both the general public and doctors about factors other than smoking that predispose women to lung cancer, such as secondhand smoke, high levels of exposure to air pollution, asbestos or radon. A family history for the disease is another significant risk factor that is often overlooked," he says.


In the 2018 Malaysian Study on Cancer Survival, lung cancer cases in women stood at 2,478, almost half the number in men at 5,543 – despite the much lower rate of tobacco use among Malaysian women compared to men. Non-smoking women who develop lung cancer also tend to be younger.

Dr Anand says one of his youngest patients was a 29 year old woman, a non-smoker with no family history of lung cancer. She had no symptoms either, but during a routine health screening for employment purposes, the chest x-ray picked up her cancer.

Cases such as these highlight the fact that the disease can affect people with no history of tobacco use, although smoking remains the most common and most identifiable risk factor for lung cancer.

Dr Anand says in Malaysia, smoking prevalence is high among males, with about 43 - 45 per cent of adult males being smokers. In comparison, less than two per cent of women smoke.

He adds that recent research indicates that up to 90 per cent of men who develop lung cancer have a history of smoking or tobacco use, whereas in women, more than 60 per cent have never smoked.

"In countries like Singapore and Hong Kong, more than half the cases involve non- smokers," says Dr Anand.

Given these figures, the significant impact of passive smoking or second hand smoke cannot be ignored.

A woman who lives with a spouse or family member who smokes or is constantly exposed to smoke in her workplace, has a much higher risk of acquiring lung cancer.

Dr Anand says it's the chronic cumulative exposure over a long period of time which increases the risk.

When women are diagnosed with lung cancer, it comes as a huge shock to them, especially when they are non-smokers, says consultant clinical oncologist Dr Jennifer Leong.

These are usually young women who lead relatively healthy lives so the diagnosis is a huge blow.

There needs to be a lot of empathy on the part of medical professionals in helping women understand and cope with the diagnosis, adds Dr Leong.

"The good news is that a lot of these women are motivated to partake in treatment due to their families. They do it because they want to get better for their families."

Equally important is for women to not dismiss the symptoms of this disease.

A persistent cough or a cough that goes away but then comes back, or feeling breathless should not be ignored.

Dr Leong says in most cases, women only seek treatment for their cough when they find blood in their phlegm.

"Lung cancer is very much a curable disease if detected early," she says.

Dr Anand adds that in Malaysia, 95 per cent of lung cancer cases are only detected at stages 3 or 4.

"Don't ignore a persistent cough for more than two weeks or recurrent chest infections," he stresses.

However, the challenge lies in the fact that the majority of those with early stage lung cancer will have little to no symptoms.

This underscores the need for lung cancer screening for high risk individuals such as heavy smokers or those with a family history of the disease.

The outcome is better for the patient and the cost of treatment is lower if the disease is caught early.

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