Author: Dr. Wesley M Jose | Updated: November 22, 2021 at 05:11 PM (IST)
November is World Lung Cancer Awareness Month | Photo: Getty
In 1950, shortly after India’s independence, British researchers Richard Doll and Bradford Hill concluded that air pollution and smoking were the two most important causes of lung cancer . After 75 years, India has become the second most populous country with the 20 most polluted cities in the world.
A good balancer, poor air quality is not good for the rich or the poor. Unfortunately, especially in developing countries, they have paid a greater price for environmental pollution due to poor living conditions.
Air pollution is still the main cause of many health problems, especially lung diseases including lung cancer. Although smoking has become the most important cause of lung cancer for decades, this trend is being reversed as more and more never-smokers are diagnosed with lung cancer. The most obvious reason for this change seems to be the deterioration of air quality due to rapid industrialization in the past few decades.
Air pollutants contain a variety of polycyclic aromatic hydrocarbons, which are a class of compounds related to the risk of human cancer because they can cause DNA damage and eventually cause cancer.
The World Health Organization (WHO) has taken note of this fact and has developed health-based air quality guidelines. Unfortunately, emissions from industry, power generation, transportation, and domestic combustion far exceed these recommended standards.
The main pollutants are gases such as sulfur dioxide [SO2], nitrogen dioxide [NO2], carbon monoxide [CO], volatile organic compounds [VOCs] and particulate matter (PM). Small diameter PM is also called fine PM or PM 2.5, with a diameter of ≤2.5 µm. It is a serious health problem because it is made of toxic compounds such as acids and heavy metals and can penetrate deep into the lungs, unlike larger PMs such as Soil and dust.
PM2.5 is highly rich in zinc (Zn), arsenic (As), selenium (Se), molybdenum (Mo), mercury (Hg) and cadmium (Cd) and many other moderately volatile and potentially toxic elements, which are harmful to human health The hazards are well known. Unlike larger particles, PM2.5 can stay in the atmosphere for days to weeks and spread over long distances.
WHO recommends a PM2.5 concentration of 10 µg/m3 based on healthy world air quality guidelines. As of 2017, India is 91µg/m3, which is nearly 9 times higher than the recommended value (2017 data). The International Agency for Research on Cancer (IARC) listed outdoor air pollution and PM as Group 1 human carcinogens (carcinogens) that cause lung cancer in 2013.
Air pollutants exist outdoors and indoors, denying the myth that staying indoors is always safe. Different from outdoor pollutants such as SO2, ozone, arsenic, chromium, nickel, etc. produced by the burning of fossil fuels, indoor pollutants are mainly smoking, biomass burning, radon (from building materials and groundwater), asbestos, minerals and synthetic fibers (resistance Fuel, heat and electrical insulation), biological contaminants (dust mites, animal dander, etc.).
Other indoor pollutants that are often overlooked are fuel and paint vapors, lead paint, adhesives, cosmetics, solvents, particle board (formaldehyde), furniture, unventilated gas heaters, herbicides, pesticides, fungicides, Household applications of cleaning products, etc.
Despite the efforts of the Indian government, many families still rely on chulha and angithi as their main cooking methods. The International Agency for Research on Cancer (IARC) has listed household burning of biomass fuel as a group 2A (possibly carcinogenic) cause of lung cancer.
Life can't go on without all of these, it may be good to understand them and choose wisely what suits your home environment. Occupational exposure accounts for a large proportion of lung cancer patients who have never smoked.
India accounts for 12% of smokers in the world, and 50% of all adults have been exposed to passive smoking. This combined with poor air quality is the root cause of the disaster. In 1990, lung cancer was the seventh most common cause of cancer disability and death. In 2016, it has become the third most common cause due to multiple factors such as air quality.
As a public policy, taking into account the existing scientific data, the government needs to add outdoor air pollution to the list of causes of lung cancer and other malignancies. This will promote the enactment of laws to improve air quality.
Like the anti-smoking campaign, the government needs to raise people's awareness of the health risks of air pollution, and identify and support high-risk groups. Interventions to reduce air pollution need to be implemented at all levels, namely individuals, communities, industries, regions, and countries.
India enacted the Air (Pollution Prevention and Control) Act on March 29, 1981 40 years ago. Since its promulgation, the "Air Act" has only been revised once, fully demonstrating our commitment as a nation to what we breathe. This requires urgent attention.
At the community level, measures to improve air quality can be taken by improving ground transportation measures, creating smoke-free, clean air areas, green spaces, and green infrastructure.
At the personal level, an individual’s efforts to reduce smoking, reduce exposure to second-hand smoke, and keep the personal environment clean is a good start.
Encouraging people who interact with us to switch to cleaner cooking methods will have a long-term impact on the community.
Various industries are promoting personal respirators and household air filtration systems, but their effects on exposure and health are difficult to assess in the general population in a short period of time. In addition, this expensive equipment is not available to those who need it most.
For those who can afford it, combining a personal respirator with avoiding areas with poor air quality can be a good but tedious and unacceptable option.
The COVID-19 pandemic has made us all familiar and accustomed to using masks. In addition to preventing the new coronavirus, N95 masks can also reduce PM2.5 inhalation by 95-99%. This is a blessing in disguise. Good mask wearing habits and a suitable N95 mask may be the most cost-effective way to prevent air pollution-related diseases.
People living in areas where air pollution is inevitable should never indulge in active or passive smoking. They also need to be constantly aware of health risks and use available government facilities to conduct preventive health checks on a regular basis.
There is no single way to solve the air quality problem. Policy at the national level may take forever. The best way out is the joint efforts of society and the local government to create a safer living space for ourselves and future generations.
(Dr. Wesley M Jose is Associate Professor of Department of Oncology, Amrita Hospital, Kochi, Kerala)
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