Lok Sabha Question No. 1950 (UNSTARRED), answered on 2024-08-02
Subject: Lung Cancer among Non-Smokers
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Dr. C M Ramesh

## GOVERNMENTOFINDIA MINISTRYOF HEALTH AND FAMILY WELFARE DEPARTMENTOFHEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 1950 TO BE ANSWERED ON 2 ND AUGUST, 2024

## LUNG CANCER AMONG NON-SMOKERS

## 1950. SHRI C M RAMESH

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) Whether as per the Lancet Journal report, more than 50 percent of lung cancer patients are non-smokers in the country, if so, the details thereof;
- (b) The extent to which air pollution, occupational exposure to asbestos, chromium, cadmium, coal, arsenic, etc. are responsible;
- (c) Whether there are the role of genetic susceptibility, hormonal status, previous lung diseases among people who are non-smokers but suffer from lung cancer incidents, if so, the details thereof;
- (d) Whether lung cancer in India infects non-smokers earlier than the people in the Western world, if so, the details thereof; and
- (e) The efforts made by the Government for early detection, giving treatment and providing surgical help in the country?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI PRATAPRAO JADHAV)

(a):- As per the information furnished by Indian Council of Medical Research (ICMR), Lancet narrative review article states that among lung cancer patients, between 40-50% are never-smokers in India. However, statistically significant association between tobacco smoking and lung cancer has been consistently reported in numerous studies (reported in the same article). Tobacco users had higher risk of developing Lung cancers, the risk can range between 3.9 to 26.2 times.

(b):-According to an ICMR-NCDIR study titled "Assessing the Global Impact of Ambient Air Pollution on Cancer Incidence and Mortality: A Comprehensive Meta-Analysis," published in JCO Global Oncology, exposure to major air pollutants (PM 2.5, PM 10, O3, NO2) demonstrates a significant relationship with cancer incidence, with a relative risk of 1.04 (95% CI, 1.02 to 1.05). No data is available specifically on lung cancer

Assessing the Global Impact of Ambient Air Pollution on Cancer Incidence and Mortality: AComprehensive Meta-Analysis | JCO Global Oncology (ascopubs.org)

As per World Health Organisation, ambient air pollution is associated with a broad spectrum of acute and chronic illness, such as lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular diseases.

(https://www.who.int/data/gho/data/themes/topics/indicator-groups/indicator-group-details/G HO/ambient-air-pollution)

(c):-ICMR has not conducted any research to ascertain the relationship between lung cancer among non-smokers and its genetic susceptibility, hormonal status and previous lung disease.

(d):-As per the ICMR- NCRP Data, the estimated median age at diagnosis of lung cancer and all sites of cancer in India, Europe and North America is given below for the year 2020.

Median age of lung cancer

| Population    |   Lung Cancer |   All Sites |
|---------------|---------------|-------------|
| India         |            64 |          59 |
| Europe        |            69 |          69 |
| North America |            71 |          70 |

(e):- The Department of Health & Family Welfare, Government of India provides technical and financial support to the States/UTs under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD). Three most common types of cancers (oral cancer, breast cancer and cervical cancer) are an integral part of NP-NCD. The programme includes the following,

- i. Strengthening infrastructure
- ii. Human resource development
- iii. Health promotion
- iv. Screening of 30 years and above population at Ayushman Arogya Mandir for common NCDs i.e. diabetes, hypertension and common cancers (oral, breast and cervical)
- v. Early diagnosis and management
- vi. Referral to an appropriate level of healthcare facility

Under NP-NCD, 753 District NCD Clinics, 356 District Day Care Centres and 6238 Community Health Center NCD Clinics have been set up.

Awareness Generation for Cancer prevention & treatment has also been focused in following ways:-

(i) Preventive aspect of Cancer is strengthened under Comprehensive Primary Health Care through Ayushman Arogya Mandir by promotion of wellness activities and targeted communication at the community level.

(ii) Other initiatives for increasing public awareness by using print, electronic & social media and for promotion of healthy lifestyle includes observation of National Cancer Awareness Day, World Cancer Day.

(iii) NP-NCD provides financial support under NHM for awareness generation activities for NCDs including Cancer to be undertaken by the States/UTs as per their Programme Implementation Plans (PIPs).

(iv) Healthy Eating is promoted through 'Eat Right India movement' of Food Safety and Standards Authority of India (FSSAI). 'Fit India movement' is implemented by Ministry of Youth Affairs and Sports. Various Yoga related activities are carried out by Ministry of AYUSH.

Action taken by Government in respect of infrastructure are:

(i) The Central Government implements Strengthening of Tertiary Care Cancer Facilities Scheme. 19 State Cancer Institutes (SCIs) and 20 Tertiary Care Cancer Centres (TCCCs) have been approved under the said scheme.

(ii) National Cancer Institute at Jhajjar (Haryana) and second campus of Chittaranjan National Cancer Institute, Kolkata have also been setup.

(iii) All new AIIMS and upgraded existing Government Medical Colleges/Institutions under Pradhan Mantri Swasthya Suraksha Yojna (PMSSY) also focus on treatment of cancer.

To facilitate accessible and affordable healthcare and treatment, the following steps have been taken:

(i) Diagnosis and treatment of NCDs including cancer is available at various levels in the health care delivery system including District Hospitals, Medical Colleges, Central Institute like AIIMS, Central Government Hospitals and private sector hospitals. The treatment in Government Hospitals is either free or highly subsidized for the poor and needy.

(ii) Treatment of cancer is available under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY), health insurance coverage of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization is provided to over 55 crore poor and needy beneficiaries. National Health Authority (NHA) has informed that the Governing Board of the NHA has approved the inclusion of diagnostic tests which are useful for staging and treatment planning in the confirmed cases of cancer. The diagnostic packages introduced are with respect to Breast, Cervical and Oral cancers. This will help beneficiaries in reducing out-of-pocket expenditure.

(iii) The Department of Pharmaceuticals has informed that the National Pharmaceutical Pricing Authority (NPPA) has fixed ceiling prices of 131 anti-cancer scheduled formulations included in Scheduled-I as per the provisions of DPCO, 2013. In addition, NPPAcapped the Trade Margin of select 42 Anti-Cancer non-scheduled formulations.

(iv) Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) Scheme was launched to set up dedicated outlets known as Pradhan Mantri Bhartiya Janaushadhi Kendras (PMBJKs) to provide quality generic medicines at affordable prices. As on 30th June, 12,616 PMBJKs have been opened in the country. Under PMBJP, 2047 types of medicines and 300 surgical devices have been brought under the basket of the scheme, of which 83 products are for cancer treatment.

(v) Affordable Medicines and Reliable Implants for Treatment (AMRIT), an initiative launched by the Ministry of Health & Family Welfare aims to provide affordable medicines for treatment of cancer, cardiovascular and other diseases. As on 15.06.2024 there are 206 AMRIT Pharmacies spread across 29 States/Union Territories, selling more than 5,200 drugs (including cardiovascular, cancer, diabetes, stents, etc), implants, surgical disposables and other consumables at discount.