Status of the rising number of patients with lung cancer in Nepal: A major public health concern

We read with great interest the article by Yadav et al.[1] and commend them for sharing their study on the profiling of patients with lung cancer at a tertiary care hospital in Nepal. Lung cancer is one of the most common and lethal cancers in Nepal, with an age-adjusted ratio (AAR) ranging from 2.6-23.7 per 100,000.[2] According to the Global Cancer Observatory (GLOBOCAN) 2022, the number of new cases of cancer is 22,008, and cancer-related deaths are 14,704 in Nepal. The age-standardized rates (AARs) in cancer incidence and mortality per 100,000 were estimated to be 65.6 and 29, respectively. Lung cancer is the most common cancer in men (1,528, 15.6% of new cases) and the third most common cancer in women (903, 7.4%) in Nepal.[2,3] In their study, Yadav et al. provided valuable insights into the characteristics of 192 patients with lung cancer treated at a tertiary care hospital in Nepal. Of these, 145 (75.5%) had non-small-cell lung cancer (NSCLC), including adenocarcinoma and squamous cell carcinoma. Approximately 97% (186 patients) were diagnosed at an advanced stage, with 56.8% (109 patients) in Stage IV and 40.1% (77 patients) in Stage III. Overall, 67.7% (130 patients) were nonsmokers, while 32.3% (62 patients) were smokers. Additionally, 90% (173 patients) were over the age of 50 years. Chemotherapy and radiation therapy were the most commonly used treatments.[1] Among the 192 patients, 90.1% (173 patients) were over the age of 50, confirming a strong association between age and the risk of lung cancer.[4,5] According to Nepal’s population-based cancer registry (PBCR), men face the highest risk of developing lung cancer before the age of 75 in urban, suburban, and rural regions.[6] The study also found that the leading cause of death among men was a histological type of non-small-cell lung cancer. This study further highlights that smoking is not the sole risk factor for lung cancer, as only one-third of participants were smokers.[1] According to the Nepal Health Research Council (NHRC), the PBCR in the Kathmandu region covered 21% of the estimated total population of the country, which was more than six million (6,249,769). Geographically, the registry covered 225,805 rural, 2,872,760 suburban, and 3,151,205 urban populations.[6] Data indicate a rising incidence of lung cancer among women, attributed to smoking, passive smoking, indoor pollution, and environmental pollution, which have become major public health concerns. Notably, lung cancer cases are more prevalent among rural women (22.2%) compared to those in urban (11.3%) and suburban (8.1%) areas of Nepal.[7] Additionally, pollution levels in Nepal are increasing due to rapid industrialization and urbanization. Approximately 74% of households - 86% in rural areas and 14% in urban areas - rely on solid fuels, such as firewood and cow dung briquettes, for cooking. Women in these households are often exposed to indoor smoke for at least six hours a day, which significantly increases their risk of lung cancer.[6,7] Despite the growing cancer burden, Nepal has yet to implement a systematic national cancer control strategy or a formal lung cancer screening program. It is crucial to initiate educational programs at both public and hospital levels to raise awareness about early detection and screening programs in both rural and urban areas. Furthermore, there is an urgent need for the Nepalese government to conduct PBCR in all provinces to guide strategies and evaluate intervention programs. Financial support and sponsorship Nil. Conflict of interest There are no conflicts of interest.