Second-hand smoke and delayed diagnosis raise lung cancer concerns

Doctors say most patients arrive after the disease has advanced, limiting curative treatment despite improving therapies

Srinagar: When 58-year-old Muhammad Afaan (name changed) coughed up blood one cold January night, he realised the persistent cough he had ignored for months was something far more serious than a seasonal illness.

By the time doctors confirmed he had lung cancer, the disease had already progressed beyond the stage where curative treatment was possible.

His story reflects a pattern oncologists across Kashmir say they encounter with alarming frequency: patients dismiss symptoms such as persistent cough, breathlessness or blood in the sputum until the disease has silently advanced.

“For nearly six months, he had a persistent cough, but he believed it was just a respiratory infection or seasonal allergy,” recalled Dawer, Afaan’s son.

“As the first light of dawn broke, he woke up and called his wife. He told her what had happened the previous night. Naturally, she became anxious and spoke to me. I immediately booked an appointment with a doctor at a hospital in Srinagar,” he said, adding that his father had been a chain smoker.

Doctors first ordered a chest X-ray followed by a CT scan, which revealed a suspicious growth in the lung. Further investigations confirmed lung cancer.

According to the family, the cancer had already spread, leaving doctors with limited treatment options.

Oncologists say such delayed diagnoses are becoming increasingly common.

“Lung cancer is the number one cancer among men in Kashmir, and its numbers have increased dramatically over the past few years,” said Dr Sheikh Zahoor, surgical oncologist at Amandeep Hospital, Srinagar.

According to Dr Zahoor, many patients seek medical attention only after the disease has reached an advanced stage.

“Most of our patients are not candidates for curative treatment because they present late or are too weak to undergo surgery or other aggressive therapies,” he said.

While smoking remains the leading cause of lung cancer, doctors say the disease is increasingly being diagnosed among people who have never smoked.

“Around 15 to 20 per cent of our lung cancer patients have never smoked. Many have been exposed to second-hand smoke, while others may develop the disease because of environmental factors such as radon gas,” Dr Zahoor said.

Radon is a naturally occurring radioactive gas released from soil and rocks. It can enter buildings through cracks in foundations and accumulate indoors, with long-term exposure recognised as a significant risk factor for lung cancer.

For one Srinagar family, the diagnosis came as a shock.

Thirty-four-year-old Shaista (name changed), who had never smoked, developed a persistent cough while staying at her parents’ home. Believing it to be a seasonal illness, she delayed seeking medical care despite repeated requests from family members.

Months later, after her mother noticed the cough had not improved, the family persuaded her to undergo medical tests.

A chest X-ray revealed a suspicious shadow in her lung. A CT scan and biopsy later confirmed advanced-stage lung cancer.

“The doctors started chemotherapy, but by then the disease had progressed considerably,” recalled Mohammad Ashraf, a family member. “She could not tolerate the treatment and passed away a few months later.”

Ashraf said the family struggled to understand how she had developed the disease.

“Shaista had never smoked in her life, but her husband was a smoker,” he said. “The doctors told us that prolonged exposure to second-hand smoke may have contributed to her illness. Her husband is healthy, but Shaista was the one who developed lung cancer.”

Dr Zahoor also expressed concern over the growing prevalence of smoking among young women in Kashmir.

“In many Western countries, lung cancer cases among men declined as smoking rates fell. However, as more women took up smoking, the disease became increasingly common among them,” he said.

“A similar pattern is slowly emerging in Kashmir. Although smoking among women is still less common than among men, we are seeing more young women, particularly college students, taking up the habit. If this trend continues, the burden of lung cancer among women is also likely to increase.”

Despite the grim outlook associated with advanced disease, oncologists say lung cancer can often be treated successfully if detected early.

Dr Zahoor recalled the case of a man in his late fifties who sought medical attention after developing a persistent cough accompanied by blood in his sputum.

Investigations, including a biopsy and PET-CT scan, showed that the cancer had been diagnosed at a stage where curative treatment remained possible.

“The affected portion of his lung was surgically removed, and he subsequently underwent chemotherapy and radiotherapy. He has recovered well and continues to do well,” he said.

According to Dr Zahoor, the greatest challenge remains delayed diagnosis rather than a lack of treatment.

“People often ignore symptoms such as a persistent cough, breathlessness or blood in the sputum, assuming they are caused by seasonal allergies, infections or smoking itself. By the time they reach a hospital, the disease has often advanced beyond the stage where it can be cured,” he said.

He urged people, particularly smokers and those over the age of 55, not to ignore a cough that persists for more than a few weeks and advised long-term smokers to undergo regular low-dose CT screening.

“The single most effective way to reduce the burden of lung cancer is to quit smoking,” Dr Zahoor said. “Equally important is seeking medical attention early. A timely diagnosis can make the difference between treatment aimed at cure and treatment aimed only at prolonging life.”