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With September and October being dedicated to the two most common cancers in Jamaica (Prostate and Breast, respectively), it’s been a busy time for cancer awareness. However, a 2020 report by the Global Cancer Observatory showed over thirty types of cancer among our population, impacting over 7,000 Jamaican men, women and children.
While some were very rare, others, like lung cancer, are common enough that we should take far more notice.
So why does lung cancer need special attention? Because of its number one cause.
Risk Factors for Lung Cancer
Like other cancers, such as colorectal cancer, there are several risk factors for lung cancer. For one, just having lungs puts you at risk. Other factors, however, include:
Increasing age
Recurrent lung infections, like certain types of pneumonia
Exposure to secondhand smoke
Exposure to certain toxic substances like radon or asbestos
A family history of lung cancer
As Consultant Oncologist and Haematologist Professor Gilian Wharfe notes, "Some occupational exposures also increase the risk of lung cancer." This includes any job that regularly exposes you to air pollutants like smoke or airborne irritants like silica dust, like construction or concrete production.
Unlike other cancers, though, most cases of lung cancer can be linked back to one modifiable risk factor for this disease: tobacco smoking.
Globally, 85% to 90% of lung cancer cases are caused by smoking, making this cancer one of the most preventable diseases in the world. And yet, in 2020, lung cancer was the fourth most common cancer among Jamaicans and the third-leading cause of cancer-related deaths. A 2023 local news report also noted that lung cancer cases were on the rise in Jamaica.
The Problem With Tobacco
As a member of the nightshade plant family, tobacco naturally contains nicotine. This highly addictive substance acts as a stimulant and anti-anxiety agent. Though poisoning is rare, it can happen, but the Centre for Disease Control currently estimates that it takes 50 to 60 mg to kill a 150 lb adult. The average cigarette contains 10 to 12 mg of nicotine.
When consumed, like through smoking or chewing tobacco, it stimulates the brain to release "feel good" chemicals, like dopamine. Over time, it changes the brain's chemistry, so it feels like you need nicotine. This makes nicotine, and so tobacco, difficult to quit. Further, the more you smoke, the more nicotine is required to give you the same high.
When burned, as in cigarettes, the smoke from tobacco produces compounds like tar, a sticky resin that destroys the structures in the lungs over time, and carbon monoxide, a poisonous gas that replaces oxygen in the blood. Both firsthand and secondhand smoke contain these substances. Over time, diseases like lung cancer develop.
Some cigarette manufacturers have sought to make cigarettes safer by reducing the amount of tar. However, research has found that because medium and low-tar have less nicotine, smokers who use these products have to smoke more to get the same high. As such, they are still exposed to high levels of these toxic compounds.
Symptoms for Lung Cancer
Like other cancers, early-stage lung cancer often has no symptoms. By the time the most common symptoms of the cancer, like a persistent cough that doesn't improve or shortness of breath, appear, the cancer has likely been present for some time.
Who is at risk of developing lung cancer?
As said above, anyone can develop lung cancer. Smokers, however, are at the highest risk.
A 2018 report by the Pan-Health Organization found that Jamaica was second highest in the region for tobacco use, with 17% of Jamaican adults using tobacco-related products, like traditional and e-cigarettes, as well as grabba, a form of tobacco that is often added to ganja before smoking.
Men make up the bulk of Jamaica's tobacco users, so it’s no surprise that it was the third most common cancer among them (compared to fifth among Jamaican women) in 2020.
Further, while a strong link between marijuana and lung cancer has not been established, marijuana smokers are not exempt from risks.
"Many people do not declare how much ganja they actually smoke," explains Professor Wharfe, so they're less likely to get screened when they need to be, or symptoms may be misassigned.
In addition, how ganja smokers smoke also increases their risk. "These smokers also tend to inhale more deeply and smoke down to the end more often. Deep inhalation means the 'bad stuff' in ganja smoke, like tar, stays in the lungs longer."
Screening for Lung Cancer
In a 2018 report by the Word Health Organization, lung cancer had the fourth highest incidence rate among the ten most common cancers in Jamaica (7.2%), but the second highest mortality rate (10.4%). Why? Low screening levels. This is in keeping with global trends. According to the American Lung Association, in 2021, only 5.8% of the 14 million U.S. adults eligible got screened for this disease. As such, most cases of lung cancer are not detected until they are advanced and more difficult to treat.
Like other cancers, regular screening is critical in the fight against this disease. When caught early, the five-year survival rate for lung cancer is over 60%.
From Professor Wharfe, "Screening guidelines speak to those persons who are between 50-80 years old, with a twenty pack-year smoking history." While quitting smoking can reduce your risk, Professor Wharfe clarifies, "Both current and former smokers should have annual lung cancer screening using low radiation dose CT scans." While these scans are available in Jamaica, Professor Wharfe notes they have to be ordered by a doctor.
Lastly, the benefit of quitting also cannot be overstated. The younger you are when you quit, the better, but even lifelong smokers can decrease their risk of developing the disease by stopping. Current smokers are 15 to 30 times more likely to develop lung cancer than persons who never smoked. However, every year you quit smoking, that risk decreases, even if you smoked heavily. So, while quitting isn't easy, it's very worthwhile.
