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Lung cancer in India is no longer a concern confined to smokers alone- it is rapidly becoming a public-health emergency, shaped by changing habits, worsening pollution, and longstanding risk factors. As an oncologist witnessing this rise in my practice, I believe urgent public awareness and preventive strategies are long overdue.

Every year, nearly one lakh new lung cancer cases are diagnosed in India. Historically, smoking whether cigarette or beedi remains the single largest risk factor. But today, the narrative has expanded: air pollution, indoor pollutants, secondhand smoke, and environmental toxins are increasingly implicated- and alarmingly; a substantial proportion of patients are non-smokers. 

Why this surge- Risk factors

• Tobacco use: Active smoking, beedis or cigarettes- dramatically increases lung cancer risk. In India, studies report a 2.23-2.64 times higher risk for cigarette and beedi smokers respectively. Even occasional smoking or switching to “lighter” tobacco does not protect you.

• Second-hand smoke: Non-smokers living or working with smokers are also at higher risk.

• Outdoor air pollution and indoor pollutants: Chronic exposure to fine particulate matter (PM2.5 and PM10), vehicular emissions, industrial pollutants, household smoke (from cooking fuels), and even radon gas especially in poorly ventilated homes significantly increases lung cancer risk.

• Occupational exposure and toxins: Certain jobs involving inhalation of hazardous dusts and fumes can elevate risk.

• Non-smoker lung cancer & genetic / regional susceptibility: In India, a sizeable number of lung cancer patients never smoked. Researchers attribute this to a mix of environmental exposures, air pollution, and possibly genetic or region-specific vulnerabilities.

Prevention- What we must do

The good news is that many risk factors can be modified or mitigated. I strongly urge:

1. Complete tobacco cessation- avoid cigarettes, beedis, hookah, and smokeless tobacco. Also, advocate for smoke-free homes and workplaces to protect family members and colleagues.


2. Protecting against air pollution- use masks on polluted days, avoid unnecessary outdoor exposure during peak pollution hours; improve indoor air quality by proper ventilation or air purifiers; minimize use of biomass fuels for cooking; reduce indoor smoke and radon exposure.


3. Healthy lifestyle and diet- a balanced diet rich in antioxidants (fruits, vegetables, vitamins) supports lung health and may reduce cancer risk.


4. Awareness of early warning signs & regular screening for high-risk individuals — persistent cough, unexplained breathlessness, chest pain or blood in sputum should never be ignored. For older individuals or long-term smokers, periodic screening (for example, low-dose CT scans where appropriate) could enable early detection when treatment can be curative.


5. Advocacy for cleaner environment and public policies — as a society, we must press for stricter regulation of air pollution, cleaner fuel use, safer workplace ventilation, and awareness campaigns against tobacco.

My Viewpoint: Time to Broaden the Lens

As an oncologist working in India, I believe we must broaden the lens with which we approach lung cancer. For decades, we focused almost exclusively on smoking; that remains necessary, but not sufficient. The increasing burden of lung cancer among non-smokers, especially the urban poor exposed to toxic air, or rural populations using biomass fuels- demands that we shift our narrative.

Prevention in 2025 India means collective action: from individuals quitting smoking and taking care of their indoor air- to policymakers enforcing clean-air laws and public health campaigns, to clinicians maintaining a high index of suspicion even in “non-typical” patients.

If we act now- with awareness, screening, and prevention, we can stem the tide of lung cancer before it becomes an even larger crisis.

Dr. Udip Maheshwari
M.D. DNB ECMO
Consultant Cancer Physician
MOC Cancer Care & Research Centre, Ghatkopar.