Lung cancer: PM2.5 Tiny particles pose Titanic threats to lungs

For more than 25 years, Thailand has struggled with poor air quality including PM2.5 threat. The North, in particular, has borne the brunt. In 2023, the amount of dust particles has exceeded safe limits by 14 times. Statistics show up to 1.7 million Thais came down with illnesses related to air pollution between January 1 and March 19, 2023. In 2022, there were also as many as 180,000 lung-cancer patients in Thailand. The number of these patients has been rising every year. 

On August 1, 2023, the Thai Cancer Society in collaboration with Krungthep Turakij and AstraZeneca held a seminar on LUNG Cancer Day #lungcancer #lungdiseases #respiratorydisorders #tinyparticlesposetitanicthreatstolungs #PM2.5 #LUNGCANCERDAY to raise public awareness without causing panic of titanic threats tiny particles pose to human lungs. The event was held to mark the World Lung Cancer Day, which falls on August 1 every year. Organizers hope people, including lung-disease or lung-cancer patients, will understand threats and know how to deal with them. The event aimed to ensure people would be able to take care of themselves in the face of threatening pollution.

“Lung cancer” is the second most common lung type in men and the fourth most common in women. Every year, about 17,000 people are diagnosed with this disease. In other words, lung cancer hits about 47 people every day. In the past, risk factors were mainly smoking and exposure to secondhand smoke. But while smoking has reduced today, air pollutants from PM2.5, open fires, vehicles’ exhaust fumes, and exposure to some types of asbestos or radiation have raised people’s risks of developing lung cancer. 

“Lung Cancer”: Early Detection for Early Treatment

“Dr Supakorn Pitakkarnkul”, the National Cancer Institute’s deputy director for medical services, says Thais’ fatality rate related to cancer has been increasing every year. The hike reflects not just better data collection but also the many risk factors related to modern lifestyles. For example, the lack of active physical activity, exposure to dust, and pollution have contributed to the increase of cancer incidences. Thailand’s transition into an aged society has also shared the flak. 

Most lung-cancer patients will find out about their illness only after their cancer has entered an advanced stage, because such disease’s symptoms are not clearly noticeable at its onset. Chest x-ray does not always detect the development of lung cancer, when it is just in the early stage and forms just a tiny spot in x-ray images. Because tumors must grow quite big for x-ray images to detect the problem, lung-cancer screenings are relatively difficult. Even the World Health Organization (WHO) has said that with current technologies, cancer screenings are efficient only for just a few types of cancer. Among them are cervical cancer, breast cancer, colon cancer, and anal cancer. 

“The government has reined in cancer threats in the country via a healthcare strategy that covers six aspects namely:

1) Health Promotion; 2) Screenings to detect cancer at early stages with all Thais having the right to a free screening; 3) Cancer Anywhere that enables universal-healthcare coverage scheme’s members to seek cancer treatments from any hospital that has registered itself with the National Health Security Office for the goal of ensuring that patients can get treated as soon as possible; 4) Palliative care that has been provided through collaboration with cancer networks to give moral support to patients; 5) Promoting cancer research in both public and private sector so as to bring medicines and technologies to the next level; 6) Gathering Thais’ cancer data in support of efficient policy formulation,” he said. 

“Col. Asst. Proft. Dr Naiyarat Prasongsook”, a medical oncologist at the Phramongkutklao Hospital, said lung cancer mostly happened to people aged between 50 and 80 years old, with smoking habit, the history of being a smoker in the past 15 years, or consuming about a packet of cigarettes in the last two decades. Presently, the average age of lung-cancer patients has been lower. On the overall, the number of cancer patients has now been divided almost equally between males and females because more women have taken up cigarettes.

By occupation, some have had a higher risk of lung cancer or lung inflammation. Jobs that come with exposure to asbestos for about 10 years, for example, are factors that may cause lung cancer. However, some people have developed lung cancer without having any risk other than their own genetic conditions. Genetic problems, which are linked to lung cancer, are often found in Asia. 

“Cancer screenings are rooted in the same old concept that early detection allows early treatments and fast recovery. But on top of that, everyone should avoid cancer risks by not smoking or accepting secondhand smoke. At present, studies also raise concerns about the impacts of e-cigarettes. Also, we should avoid PM2.5. People with cancer risks should undergo screenings. If the disease is detected in Stages 1 to 3, it will still be controllable and even curable. But if cancer has already progressed into an advanced stage, patients can still get palliative care. Such care can help them live longer or return to good quality of life,” he said. 

Raising Awareness among Cancer Patients

Sirintip Kudtiyakarn, chairwoman of the Thai Cancer Society, a survivor of Stage-4 cancer and an asthma patient, revealed that her organization had set up a work panel to gather data on pain points and make recommendations to the government. At the same time, the Thai Cancer Society has educated patients about supportive government policies. Presently, the society has been pushing for similar healthcare benefits of cancer patients across the country’s three major healthcare systems because the push – if successful – will increase cancer patients’ access to treatments. In addition, the Thai Cancer Society is encouraging cancer screenings for all people, not just the risky ones. Early detection will significantly curb the country’s healthcare expenses. 

“I would like to recommend annual health checks for everyone. Such checkups can be life-changing. Cancer patients are mainly divided into two groups. The first group covers patients whose illness is detected at an advanced stage. These patients will develop serious conditions and die soon later. The second group covers patients who happen to detect cancer at an early stage. The life paths of patients in the first and second groups are far different in terms of expenses and symptoms. With screenings, the disease can be fast detected paving the way for early treatments and recovery. If the illness is detected at a later stage, treatments become more complicated. So, it is better to get a regular checkup,” she said. 

Jitnipa Pakdee, founder of Oil’s Cancer Diary and a lung-cancer patient, shared her experience at the seminar. More than three years ago, she discovered at the age of 29 that she had the terminal stage of lung cancer with carcinogenic tumors spreading across both her lungs. She said she had never thought that she would get cancer before the diagnosis because she was neither a drinker nor a smoker. None of her family members had cancer records either. She first went to see a doctor because she had chronic coughing, without any phlegm. In the beginning of the symptom, she just thought she might have just got allergic rhinitis. After listening to her doctors, she found out that getting cancer did not mean dying. During the first three years of treatments, she had taken a tablet of targeted therapy on a daily basis. Following the therapy, Jitinipa can live a normal life. Apart from the fact that her lungs have cancer, she can carry out all daily activities just like others. She can even hike or trek. Living with cancer makes her more aware of time value. She has also learned to take better care of her health. 

“To people who have not had cancer, you too should take good care of your health regarding your food and sleep. If you happen to develop cancer one day, your normal blood cholesterol and blood pressure levels as well as your healthy heart will make treatments more controllable. Your cases won’t be complicated like cancer patients who have struggled with other illnesses too. You will be in a better position than they,” Jitnipa explained.

Upgrading Efforts against Smog – Taking Care of People’s Health 

“Pinsak Suraswadi”, director-general of the Pollution Control Department, said PM2.5 threat grew further in 2023 as economic activities rebounded from Covid-19 crisis. All relevant authorities are now most worried about the health of people and the environment. Driven by concerns, the government has declared PM2.5 threat as a national agenda since 2019. Every year, ad-hoc plans have been drawn up for implementation. Authorities have also raised the standard of air quality. The safe limit of PM2.5 amount has now fallen to 37.5 micrograms per cubic meter of air, down from 50 micrograms last May.

Moreover, authorities seek to introduce the right solutions to cities, forest zones, and agricultural zones as their major PM2.5 sources are different. In cities, solutions focus on road traffic and industrial plants. Euro 5 emission standards will soon apply to petrol cars. Vehicles will also need to have better standards. The government, moreover, has promoted the use of electric cars. In forest zones, the utilization of forest resources must be better managed for proper man-forest coexistence. In agricultural sectors, authorities have striven to reduce the number of hotspots by adding value to agricultural waste that would otherwise be just burnt down. An integrated system has also been developed for efficient monitoring and reporting. 

On transnational smog, Clear Sky strategy is in place to upgrade efforts to fight the problem. A system has been developed to monitor and investigate hotspots in agricultural areas. Good Agricultural Practice (GAP) PM2.5 Free guideline also rolled out. Plans are laid down to manage forests in collaboration with local communities. War rooms are in place to analyze and manage fires. The National Air Quality Information Center will be established too. On top of this, the Clean Air law will be introduced to drive anti-smog efforts. Budgeting will focus on strategic integration to seriously address smog by 2025.

Suksan Kittisupakorn, deputy permanent secretary of the Bangkok Metropolitan Administration (BMA), said his city administration’s policies had extended from upstream to downstream in suppressing smog. For example, its monitoring and alert system for smog threat has now covered 1,000 spots at subdistrict level. The BMA has also communicated with people about PM2.5 forecasts, updates, warnings and preventive tips. New forecast models have demonstrated higher accuracy. In addition, the BMA has been developing BKK Clean Air Areas by planting trees in outdoor zones and installing air purifiers in indoor zones. It has gone all out with the plan to plant one million trees in the capital too. Crackdowns on vehicles and businesses emitting excessive exhaust fumes are also ongoing. The BMA, furthermore, has set up Dust Detective Teams to study dust problems. Campaigns are also conducted to promote electric vehicles over diesel-engine vehicles, seeking cooperation from the public, private as well as all other sectors. 

On the care for people and patients in the capital, the BMA has networked with the Public Health Ministry, medical schools, the military-connected Bhumibol Hospital, and some private hospitals. There are seven Bangkok Health Zones, with allied hospitals assigned to people and patients in their neighborhoods and work with BMA’s health volunteers, ‘Warmth’ clinics, and public healthcare service centers. BMA has delivered seamless services to ensure that patients can fast access treatments. The BMA has also worked closely with the National Health Security Office (NHSO). This year, the Bangkok governor hopes to ensure that one million Bangkokians get lung-cancer screenings as the BMA steps up screening efforts. 

Lung & Respiratory Diseases are No. 1 at OPD

“Dr Winai Boweja”, who specializes in pulmonary and critical care, said most patients had now come to hospitals with chronic cough, phlegm, and squeaky sounds during cough. Common causes are infections by seasonal viruses and bacteria, tuberculosis, and allergies that are in line with season changes and the growing amount of dust. In the past five years, lung and respiratory diseases have ranked No. 1 at most hospitals’ outpatient wards. They have been No. 2 at some other hospitals. 

“Over the next decade, lung illnesses will definitely be spreading far and wide because of changing weather conditions, higher density of population, and more combustion. Moreover, many people have failed to get a checkup and missed out on opportunities to take good care of their health. It may be relatively difficult to detect lung cancer at screenings. Some say they were diagnosed in Stage 4 because they did not have any symptoms. But investigations show they in fact had some symptoms before but just put up with those conditions for long. As for other lung illnesses, it is not difficult to diagnose them. Just the use of investigations, stethoscope, and x-ray that costs just between Bt600 and Bt700 are enough,” this medical specialist said. 

He continued that asthma was now found among the elderly too because of climate change. Some patients started developing asthma at the age of 70 or 80 because their houses are located by main roads, thus breathing in much dust particles. They end up developing windpipe issues and pulmonary diseases. Aside, the elderly is the highest risk group when it comes to choking on food. During aging process, sphincter is no longer firm. Old people also have a big risk of lung inflammation because their immunity drops. Vaccination trend in the country is not yet popular enough. There are also risks from weather conditions and medications that are used regularly by elderly people. Immunosuppressant and medicines used for blood-pressure control may have some adverse side-effects.

The dangerous amount of dust particles in the air in China and India has provided clear findings that PM2.5 can lead to cancer. In line with these findings is the fact that more kids and teenagers in Thailand’s North are diagnosed with cancer. Exposure to smog in the short run causes eye irritation, nasal irrigation, nasal congestion, cough, and phlegm. But people who start developing lung conditions may also notice cough, bronchospasm, and shortness of breath. In the long run, they may develop cancer. More incidences of cancer have been reported. 

“Shortness of breath is different from fatigue. With shortness of breath, people breathe fast or have to stop their activity to rest and take air in by mouth. Their pulse rate will increase and they will sweat. If conditions worsen, they will struggle already. If walking to a toilet becomes difficult, you must notice your symptom. If you get exposed to air conditioning and start coughing, especially during the night, you must listen to what your windpipes want to say. Do not buy drugs to ease symptoms from pharmacies. You should see a doctor to get diagnosed,” Dr Winai emphasized. 

“Nipawan Klakasikij”, speaking as a representative of patients battling pulmonary and respiratory diseases, revealed that she used to have allergies and asthma, get tired easily, and cough and wheeze. She therefore decided to see a doctor and got diagnosed with allergies. After taking medication and using nasal spray in line with the doctor’s advice, her conditions have improved to the point she can use pedestrian bridges without problems. However, she still needs to be careful about PM2.5 and rain because her body is apparently sensitive to such elements. When she goes out, she tries to put on a facemask all the time. She also avoids getting into a crowded place. Her advice to everyone is: “If you have symptoms, see a doctor to get a diagnosis and treatments to avoid falling seriously sick”. For more information, please visit https://www.youtube.com/live/u2Nz1bc71VI?feature=share 
www.thaicancersociety.com 

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