Risk Factors Associated with Lung Cancer: Smoking and Environmental Influences in the Philippines

Introduction

February is National Cancer Awareness Month in the Philippines, a time to reflect on the impact of this disease and advocate for prevention and treatment. Cancer is the second leading cause of mortality in the Philippines ¹, and lung cancer, in particular, presents a significant health challenge. This article examines the risk factors associated with lung cancer, specifically focusing on the roles of smoking and environmental influences within the Philippine context.

Lung cancer is the leading cause of cancer-related deaths worldwide, with smoking being the primary risk factor ². While this holds true in the Philippines, unique environmental factors and occupational hazards also contribute to the burden of lung cancer in the country ¹. This article aims to provide a comprehensive overview of these factors, drawing upon the latest research and statistics.

Prevalence of Lung Cancer in the Philippines

Lung cancer poses a significant health burden in the Philippines. In 2020, there were 19,180 new cases of lung cancer in the Philippines, accounting for 12.5% of all new cancer cases ³. It is the leading type of cancer among Filipino men, with 13,406 new cases reported in that year ³. Lung cancer is also the most common cause of cancer-related mortality among men in the Philippines ⁵. Furthermore, it claims the highest mortality rate among all cancers in the Philippines, accounting for 18.4% of cancer-related deaths in 2022 ³.

Data from 1998 showed an estimated 11,123 new cases of lung cancer, with 8,474 in males and 2,649 in females ⁶. The age-standardized incidence rate for lung cancer in males was highest in Manila (58.7/100,000), followed by Rizal (48.3/100,000) and Cebu ⁶. In females, lung cancer ranked third in both Manila and Rizal, with age-standardized incidence rates of 16.8/100,000 and 12.9/100,000, respectively ⁶.

While lung cancer contributes significantly to cancer deaths, cancer overall is the third leading cause of death in the Philippines ⁷.

Smoking as a Risk Factor

Smoking is undeniably the most significant risk factor for lung cancer. Tobacco smoke contains numerous carcinogenic compounds that damage DNA and lead to mutations that can initiate and promote cancer development ⁸. Studies have consistently shown a strong correlation between smoking and lung cancer incidence, with smokers having a significantly higher risk of developing the disease compared to non-smokers ¹. Annually, about 110,000 Filipinos die due to tobacco-attributable diseases ⁹.

In the Philippines, the prevalence of smoking among adults was 19.5% in 2021, with a much higher prevalence among males (nearly 35%) compared to females (just over 4%) ¹⁰. This disparity in smoking rates is reflected in the higher incidence of lung cancer among men ³.

The risk of lung cancer increases with the number of cigarettes smoked and the duration of smoking ¹. There is also an approximate three-decade lag time between smoking prevalence and lung cancer rates, meaning that the effects of smoking can manifest years later ¹¹. Even former smokers remain at an elevated risk compared to those who have never smoked, although their risk decreases over time ¹. In 2012, the economic burden of tobacco use in the Philippines was just under PHP₱270 billion, highlighting the significant economic impact of smoking in addition to the health consequences ¹².

Environmental Influences

Beyond smoking, various environmental factors contribute to lung cancer risk in the Philippines. These include:

Air Pollution

The Philippines faces significant challenges with air quality, particularly in urban areas. High levels of particulate matter (PM2.5) and other pollutants in the air are linked to an increased risk of lung cancer ¹. In 2019, air pollution was responsible for an estimated 66,230 deaths in the Philippines ¹⁴. The World Health Organization (WHO) has officially classified outdoor air pollution as a leading human carcinogen, similar to tobacco smoke ¹⁵. Air pollution disproportionately affects marginalized communities in the Philippines, highlighting the social justice aspect of environmental health risks ¹⁶.

Occupational Hazards

Certain occupations expose workers to carcinogens that increase their risk of lung cancer. These include exposure to asbestos, silica, metals, and diesel exhaust ¹. In the Philippines, a study of former workers from the Subic Naval Base revealed that 58.75% had asbestos-related interstitial lung or pleural disease ¹⁹. Construction workers, in particular, face a high risk of developing occupational lung diseases, including restrictive spirometry pattern (RSP), due to exposure to hazardous materials ²⁰. Asbestos workers have the highest prevalence of RSP (35.3%), followed by teamsters (truck drivers) at 32.9% and boilermakers at 31.2% ²⁰.

Indoor Air Pollution

In many parts of the Philippines, the use of solid fuels for cooking and heating in poorly ventilated spaces contributes to indoor air pollution. These emissions contain harmful substances, including carcinogens such as benzopyrene and formaldehyde ²¹.

Secondhand Smoke

Exposure to secondhand smoke, even without actively smoking, increases the risk of lung cancer ²². Studies have shown that children exposed to secondhand smoke early in life may have a higher risk of developing lung cancer later on ¹⁸. Research also indicates that risk factors for oral cavity cancer, such as passive smoking, chewing tobacco, and inverted cigarette smoking, can contribute to lung cancer risk ²³.

Emerging Concerns: Vaping and Cannabis Use

While tobacco smoking remains a primary concern, the increasing use of vaping and cannabis raises new challenges in lung cancer prevention. Although research on the long-term effects of vaping and cannabis smoking is limited, studies suggest potential cardiovascular and cancer risks associated with burning and inhaling any plant product ²⁴.

Other Risk Factors

While smoking and environmental factors play major roles, other factors can also influence lung cancer risk:

Family History: Individuals with a family history of lung cancer have an increased risk of developing the disease ²⁵. Notably, lung cancer is a leading cause of cancer mortality for Asian American women who have never smoked, emphasizing the significance of environmental factors and genetic predisposition in lung cancer development ²⁵.
Chronic Lung Diseases: Certain lung diseases, such as tuberculosis and chronic obstructive pulmonary disease (COPD), can increase the risk of lung cancer ²⁵.
Genetic Predisposition: Emerging evidence suggests that genetic factors may contribute to lung cancer risk, particularly among Asian women who are non-smokers ¹.

National Cancer Awareness Month and Life+Saver Events Management Services

National Cancer Awareness Month in the Philippines serves as a crucial platform to raise awareness about cancer prevention, early detection, and treatment. It is a time to mobilize communities, healthcare providers, and policymakers to work together in the fight against cancer. Various organizations and initiatives contribute to this effort, including Life-Saver Events Management Services (Life+Saver).

Life+Saver is committed to supporting cancer patients and their families through its program “Bonnet The Cause.” This program aims to raise awareness and funds for cancer care facilities by selling specially designed bonnets, each featuring a different cancer ribbon ²⁶. This initiative not only promotes awareness but also provides tangible support to those battling cancer.

Life+Saver’s mission and vision align with the spirit of National Cancer Awareness Month by emphasizing the importance of community involvement and support in the fight against cancer. “Bonnet The Cause” exemplifies this commitment by providing a means for individuals to contribute to this important cause.

Conclusion

Lung cancer remains a significant public health concern in the Philippines. While smoking is the primary risk factor, various environmental influences and occupational hazards contribute to the burden of this disease. The majority of lung cancer incidence, mortality, and disease burden occurs among men, but women also have a significant risk ²⁷. This highlights the need for targeted prevention and awareness campaigns for both genders.

National Cancer Awareness Month provides an opportunity to highlight these risk factors and advocate for comprehensive strategies to prevent lung cancer and support those affected by it. The interplay between smoking, environmental factors, and genetic predisposition underscores the need for integrated public health approaches that address both individual and environmental risk factors.

Initiatives like Life+Saver’s “Bonnet The Cause” demonstrate the power of community engagement in raising awareness and providing support to cancer patients and their families. By working together, healthcare professionals, policymakers, and the public can take concrete steps to reduce lung cancer risk in the Philippines. This includes promoting smoking cessation programs, advocating for stricter air quality regulations, raising awareness about occupational hazards, and supporting initiatives that provide care and support to those affected by lung cancer.

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