Former Vice Superintendent of NTU Hospital
Go Get a Lung Screening Immediately, Even If You Don’t Smoke!
Lung cancer is commonly associated with heavy smoking. However, non-smokers in Taiwan would be ill-advised to think they are not at risk as they are more likely to develop lung cancer than heavy smokers in the West. Air pollution, incense use and unsafe cooking methods are believed to be among the culprits.
Go Get a Lung Screening Immediately, Even If You Don’t Smoke!By Ming-jiuh Wang
Editors' Note: This article is translated from an op-ed from Opinion@CommonWealth
The Health and Welfare Ministry’s Lung Cancer in Non-Smokers research project will soon go into its third phase, screening 3,000 people for lung cancer.
The second-stage study found that Taiwanese non-smokers are twice as likely to develop lung cancer as heavy smokers in Europe and North America. The possible causes are related to family history, smoke from heated oil during cooking as well as second-hand and third-hand smoke [Note: third-hand smoke are the contaminants that remain in a room or on clothes, hair etc. hours after tobacco has been smoked and put out]. However, the previous research did not factor in air pollution as a risk factor.
Why do the Taiwanese develop lung cancer so easily? We still don’t have a clear-cut answer.
But this frightening discovery is sufficient evidence that none of the European and American recommendations for using low-dose computer tomography (CT) scan lung cancer screening are at all suitable for Taiwan.
In the United States, doctors recommend that only people who have smoked a pack of cigarettes a day for 30 consecutive years need to undergo low-dose CT scan screening for lung cancer. So, when I made efforts to promote “10,000 lung cancer screenings” during my stint at the National Taiwan University (NTU) Hospital Chu-Tung Imaging Center three years ago, many experts and senior colleagues showed me these guidelines and recommendations, arguing that conducting low-dose CT scan lung cancer screenings was completely unnecessary.
Let’s look at this problem in light of air pollution. There are more than 10 million motor scooters and motorbikes in Taiwan, and many people ride their scooters for more than an hour per day. For decades, all the motorbikes in the streets were high-polluting, two-stroke motorbikes. Many people in Taiwan burn incense in their homes on a daily basis and frequently visit temples for offerings. A single stick of burning incense can increase [the ambient air pollution with] PM2.5 particulate matter to above 100 [micrograms per cubic meter [(μg/m3)]. On top of that, Taiwan uses techniques that are unique to Chinese cuisine such as shallow frying, stir frying and deep frying. I measured myself that you only need to put a little oil in a wok and fry an egg without using a lid to increase PM2.5 particulate matter to above 300 [μg/m3] in the air near the stove.
Taiwan is a small, densely populated place that underwent rapid economic development. In the past, there was massive development of the petrochemical industry and large thermal power plants. Coal-fired power plants are still being used, with many close to metropolitan areas. Air pollution has already become a nightmare for all people across Taiwan.
The World Health Organization (WHO) has issued the following recommendations for PM2.5 particulate matter: [Exposure should be] less than 15 [μg/m3] for the annual average, whereas the daily average should be less than 25 [μg/m3]. In Taiwan, the annual average has exceeded 30 [μg/m3] for the past 30 years. In recent years, there has been slight improvement but the annual average still remains above 20 [μg/m3].
I have no idea who is at high risk for lung cancer. Experts are making efforts to research this problem, hoping to find an answer sooner rather than later so that all people in high-risk groups will be able to undergo screening as early as possible, because lung cancer mortality can only be truly reduced if the cancer is detected when it is still in an early stage.
However, before experts have found out who belongs into the high-risk group, given Taiwan’s poor air quality, everyone - even if they are non-smokers - is twice as likely to develop lung cancer as a heavy smoker in Europe or North America.
The governmental research plan covers only 3,000 people due to budgetary constraints. For the sake of your own health, anyone who has never done a low-dose CT scan, particularly women, please go for a scan. We don’t want to see more tragedies happen such as the star performer or the early democracy activist who passed away after suddenly discovering they had lung cancer in the terminal stage.
At the same time, I would like to appeal to all hospitals in Taiwan, please lower your prices for low-dose CT scan lung cancer screening. You certainly can do that so that more people can afford to pay for a checkup out of their own pockets. Using our own efforts, we can see to it that lung cancer will no longer have the highest mortality rate among cancers in Taiwan. Only if we do this will it be possible to create a healthier Taiwan.
Translated from the Chinese article by Susanne Ganz
About the author
• Attendant physician, Dept. of Anesthesiology, National Taiwan University (NTU) Hospital
• Professor, Department of Anesthesiology and the Department of Forensic Medicine, School of Medicine, NTU
• Former Vice Superintendent of NTU Hospital, superintendent of NTU Hospital Chu-tung Branch
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