Lung cancer, often described as a silent killer, is rapidly emerging as a hidden epidemic in parts of the world where traditional tobacco use and systemic underdiagnosis collide. While the global health community has been preoccupied with infectious diseases and the rise of vaping, a much older and deadlier threat has quietly tightened its grip—especially among the youth in India and the underserved populations of sub-Saharan Africa. Recent warnings from health experts and a revealing report by NPR have thrown this crisis into sharp relief, demanding urgent attention and coordinated action.
In India, traditional tobacco products such as cigarettes, bidis, and chewable forms like gutkha and khaini are fueling a crisis that disproportionately affects young people. According to the 2019 Global Youth Tobacco Survey, a staggering 8.5% of students aged 13 to 15 use tobacco, contributing to 1.3 million deaths annually. As Dr. Narender Saini, Chairman of the Antimicrobial Resistance Standing Committee at the Indian Medical Association, told IANS, "Over 90 per cent of lung cancer cases in India are linked to combustible tobacco. In my clinical experience, I regularly treat patients as young as 17 for tobacco-induced complications. What we need is a calibrated approach that combines prevention, regulation, and public awareness—not selective panic."
This crisis isn't confined to India. Globally, lung cancer claims 1.8 million lives each year, making it the deadliest cancer worldwide, as NPR recently highlighted. Yet, in many regions—especially sub-Saharan Africa—the true scale of the problem is obscured by underreporting and misdiagnosis. The story of Eleanor Ceres from Cape Town, South Africa, brings this reality into painful focus. After more than three decades of smoking, Ceres was diagnosed with terminal Stage 4 lung cancer in April 2024. Her only initial symptom had been a sore arm, which doctors mistakenly attributed to arthritis. By the time the real cause was discovered, it was too late for curative treatment. "I've got a child around 12 years old. I want to see her grow up and get married and have her own children," she told NPR. "I cry a lot because I'm gonna die and everybody's gonna stay alive."
The situation in sub-Saharan Africa is particularly dire due to a combination of rising smoking rates, inadequate health infrastructure, and the misattribution of symptoms. As Dr. Coenie Koegelenberg, a pulmonologist at Tygerberg Hospital in Cape Town, explained to NPR, "We have the most accurate stats because we actually diagnose lung cancer." In much of the continent, however, lung cancer often goes undiagnosed or is mistaken for tuberculosis—a disease with similar symptoms but a very different prognosis. Lorraine Govender, national manager of health promotion at The Cancer Association of South Africa, noted, "Patients would go through the whole treatment regimen for tuberculosis and not really be investigated for lung cancer." This delay, often lasting six to nine months, can be fatal, as 55% of people with lung cancer die within a year of diagnosis, according to Cancer Research UK.
Complicating matters further, tuberculosis itself doubles the risk of developing lung cancer, likely due to chronic lung inflammation and DNA damage. HIV infection, which weakens the immune system, also increases both the risk and severity of lung cancer, Dr. Koegelenberg's research shows. In fact, among lung cancer patients, those with HIV tend to be younger and present with more advanced disease.
In India, the silent epidemic of oral and throat cancers among people under 25, linked to smokeless tobacco products, is a growing concern. Dr. Chandrakant S Pandav, Padma Shri Awardee and former Professor at AIIMS New Delhi, emphasized to IANS, "The data points to a stark reality—traditional tobacco’s grip on our youth far outweighs other concerns, urging us to rethink our priorities. Our focus must expand from trendy alternatives to the proven killers: cigarettes, bidis, and chewable tobacco." Despite growing alarm over vaping, traditional tobacco products remain deeply entrenched in schools and villages, buoyed by cultural acceptance and lax enforcement of regulations.
Experts in both India and Africa agree that the fight against lung cancer requires more than just medical intervention. Dr. Pawan Gupta, Senior Consultant in Pulmonary Medicine, told IANS, "The damage inflicted by traditional tobacco begins early and lasts a lifetime. We witness its devastating consequences daily—oral cancers, lung diseases, and heart conditions—often in individuals who started using these products in their teenage years. With 1.35 million deaths annually, the science is clear: traditional tobacco is a proven killer, and our youth are its most vulnerable targets."
In South Africa, the challenge is compounded by socioeconomic factors and aggressive marketing by tobacco companies. In Khayelitsha, a densely populated township near Cape Town, cigarettes are sold for as little as 10 rand (about 50 cents), and local shop owners rarely enforce age restrictions. As NPR reported, these low prices and easy access are driving up smoking rates, particularly in poor communities. Dr. Ayanda Trevor Mnguni, head of internal medicine at Khayelitsha District Hospital, told NPR, "We obviously diagnose lung cancer a lot better compared to the rest of the country and the rest of the continent. But that doesn't mean much if smoking rates continue to rise, and the disease is almost always so advanced that the only option is palliative care."
Screening for lung cancer, while effective in high-resource settings, remains out of reach for most people in sub-Saharan Africa. Private insurance in South Africa has begun to cover screening for a small, wealthier minority, but public health systems lack the capacity to implement widespread programs. Dr. Keertan Dheda, a pulmonologist at Groote Schuur Hospital, acknowledged, "Lung cancer screening isn't practical for the 84% of South Africans in the public system, or even most other countries in sub-Saharan Africa, although we should be screening and we know we should be screening." Even if CT scanners were available, there would not be enough resources to biopsy and treat all detected cases.
Given these constraints, experts argue that the most viable prevention strategy is comprehensive anti-smoking campaigns, stricter regulations, and better public awareness. South African lawmakers are considering new legislation that would ban all tobacco and e-cigarette advertising and impose harsh penalties—up to 15 years in jail—for selling tobacco to children or at cut-rate prices. Dr. Mnguni stressed, "For most limited resource countries, the best bet is to prevent people from getting the disease."
Meanwhile, innovations from other countries offer hope. Research from Vietnam suggests that lung cancer screening using chest x-rays combined with artificial intelligence could be a scalable solution for resource-limited settings, Dr. Koegelenberg told NPR. However, the foundation of any effective response must be better data collection. As Dr. Kelechi Okonta, a cardiothoracic surgeon in Nigeria, put it, "With adequate record keeping and follow-up of patients, we can solve this. Maybe the government will start paying attention to lung cancer."
Ultimately, the fight against lung cancer—whether in India, South Africa, or beyond—demands a coordinated approach that bridges the gap between data and policy, prevention and treatment, and awareness and action. As Salomé Meyer of South Africa's Cancer Alliance aptly put it, "We must stop hiding behind, 'Oh, it's not going to be affordable.' We must just do it."
The cost of inaction, experts warn, is measured not just in statistics but in the lives of young people and families shattered by a disease that is, in many cases, entirely preventable.
