When celebrated actor, Natthawut "Poh" Skidjai, revealed on his YouTube channel @PohSakidAey that his wife Aey Pornthip had been diagnosed with stage one lung cancer after an annual health checkup, the video worried many viewers because Aey does not smoke.
According to the Ministry of Public Health, in 2024, lung cancer was the second most common cancer after liver and bile duct cancer with 17,222 new patients reported that year, and an average of 40 deaths per day.
Smoking is the leading risk factor for lung cancer, but there are other factors that increase the risk as well. Assoc Prof Dr Thanyanan Baisamut, a lung cancer expert and medical oncologist, at Horizon Cancer Center, Bumrungrad International Hospital and the Faculty of Medicine Ramathibodi Hospital, Mahidol University, explained that there are two types of lung cancer: small cell lung cancer and non-small cell lung cancer.
"Smoking is the main cause of small cell lung cancer. Meanwhile, the majority of non-small cell lung cancers are called adenocarcinoma -- the most common type found in non-smokers. Due to effective anti-smoking campaigns run by Dr Prakit Vathesatogkit for decades, the number of smokers in Thailand has decreased from more than 30% in the past 30 years to 17% today. Therefore, the number of small cell lung cancer cases has decreased," explained Assoc Prof Dr Thanyanan.
"Many studies in East Asia and Southeast Asia have found a prevalence of EGFR (epidermal growth factor receptor) gene mutations in adenocarcinoma lung cancer in the Asian population (around 50%) compared to Caucasians (20%). Additionally, in the past two years, initial studies suggest that PM2.5 may be an initiator for the development of adenocarcinoma lung cancer with mutated genes. However, PM2.5 may be only one of the factors that leads to lung cancer. Other factors can be cooking methods and the use of incense in areas without proper ventilation."
When it comes to cancer, many people feel scared because treatment, especially chemotherapy can lead to severe side effects. It is fortunate that Aey discovered cancer at an early stage because stage one and stage two are considered curable. Since Aey discovered her lung cancer during a health checkup, it encouraged many people to get their health checked as well.
"People who do not have symptoms can undergo a screening test with a 2D Xray which costs a few hundred baht. However, they should be aware of the limitations of the 2D Xray because if a lump is hidden behind the bone, heart or liver, it cannot be seen."
Low dosage CT screening is an effective option for checking for lung cancer because it can detect abnormal lumps in the lungs. However, it costs anywhere from 2,500 baht to 6,000 baht and Thailand does not have a reimbursement programme/benefit for this kind of test.
Since low dose CT screening is expensive, Assoc Prof Dr Thanyanan emphasised it as an option. However, she recommended that the two groups of people who should consider low dose CT scans are people with a history of smoking one pack per day for 30 years (or what is called 30 pack years) and people with a family history of lung cancer.
Bangkok's sky heavily blanketed under PM2.5. (Photo: Pattarapong Chatpattarasill)
"A study found that low dose CT screening of heavy smokers reduced the lung mortality rate by 20%. Additionally, people with first degree family members (parents, sibling and children) who had adenocarcinoma lung cancer should consider undergoing the low dose CT screening. These family members live in the same house, so they encounter many of the same environmental factors," explained Assoc Prof Dr Thanyanan.
In order for lung cancer to be cured, patients should be diagnosed at an early stage. Assoc Prof Dr Thanyanan explained that lung cancer is a systemic disease which means it can affect not only the lungs, but also other parts of the body. Therefore, lung cancer symptoms vary depending on where the cancer is located and whether it has spread to other body parts such as the brain, spine, liver, or adrenal glands.
"If it is located in the lung, patients will have a persistent cough, cough up blood and experience chest pain. If it is located in the brain, patients will have blurred vision, feel nauseous and vomit. If it is located in the bones, patients will feel abnormal pain. In some cases, patients may wake up in the middle of the night due to pain. People should notice abnormal symptoms and seek a doctor immediately to detect lung cancer early on," Assoc Prof Dr Thanyanan advised.
Due to PM2.5 air pollution which causes serious health issues and lung cancer cases, Thailand is actively pushing for a Clean Air Act. There have been seven drafts of regulations, but there is now a consolidated version of all the drafts. According to the latest news report, the Clean Air Act is expected to be launched this year. However, it is still in the process of being reviewed by parliament.
Penchom Saetang, an executive director of Ecological Alert and Recovery–Thailand (EARTH), explained that the Clean Air Act guarantees the right of citizens to live in a safe and clean environment, the right to file a lawsuit if their right is violated and the right to get compensation when they get sick from air pollution. In addition, there will be funding to help people file a lawsuit.
Although the Thailand Clean Air Act aims to reduce air pollution and protect public health, Penchom commented that the goal of the law may not be achieved due to its lack of an emission inventory. An emission inventory is a data collection of the amounts and types of pollutants released into the atmosphere from various sources within a specific area and time period.
"I am not on the committee, but I heard members comment that the draft was fine. However, they said that solving the PM2.5 air pollution in many areas will not be possible because there is no emission inventory. Therefore, if Thailand passes the law and regulations, Pollutant Release and Transfer Register (PRTR) will provide information on what, where, how much and whom is causing the emission and then air pollution issues can be addressed at the root cause," said Penchom.
Following the US, the European Union, Australia and Japan, Thailand's EARTH foundation developed the draft of PRTR regulation and the draft bill has been submitted to Parliament for consideration for over one year. However, proposers have not been invited to discuss the regulation yet.
Although Thailand has regulations on industrial emissions which set the standard value of exhaust emission from factory chimneys for various pollutants such as sulfur dioxide, nitrogen oxides, carbon monoxide and volatile organic compounds, the PRTR will create a huge database which will be released publicly.
"After gaining data on pollution sources, there will be a process to evaluate if the data is correct. Then, general people can access this database. For example, people can search to see how many factories are located in the Bangkok Metropolitan Region. If any factory releases severe PM2.5 air pollution, the state agency can order them to install additional technology to filter and/or capture the pollution. The data of PRTR will help the government solve the issues directly and quickly. The longer we delay PRTR, the longer people will have to suffer PM2.5 air pollution," concluded Penchom.
