A major Indian Journal of Medical Research 2025 study reveals rising lung cancer incidence in India, sharp regional and gender disparities, increasing adenocarcinoma dominance, and worrying projections up to 2030.
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Lung cancer continues to pose a growing public health challenge in India, with marked regional, gender-based, and morphological differences in disease burden. A large analytical study published in the Indian Journal of Medical Research in December 2025 reports increasing incidence trends across multiple regions of the country, particularly among women, and projects a further rise in cases by 2030. The study highlights significant geographical heterogeneity, changing histological patterns, and possible gaps in mortality reporting.
Conducted by researchers from the Regional Cancer Centre, Thiruvananthapuram, and the Manipal Academy of Higher Education, this work represents one of the most comprehensive region-wise assessments of lung cancer incidence, mortality, trends, and future projections in India.
The researchers analysed lung cancer data from 57 population-based cancer registry areas across six Indian regions, namely North, South, East, West, Central, and North-East, covering the period from 1978 to 2022. Incidence and mortality data were obtained from Cancer Incidence in Five Continents, CI5plus, peer-reviewed literature, and population-based cancer registry records from Thiruvananthapuram and Kollam.
Age-standardized incidence rates and age-standardized mortality rates were calculated, and mortality-to-incidence ratios were derived to assess fatality patterns. Tobacco and alcohol use prevalence were mapped using data from the National Family Health Survey-5.
Long-term trends were examined using Joinpoint Regression Analysis to calculate average annual percent change by age and gender. Future incidence up to the year 2030 was projected using Auto-Regressive Integrated Moving Average time-series models.
The study revealed substantial regional variation in the lung cancer burden across India. Among men, the highest incidence rates were observed in Srinagar at 39.5 per 100,000 and Aizawl at 35.9 per 100,000. Among women, Aizawl recorded the highest incidence at 33.7 per 100,000. The North-Eastern region consistently showed the highest incidence and mortality for both sexes, closely paralleling the high prevalence of tobacco consumption in this region.
In contrast, several southern regions demonstrated relatively high incidence despite lower reported tobacco and alcohol use, suggesting the influence of non-tobacco risk factors. Mortality rates were highest in Kollam and Aizawl. However, mortality-to-incidence ratios varied widely and remained unexpectedly low in many regions, raising concerns about underreporting of lung cancer deaths and limitations in cause-of-death certification.
Incidence trends showed a steady rise in lung cancer across most populations, with particularly sharp increases among women. The highest annual increase among women was observed in Thiruvananthapuram with an average annual percent change of 6.7 percent, followed by Dindigul and Kollam. Among men, Dindigul recorded the steepest rise with an average annual percent change of 4.3 percent.
Older adults aged sixty years and above continued to show the highest incidence rates. However, increasing trends were also evident in younger age groups, especially among women, indicating a worrying shift in the epidemiology of the disease.
A major and clinically significant finding of the study was the dominance and rapid increase of adenocarcinoma, which has now become the most common lung cancer subtype across most regions of India. The proportion of adenocarcinoma was particularly high among women, exceeding 55 percent in Bengaluru.
Squamous cell carcinoma remained more prevalent in the North-Eastern states, reflecting persistent tobacco exposure patterns. Large-cell carcinoma showed a notable rise in Delhi over the past two decades, suggesting evolving diagnostic and exposure profiles.
Projections indicate that lung cancer incidence will continue to rise across India over the coming years. By 2030, male age-standardized incidence rates are expected to range from 1.8 per 100,000 in Barshi to 33.1 per 100,000 in Kollam. Among women, incidence rates may reach 8.1 per 100,000 in Bengaluru and 7.6 per 100,000 in Thiruvananthapuram and Kollam.
This nationwide analysis highlights the evolving epidemiology of lung cancer in India, marked by widening regional disparities, a rapidly rising incidence among women, and a clear shift toward adenocarcinoma as the predominant histological subtype.
While tobacco use remains the dominant risk factor, particularly in the North-Eastern states, the increasing burden of lung cancer in regions with lower tobacco prevalence strongly suggests the role of additional contributors such as air pollution, occupational exposures, indoor biomass fuel use, and delayed diagnosis.
The relatively low mortality-to-incidence ratios reported in several regions stand in contrast to global estimates and likely reflect incomplete death registration and misclassification of causes of death. The authors stress the urgent need to strengthen cancer mortality surveillance systems and improve the quality of cause-of-death data in India.
With lung cancer incidence projected to rise further over the next decade, the study calls for region-specific prevention strategies, improved early detection systems, expanded research into non-tobacco risk factors, and stronger public health policies addressing environmental and occupational exposures.
George JE, George PS, Nair RA, Jacob JS, Mathew A. Indian Journal of Medical Research, December 2025.
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