For the latest episode in DynaSpan Global’s series on the myths of dynamic aging, host Adam Satir sat down with Dr. Mukul Roy, a radiation oncologist at Jaslok Hospital in Mumbai with a special interest in cancer care for older adults. The conversation tackled one of the most persistent assumptions in oncology: that age itself determines whether someone gets lung cancer, whether it’s worth screening for, and whether it’s worth treating. Dr. Roy’s answer, again and again, was the same — it’s not the number of candles on the cake that matters. It’s fitness.
Aging Increases Risk — But It’s Not a Life Sentence
Dr. Roy opened by separating two things people often conflate: aging and inevitability. Cancer, he explained, is fundamentally a disease of “wear and tear,” so the odds of a diagnosis do climb as we get older. But that’s a statistical tendency, not a guarantee — plenty of people age without ever developing lung cancer, and getting older doesn’t mean it’s coming for you.
Smoking remains the dominant risk factor, present in an estimated 85% of cases, whether through active or passive exposure. But Dr. Roy was careful to note that a meaningful minority of patients who have never smoked still develop lung cancer — and that environmental factors like air pollution and radon exposure play a smaller, but real, contributing role. He even confirmed an old rumor: air pollution in large cities can, at its worst, carry a health impact roughly comparable to smoking a few cigarettes a day.
Screening: Skip the X-Ray, Ask About Low-Dose CT
One of the more actionable parts of the conversation centered on screening. A standard chest X-ray, Dr. Roy explained, simply isn’t sensitive enough to catch lung cancer early — overlapping structures in the image reduce both sensitivity and specificity, so tumors often aren’t visible until they’ve grown significantly. The better tool is a low-dose CT scan, which can pick up lesions as small as 3-4mm while keeping radiation exposure minimal. AI is increasingly part of this process too, helping radiologists screen large volumes of scans faster and more accurately.
Who should be asking for one? Dr. Roy’s guidance follows major guidelines (NCCN, UK NICE): adults over 50 with a significant smoking history — roughly 20 pack-years or more — are the primary target population, with screening repeated around every three years. Importantly, he emphasized that eligibility isn’t really an age cutoff — it’s about risk profile and overall health. An 85-year-old former smoker in good health, he noted, will still benefit meaningfully from screening.
Diagnosis and Treatment: Performance Status Over Birth Certificate
The heart of the episode was a direct challenge to a common — and harmful — assumption: that patients in their 70s, 80s, or even 90s are automatically too frail for effective treatment. Dr. Roy was unambiguous: that’s not true. What matters clinically is “performance status” — a person’s functional ability to independently manage daily life, not their chronological age. He described patients in their 90s who are excellent candidates for curative treatment, and pointed to tools like geriatric screening questionnaires and clinical frailty scores that let oncologists personalize care based on how a patient is actually doing, not how old they are.
He also pointed to a structural problem behind the myth: older patients have historically been underrepresented in clinical trials, which has left a genuine gap in data — and led some patients to be told, incorrectly, that their age alone disqualifies them from a given treatment. Dr. Roy called this out plainly, citing more recent reviews of immunotherapy outcomes in patients over 75, 80, and 85 that show promising tolerance and results when functional fitness is accounted for.
What Patients Should Know
Dr. Roy’s advice for anyone facing a diagnosis was practical: know that treatment today is rarely a single path. Between surgery, SBRT (a non-invasive, targeted radiotherapy), immunotherapy, targeted therapy, and emerging options like antibody-drug conjugates, most patients have real choices — and a right to a second opinion if something about their care plan doesn’t sit right. He encouraged patients and caregivers to lean on resources like the NCCN and Cancer Research UK for accessible, jargon-free information, and to treat shared decision-making with their care team as the standard, not the exception.
The Takeaway
The episode’s throughline echoes a theme DynaSpan keeps coming back to: chronological age is a poor proxy for what actually matters in health decisions. Whether it’s screening eligibility or treatment intensity, Dr. Roy’s message was consistent — assess the person, not the birth year. As he put it, there’s no fixed age limit for deserving good care; as long as the body is fit for it, the treatment options are there.
As Adam closed the episode: you’re not getting older — you’re just growing up.