Surgeon's Poem Dares to Link Smog, Lung Cancer in China

Nick Mulcahy

January 12, 2017

A poem by a thoracic surgeon that acknowledges the link between lung cancer and smog has hit a nerve with Chinese people and gone viral as thousands of readers view and share it online in China, where air pollution is rampant, according to multiple news sources, including the New York Times.

The poem, by Zhao Xiaogang, MD, PhD, deputy chief of thoracic surgery at the Shanghai Pulmonary Hospital of Tongji University, is entitled, "I Long to Be King." (The title has also been translated as "I Want to Be the Boss.")

The poem was first published in English in the October 2016 issue of Chest.

In writing the poem, Dr Zhao did not shy away from using medical terminology. The first line is "I am ground glass opacity (GGO) in the lung".

In an author's note published in the journal, Dr Zhao explained the context and the term. "Although pulmonary ground-glass opacity (GGO) could be benign or malignant, it most likely represents neoplastic lesion. Currently, the detection rate of GGO has increased remarkably in China. As a thoracic surgeon...I have diagnosed a large number of patients with GGO adenocarcinoma in daily clinical practice. I hope more people could understand it and take it seriously."

The poem goes on to describe how the lesion grows into lung cancer. Dr Zhao explained that the voice is that of the cancer itself, because he believes "everything in this world has consciousness and determination."

I am ground glass opacity (GGO) in the lung,
A vague figure shrouded in mystery and strangeness,
Like looking at the moon through clouds,
Like seeing beautiful flowers in the fog.

I long to be king,
With my fellows swimming in every vessel.
My people crawl in your organs and body,
Holding the rights for life or death, I tremble with excitement.

When young you called me "atypical adenomatous hyperplasia",
Then when I had matured, you declared me "adenocarcinoma in situ",
When fully developed, your fearful denomination: "invasive adenocarcinoma".
You forgot my strenuous journey to become the king.

From tiny to strong,
From humble to arrogant.
None cared when I was young,
But all fear me we when full grown.

In the following lines, the voice of the villainous lung cancer links itself to both smog ("delicious mist and haze") and smoking.

"I've been nourished on the delicious mist and haze,
That sweetly warmed my heart,
Always loving when you were heavy drunk and smoking,
Creating me a cozy home."

Last week, months after appearing in Chest, the poem was finally published in Chinese in the Paper, a state news website. It was also reported in many other Chinese media, a number of which highlighted the association between lung cancer and smog.

Public discussion of the causes and health hazards of smog has been controversial in China. The air pollution documentary "Under the Dome" was censored by the Chinese government soon after it aired in 2015 but was nevertheless seen by 150 million viewers in the limited days that it was available online.

Dr Zhao's poem is less pointed but still addresses the negative health consequences of smog.

"The intense rise in lung cancer [in China] intimately related to smog," said Dr Zhao on one website.

Air pollution is a huge problem in China and has been dubbed the airpocalypse. It kills an estimated 1.6 million people in China annually, which is about 17% of all deaths in the country, according to a 2015 study from US researchers published in the open source journal PLOS One.

"Air pollution is a problem for much of the developing world and is believed to kill more people worldwide than AIDS, malaria, breast cancer or tuberculosis," wrote the authors of that study, Robert A. Rohde, PhD, and Richard A. Muller, PhD, of the University of California, Berkeley.

The arrival of the poem online in Chinese is especially timely. In the past 2 weeks, parts of China, including areas around Beijing, have been in a thick smog and have been placed under a "red alert" – the highest of four smog alert levels, according to news reports.

In the recent New York Times article, Dr Zhao said he has seen increasing numbers of nonsmokers with lung cancer and that the cases are likely smog related.

"Most of the female lung cancer patients are nonsmokers," he said. "Some are little girls. I even had a 9-year-old patient, a little girl, and we had to cut out part of her lung. I'll never forget her."

The full poem can be read online in Chest.

Chest. 2016;150:974-975.

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