Opinion: Supporting early detection of lung cancer to address NCD burden

Noncommunicable diseases, including lung diseases, are a major health burden across the globe and the World Health Organization estimates that 17 million people under the age of 70 die from an NCD each year. Yet, the challenges are not felt equally across the globe, and 77% of all NCD deaths occur in low- and middle-income countries.

Lung cancer remains one of the most lethal NCDs and types of cancer globally, responsible for 1.8 million deaths per year. LMICs struggle with the highest mortality due to lack of resources and infrastructure to detect and manage the disease early. At the World Cancer Congress held in Geneva in September, the Malaysia Ministry of Health, global leaders, and the private sector came together to champion improved lung cancer care through increased early detection, reduced mortality and, ultimately, better patient outcomes.

Disproportionate burden in LMICs

Lung cancer is a significant public health challenge in LMICs, and 63% of global lung cancer deaths occur in Asia where approximately 70% of patients are diagnosed with advanced stages of nonsmall cell lung cancer. This means that the cancer has spread to other lung tissue, or even other parts of the body, greatly reducing the patient’s chance of survival and successful treatment. In Malaysia, where lung cancer is one of the most common cancers, nearly 90% of all patients are diagnosed with Stage 3 or Stage 4 cancer and the average five-year survival rate is only 9%.

The barriers to early detection in LMICs are manyfold, including health care infrastructure needed for comprehensive screening. In the few places where they are available, screening focuses on heavy smokers despite growing evidence of lung cancer also affecting nonsmokers due to factors such as family history or air pollution.

In addition, lung cancer in its early stages often presents itself with little to no symptoms, making it less likely for the patient to seek out treatment until the disease has progressed to a more advanced stage. Poor socioeconomic status and potential financial burdens for the patient add to the problem: While low-dose computed tomography, or LDCT, has proven effective in diagnosing lung cancer in smokers, few countries implement nationwide screening programs due to their high cost and lack of patient reimbursement.

Improving early detection and screening

Yet, there are many opportunities for improving early screening and detection of lung cancer in LMICs. First, the global health community needs to consider the combination of risk factors — such as family history of lung cancer and smoking — that contribute to the development of lung cancer through the use of digital risk prediction models. These tools combine different risk factors to estimate a person’s probability of developing lung cancer over a set period of time and can then determine whether an individual should be screened for lung cancer.

In Asia, a high proportion of lung cancer cases can be found in nonsmoking women — figures range from 40% to 50% in studies from India — due to air pollution in urban areas, exposure to pollutants from construction or mining, and secondhand smoke from the indoor use of coal or other biomasses.

Under-resourced health systems need more support to utilize technologies that can be integrated into screening programs and help improve the efficiency of screening, reach more patients, and ensure an integrated approach to care. This can include, for example, incidental detection of lung cancer in routine care through artificial intelligence-assisted chest X-rays — which use AI algorithms to interpret radiology images — to identify patients with suspicious radiographic lung markers and support their referral to more advanced screening and a firm diagnosis.

Since 2021, the Malaysian Ministry of Health has actively supported initiatives to enhance early lung cancer screening, with an initial focus on private health care settings and later the incorporation of public hospitals in 2023. The partnership includes integrating AI into private clinics and hospitals for early lung cancer screening to improve the efficiency and accuracy of lung cancer diagnoses, while reducing the financial burden on the healthcare system.

Additionally, a community outreach program, including a recent partnership with AstraZeneca, has helped 40,000 individuals get scanned, with over 900 high-risk patients referred to hospitals for further testing. Later this year, the project will be introduced in selected government hospitals and will also expand to include the mapping of the country’s lung cancer screening capabilities and disease diagnosis.

Global collaboration to drive action

To effectively address lung cancer across LMICs, global collaborations to drive the prioritization of early diagnosis is key. Governments should look at closely collaborating with global health organizations as well as the private sector to prioritize lung cancer screening among high-risk populations and implement resource-stratified approaches. The focus should be on creating integrated lung health initiatives on screening, diagnosis, and treatment of lung diseases — including lung cancer.

The Malaysian Ministry of Health has been leading a global effort to tackle lung-related disease by spearheading the submission of a landmark WHA Lung Health Resolution at the World Cancer Congress 2024. The resolution aims to be adopted as a global health priority at next year’s World Health Assembly and will target both communicable and noncommunicable lung diseases.

“We hope that the passing of the WHA Lung Health resolution will accelerate a policy change across all member states to reduce the overall lung disease burden, including lung cancer, worldwide,” I said in my address at the World Cancer Congress 2024.

The resolution also looks to support cost-effective approaches to cancer care in LMICs in order to ensure a broader and more equitable access to screening, diagnosis, and care. “Securing global recommendations will ensure the commitment of member states and encourage the adoption of a global strategy to promote lung health and address the burden of lung diseases, including lung cancer. We commend the Malaysian government in leading the development of a global lung health resolution”, said Ti Hwei How, vice president of international oncology and market access at AstraZeneca, at the World Cancer Congress 2024.