Revolutionizing lung cancer care and early screening in LMICs

Globally, lung cancer is the leading cause of cancer death, responsible for killing an estimated 1.8 million people in 2022 alone.

While smoking remains the main cause of lung cancer, some reports indicate that the proportion of lung cancers occurring in individuals who have never smoked has increased.

Yet the disease has been largely overlooked on the global health agenda.

Despite lung cancer being “responsible for more deaths than breast, prostate, and colorectal [cancer] combined, it receives disproportionately low funding for research, awareness, and health system strengthening,” said Catharine Grimes, president of the Bristol Myers Squibb Foundation, or BMS Foundation, an independent charitable organization. The BMS Foundation is working to address the growing burden of lung cancer through its Multinational Lung Cancer Control Program, or MLCCP — a globally aligned framework guiding the foundation’s grantmaking across multiple countries.

At the 2025 World Conference on Lung Cancer in Barcelona, Spain, this September, medical experts, advocates, and survivors highlighted that many countries still lack national screening programs — contributing to limited public awareness, insufficient data collection, and delayed diagnoses that drive the disease’s high mortality rate.

But the adoption in May this year of the World Health Organization’s signature resolution on lung health reflects a growing global consensus to prioritize lung cancer, including integrating risk-based screenings into national cancer control plans and improving diagnostics access.

Early detection can increase a patient's chance of surviving for five years from 4% to 55% — a figure that underpins the BMS Foundation approach to empowering innovative screening initiatives that expand access to early detection and can therefore dramatically increase survival rates. Through the MLCCP, the BMS Foundation is supporting grantees in Brazil, India, seven countries in sub-Saharan Africa, and the United States who are working to improve and scale access to these lifesaving services. Devex spoke to some of those grantees to find out how they are working to address barriers to care, from lack of screening infrastructure to limited awareness of nonsmoking risk factors.

Collaboration to raise awareness of lung cancer risk

While tobacco smoking remains responsible for approximately 85% of lung cancer cases, other common causes include exposure to second-hand smoke, outdoor and indoor air pollution, and asbestos. For many of the BMS Foundation’s MLCCP grantees, work starts with raising awareness of the disease and such risk factors.

In Zambia, Batuke Walusiku-Mwewa, country director of Access to Health Zambia has been leading efforts to improve early diagnosis through engagement with communities and local and national health authorities. In a handful of districts, Walusiku-Mwewa’s team has worked to train health professionals in identifying lung cancer and understanding related issues such as stigma, the importance of early detection, and the need for timely follow-up care.

“Bringing community members, nurses, radiologists, oncologists, [and] pulmonologists into the same space with a multidisciplinary team [to discuss the] importance of issues around lung cancer … it has broken barriers,” she told Devex.

Walusiku-Mwewa’s team is also collaborating with the Zambian Ministry of Health and the National Cancer Diseases Hospital to develop national guidelines for lung cancer management — placing emphasis on community engagement to ensure health professionals “speak the same language” as community members and can work with them to identify cases early, she explained.

Integrating lung cancer care initiatives with national screening programs

Across Africa, the high prevalence of tuberculosis, or TB — an airborne bacterial infection — often leads to lung cancer being misdiagnosed. The two illnesses share similar symptoms, including a persistent cough, chest pain, and fatigue.

In Tanzania, misdiagnosis of lung cancer posed a significant barrier when Dr. Nestory Masalu, medical oncology head at Bugando Medical Centre, set out to improve diagnosis and treatment nationwide. Data showed that only five lung cancer cases had been reported over 10 years, Masalu said.

According to Masalu, when he and his team partnered with the country’s TB unit to improve diagnosis, they discovered in the first year that 30% of those treated for TB actually had lung cancer. In response, they worked with health institutions to strengthen capacity, tackle the scale of misdiagnosis, and introduce advanced tests, such as biomolecular analysis.

Similarly, in Zambia, Walusiku-Mwewa’s team suspects that many treatment-resistant TB cases may have been undiagnosed lung cancer and are now conducting a retrospective study to uncover missed diagnoses. Walusiku-Mwewa believes lung cancer screening could be effectively integrated into TB programs and broader health initiatives.

Her team has already partnered with community health workers delivering HIV and AIDS services to build trust at the grassroots level, generate demand for lung cancer care, and lay the groundwork for community-led collaboration to address lung cancer.

Bringing screening services to medically underserved populations 

In the U.S., where significant disparities in lung cancer care persist, Derek Raghavan, attending medical oncologist at the Veterans Administration Health Care Center in North Carolina, set out to increase access to screening for uninsured and medically underserved populations. By establishing the country’s first mobile low-dose computed tomography, or CT, scanning unit, his team was able to reach populations who generally aren’t able to access hospital-based screening. Raghavan expects the program to expand throughout the U.S. in coordination with other cancer screening programs, and believes it could be replicated in other countries.

A similar innovation is already bringing screening services to remote populations in Brazil, spearheaded by Dr. Ricardo Sales do Santos, a thoracic surgeon at Hospital Israelita Albert Einstein in São Paulo. Lung cancer is responsible for approximately 30,000 deaths per year in Brazil, but it’s “an invisible disease” that lacks the attention or funding needed, said Santos.

Brazil’s vast size means many high-risk communities are located hundreds of miles from urban health centers. Using a mobile unit, Santos rolled out low-dose CT screening to populations in the northeast, where lower education levels also limit disease awareness. Meanwhile, in collaboration with local municipalities, Santos and his team trained 400 community health agents — trusted locals who play a crucial role in raising awareness and encouraging screening among high-risk individuals, Santos explained.

Since its 2013 launch, the program has reached 4,000 people, leading to increased diagnoses. “The experience that we have in Brazil in these small villages in the northeast can be [replicated],” said Santos. “If we’re doing it there, it's possible to do [it] anywhere.”

Santos is now focused on improving the whole line of care for lung cancer patients in Brazil to ensure high-quality treatment after diagnosis, regardless of a patient’s income. Through the Propulmão project, he is designing an integrated lung cancer prevention, early detection, and care program that will bring together several ongoing regional screening programs and ultimately act as a blueprint for the country.

Strengthening health systems

Getting cancer screening and implementation pilots off the ground in LMICs requires a comprehensive, multipronged approach, said the BMS Foundation’s Grimes.

Recognizing that one size does not fit all, the MLCCP supports grantees in implementing projects that are responsive to local needs and realities. What all projects share is alignment with the BMS Foundation’s approach to building health systems that are not only stronger but also sustainable — with local capacity building at the heart of this strategy. It’s an approach that has shown results in places such as Tanzania, where Masalu credits the country’s progress in empowering policymakers and mobilizing key specialists to establish a comprehensive national lung cancer control team.

Grimes emphasized that “health system strengthening [and] investing in individuals and infrastructure” will be key to turning global commitments — such as WHO’s lung cancer resolution — into meaningful action on lung cancer care.