How to transform lung cancer outcomes in low- and middle-income countries

Lung cancer, a non-communicable disease (NCD) and one of the major contributors to the NCD mortality burden, claims over 1.8 million lives annually. While advancements in treatment and early detection have improved, outcomes in many regions and low- and middle-income countries (LMICs) remain particularly burdened as they often lack adequate healthcare infrastructure, including access to early lung cancer screening, diagnosis and treatment.

This leads to diagnoses at advanced stages where treatment options are limited, and survival rates are lower. Addressing lung cancer as a global health crisis is vital in changing the course of the significant NCD burden in LMICs. It demands a concerted, international effort that allows for a resource-stratified approach where early diagnosis and care are accessible across high-risk populations.

Of the newly diagnosed lung cancer cases across the globe, LMICs in Asia bear a disproportionately high burden, with 63.1% of new lung cancers occurring in the region – across Southeast Asia, lung cancer has now surpassed other cancers as the most common cause of mortality. In Malaysia, 90-95% of lung cancer cases are diagnosed at stages three and four, where the five-year survival rate is low at 7.5% and 6.3%, respectively. Adding to the burden is the fact that the majority of patients – up to 70% – across the region are diagnosed when their lung cancer has already spread, making screening and early detection even more vital to improve patient outcomes.

The risk factors for lung cancer are manifold. Tobacco smoking is a major one. Within Southeast Asia, there are around 600 million tobacco smokers, with nearly half the male population in the region and two in every five women consuming tobacco. Other factors include secondhand smoke as well as indoor and outdoor pollution, through occupational or environmental exposure. It is also important to recognize the relatively high proportion of “never-smokers” who are affected by lung cancer in Asia – 60% of female lung cancer patients in East Asia are never smokers, compared to 15-20% in Europe or the United States. Among risk factors for lung cancer in never smokers (LCINS) include family history of lung cancer, environmental tobacco exposure, and chronic lung disease including chronic obstructive pulmonary disease.

Given the high burden of lung cancer mortality and the known challenges in early detection, especially in LMICs, as well as its close link with other lung diseases, an urgent rethink is required in terms of how the disease is addressed and managed.

LMICs can greatly benefit from an overarching approach – both national and global – to set the foundations for successfully managing lung cancer. The Malaysian Ministry of Health is currently developing a roadmap for tackling lung cancer, among different lung diseases, with a special focus on prevention, diagnosis, treatment, rehabilitation, and palliative care as part of its National Strategic Plan for Cancer Control Programme. This strategy also focuses on partnerships between governments, NGOs and the private sector, as these play an important role in fostering collaboration, leveraging expertise, and implementing effective lung cancer screenings and early detection using innovative technologies such as AI. Lung Cancer Network Malaysia and AstraZeneca’s partnership, for example, led to the first AI-detected lung cancer case in a non-smoker who had undergone a routine health screening in August this year.

In addition, we have made decisive progress towards developing a World Health Assembly resolution to prioritize lung health globally, including lung cancer. The draft resolution, which aims to be adopted as a global health priority at the 2025 World Health Assembly, focuses on creating a unified and integrated approach to strengthening lung health programmes within healthcare systems. It includes a comprehensive strategy that covers prevention, care and treatment while highlighting the importance of multidisciplinary collaboration.

Such an approach can only succeed with participation at the country and global level. Within the resolution, we call health authorities to prioritize lung disease prevention, collaborate with stakeholders to build capacity and develop global standards, and develop a global strategy and action plan for integrated lung health with measurable outcomes by 2030. On a national level, we hope that this resolution will support member states in creating policies aimed at strengthening primary healthcare services for universal health coverage, implementing preventive measures and clinical guidelines for lung disease care across high-risk populations, as well as raising awareness around the impact of air pollution and occupational risks.

Transforming lung cancer outcomes requires a global commitment to addressing the unique challenges faced by LMICs. By working together to improve access to early detection and treatment and supporting local communities, we can make significant strides towards reducing disease impact. A coordinated global approach coupled with tailored local and regional strategies are essential to ensure that every patient, regardless of where they live, has access to the best possible lung cancer care.