A Call to Action On World Lung Cancer Day – A Time of Hope, Concern & Action – Lung Cancer Network Malaysia

The much overdue recently published National Cancer Registry (2017-2021) data from the National Cancer Institute (IKN, Ministry of Health) confirms bronchogenic lung cancer remains a leading and deadly cancer amongst Malaysian men and women. The age standardized incidence rate (ASR) has increased for both genders from 13.2/100,000 (2012-2016) to 16/100,000 (2017-2021) in men and 5.9/100,000 (2012-2016) to 7.4/100,000 (2017-2021) in women, with a rising incidence over age 45 and 50 years for men and women respectively. Lung cancer remains the second most prevalent male cancer here and is now the third most common female cancer in Malaysia. The lifetime risk has increased from 1 in 138 (2012-2016) to 1 in 113 (2017-2021) for women and is highest for ethnic Chinese females (1 in 80). Similarly, in men, the lifetime risk is elevated; 1 in 60 (2012-2016) to 1 in 50 (2017-2021) and remains highest for ethnic Chinese males (1 in 37). Alarmingly, advanced stage (3 & 4) disease presentation at initial diagnosis has increased to 95.4% for men and 94.3 % for women.

Dr Tho Lye Mun, a clinical oncologist and LCNM president elaborates that progress made in recent times with greater awareness and screening efforts may have been undone in part by the Covid pandemic (2020-2022) when clinical services were disrupted. However, he remains hopeful as tremendous recent advances in the diagnostic and treatment landscape with bespoke oral targeted therapies and highly effective systemic intravenous immunotherapy for some lung tumours, have resulted in vastly better outcomes in terms of disease-free survival and overall survival. Dr Tho observes, many patients even with stage four lung cancer are living longer, highly productive lives with a good quality of life. However financial toxicity remains a huge concern as many of these efficacious drugs are prohibitively expensive despite means-tested patient assistance programmes from the pharmaceutical providers. The recent proposal to introduce insurance co-payments could further exacerbate affordability and impact cancer patients accessing such therapies. LCNM hopes the Health White Paper will address these real-world concerns thoughtfully.

According to Dr Hilmi Lockman, a respiratory physician and LCNM vice president, the latest data reinforces the need for LCNM and other relevant organisations to continue awareness and educational campaigns, and screening programmes, something LCNM has championed since inception in 2019. The general public, primary care doctors and non-lung hospital specialists must remain vigilant of potential ‘red flag’ symptoms such as a persistent cough (beyond two weeks duration) or recurrent chest infections and maintain a low threshold to request relevant investigations like a chest x-ray or CT thorax scan. Effective tobacco control including regulation of vapes, heated products and e-cigarettes is also crucial as nicotine is highly addictive and smoking remains a major risk factor for lung carcinoma, adds Dr Hilmi.

Professor Anand Sachithanandan, a cardiothoracic surgeon and LCNM founding president adds that targeted screening of ‘at risk’ individuals including former or current heavy smokers over 45 years old, and those with a family history of lung cancer is vital and a potential game changer. Such persons will benefit from screening with a low dose LDCT thorax (chest) scan or as a minimum, a preliminary artificial intelligence-enabled chest x-ray, even if they have no symptoms. The screening benefit in high-risk individuals is well proven and truly life-saving as it facilitates detection of earlier stage lung cancer when the tumour can be treated more effectively and cheaply, often achieving a cure. According to Prof Sachithanandan, given the high disease burden here and worsening preponderance of late stage diagnosis, the time is ripe, for a national lung cancer screening programme. This could be funded in part by ‘sin tax’ revenue collected from increased taxation of tobacco products. On a separate note, Prof Sachithanandan shares that LCNM strongly supports the proposal by our esteemed Health Minister Dr Dzulkefly Ahmad to make all cancers including lung cancer, a notifiable disease. Once mandated, it will enable more complete and accurate collection and analysis of national data to help shape future health policy, planning and provision of much needed cancer services for Malaysia.