Let’s look at lungs, closely
Screening for lung cancer in Malaysia: Are we there yet?
PETALING JAYA: Lung cancer is the third most common cancer in Malaysia, accounting for 19.8% of all medically certified cancer mortality in this country (Second Report of the National Cancer Registry, Cancer Incidence in Malaysia).
Since most lung cancer patients are diagnosed when they reach an advanced, incurable stage, mortality rates in Malaysia remain high – over 75% of lung cancer cases are diagnosed at either stage III or IV, and often, patients can only be offered palliative but expensive therapy.
It is a well known fact that individuals who have had family members diagnosed with cancer are prone to developing the disease themselves.
And while genetics may predispose certain people to lung cancer, cigarette smoking remains a major risk factor.
Local data suggests 92% of Malaysian male lung cancer patients have a significant history of smoking.
Lung cancer occurs mostly in men over age 50, and the incidence in those under age 40 is relatively lower (approximately 5%).
In spite of the statistics, cigarette smoking in Malaysia starts early, with a whopping 36.9% of children between ages 14 and 15 using e-cigarettes and vaping devices.
Despite the Government’s best efforts to deter Malaysians from picking up the habit – including a National Strategic Plan to make Malaysia smoke-free by 2045, the prevalence of smoking in Malaysia is exceptionally high.
Smoking not only harms the health of an individual or family, but has serious implications on our national treasury.
The morbidity and therapy of smoking-related diseases account for approximately RM440mil annually, and is thus a major economic
burden on our personal and national healthcare finances.
The high prevalence of lung cancer in Malaysia and the fact that smoking is the most common, preventable cause of death, mandates serious consideration for disease screening.
Screening for lung cancer ups the chances of early diagnosis, facilitating early effective intervention.
There is no question that the earlier a lung cancer is diagnosed and treated, the better the patient’s
chance of survival.
Studies from the United States, UK and Europe have shown that screening for lung cancer increases the chances of early diagnoses.
Published studies evaluating the efficacy of a lung cancer screening programme indicate the need to target screening of individuals of the highest risk to make the programme cost-effective.
Our collective challenge, therefore, is to identify that high-risk group here in Malaysia.
A pilot study targeting a smaller “at risk” based on local epidemiology of the disease should be undertaken to determine precisely who should be screened.
Of course, a national anti-smoking policy that prevents tobacco use is far more effective than a screening programme.
After all, we are all familiar with the adage, prevention is better than cure.
Some might argue that national resources and efforts should be prioritised for preventative strategies instead, but this will only address a future generation.
Even if all cigarette smokers were to quit smoking today, it would take 20 years before the resulting decrease in mortality from lung cancer becomes evident.
Lung cancer screening does not compete or contradict efforts to promote smoking cessation.
Lung cancer is a major and costly health concern and the leading cause of cancer-related deaths in this country.
Due to the long latency phase of lung cancer, smoking cessation will have minimal impact for many decades.
The importance of early diagnosis cannot be emphasised enough – early detection of lung cancer remains the cornerstone of treatment success.
A well-executed and comprehensive screening programme may potentially save many lives and billions of ringgit in the long term, although admittedly evaluating cost-effectiveness is not straight forward.
It is imperative, however, that appropriate clear guidelines and quality assurance programmes are established by a dedicated multi-disciplinary interest group prior to embarking on a national screening programme.
The case for lung cancer screening in Malaysia is persuasive and the decision time is now.