Lung cancer is more deadly in poorer nations:

Successful public health initiatives have contributed to a steady rise in lifespan around the world, but this positive trend is not without consequences. As people live longer, combined with environment and lifestyle changes, the risk of cancer increases, with over 70% of cancer cases occurring in people over 50.

The most common cause of cancer death worldwide is lung cancer, a burden that is most heavily felt in lower- and middle-income countries (LMICs) where early detection and treatment is limited. By understanding the gaps and barriers in identifying and treating lung cancer in LMICs, healthcare systems can invest in the necessary infrastructure to curb cancer trends as populations continue to age.

Worldwide, approximately 70% of cancer deaths occur in LMICs, a large fraction of which is attributed to lung cancer. Smoking is the leading risk factor for lung cancer and over 80% of smokers worldwide live in LMICs.

Environmental factors like poor air conditions created by traffic and residential heating also contribute to this disease. Smoking habits, industrialized cities, and growing populations, raise the need for widespread cancer screening across LMICs for early detection and treatment.

Early detection of cancer is one of the most effective ways to improve survival outcomes. Detection begins with screening to identify individuals with cancerous or pre-cancerous abnormalities. Next, diagnosis helps determine the most effective treatment regimen, which can save time and resources.

Infrastructure challenges like a lack of transportation, long travel distances, and poor road conditions can limit access to cancer screening in LMICs. The equipment and personnel necessary also means that available screening centres may be limited. Lung cancer symptoms that are similar to other diseases like tuberculosis, which infects the lungs, can lead to misdiagnoses and further delay treatment.

Even once a diagnosis is made, individuals in LMICs are not guaranteed adequate treatment. According to the World Health Organization, in low-income countries, fewer than 30% of patients diagnosed with cancer have access to treatment, versus 90% in high-income countries. This disparity is partly due to poor access to medications and inability to see the necessary surgical and cancer specialists.

The COVID-19 pandemic has further exacerbated the lung cancer burden in LMICs. Healthcare resources have shifted towards fighting the pandemic, while the implementation of pandemic mitigation steps like physical distancing has impaired hospital services by postponing cancer screening, in-person consultation, and limiting treatments.

As countries reimagine their healthcare systems post-pandemic, specific attention must be given to cancer as populations age and as lifestyle changes lead to higher incidences of noncommunicable diseases.

The first step towards reducing lung cancer mortality in LMICs starts with better screening and education. Unlike other types of cancer, screening for lung cancer is not economical or justifiable on a population level. Instead, targeted screening of high-risk individuals is a practical way to promote early detection. Mobile CT scanners can help reach remote communities or individuals unable to travel. These screening efforts should also be paired with initiatives to help people quit smoking.

Addressing lung cancer in the pursuit of healthy ageing