Data from the latest Malaysian National Cancer Registry Report (MNCR) 2017-2021 has confirmed the rising incidence of lung cancer here.
The age standardised incidence rate (ASR), a metric of how many cases can be expected per 100,000 of the population if there was a standard age structure, has increased for both Malaysian men and women.
From 2017 to 2021, a total of 17,028 new cases of lung cancer were recorded making the disease the third most common cancer in Malaysia, accounting for 10.1 per cent of all cancers here.
In men, lung cancer ranks number two after colon cancer, and in women, it is only surpassed by breast and colon cancer. On average, nine people are diagnosed with lung cancer every day in Malaysia.
Alarmingly, over 95 per cent of all recorded cases are diagnosed in locally advanced stage 3 and metastatic stage 4, often beyond the realm of curative therapy. The high preponderance of late-stage diagnosis accounts for poor outcomes and greater healthcare expenditure as prognosis, treatment, and therapy costs are largely stage-dependant.
Lung cancer remains the leading cause of cancer reacted mortality in Malaysian men and in women, only breast cancer is more fatal. Stage migration with impactful targeted screening is an imperative to improve outcomes and deliver value-based healthcare for the nation.
The national Lung Health Initiative (LHI) which leverages artificial intelligence aided chest radiography (Ai-CXR) in government clinics (linked to the real-time NALURY database) as part of a broader lung health check, is a step in the right direction.
While low dose computed tomography (LDCT) imaging remains the gold standard for lung cancer screening with strong evidence for reduction in lung-cancer specific mortality, the strategy of Ai-CXR screening first pioneered locally by Lung Cancer Network Malaysia (LCNM) in 2021, remains a reasonable and cost-effective strategy for low and upper middle income countries like Malaysia, to triage or funnel high-risk individuals for a more definitive LDCT scan.
The MNCR report highlighted that 53.4 per cent or 9,105 (of the total 17,028) cases of lung cancer recorded (from 2017-2021) had no documented staging information. This glaring omission of critical staging data is a concern and unacceptable.
Cancer care is increasingly complex and costly, with most patients requiring multi-disciplinary care and varying permutations of multi modal therapy such as surgery in combination with chemo-immunotherapy, oral targeted therapies, antibody drug conjugates, or radiotherapy.
Accurate staging data will facilitate better workforce planning, more efficient utilisation of resources and facilities, and strategic bulk purchasing of expensive cancer drugs.
Since April 2020, a Ministry of Health (MOH) circular has mandated reporting of all cancer cases including lung cancer from all government healthcare facilities. Private hospitals are strongly encouraged to do likewise but presently, it is not compulsory.
LCNM implores the MOH via the authority of the health minister or health director-general to make lung cancer a notifiable disease for all new cases from any public, private or academic healthcare facility in Malaysia, with a mandatory additional requirement for the submitting medical officer or specialist to include clinical staging information.
This will enhance data collection and is vital for better planning and provision of lung cancer services nationally, in addition to supporting critical research through the LHI, to continually improve care and outcomes for the rakyat.
Prof Anand Sachithanandan and Dr Tho Lye Mun are the co-founders of Lung Cancer Network Malaysia (LCNM).
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