Lung cancer is the most fatal of all cancers globally, responsible for approximately one in five cancer deaths. In 2022 alone, there were about 2.5 million new cases and 1.8 million deaths from lung cancer, worldwide.^1,2 The five-year survival rate is 10–20% in most countries, including developed ones, primarily because many cases are detected at an advanced stage when treatment options are limited.² If we don’t do more to address the lung cancer burden, it is projected to increase to 4.62 million new cases and 3.55 million deaths annually by 2050.³

There is a strong link between lung cancer burden and the human development index. Low and middle-income countries (LMICs) bear the greatest disease burden, accounting for 67% of cases (over 1.6 million) and 69% of deaths (over 1.2 million). ¹ The survival rates for lung cancer in LMICs lags far behind developed countries, with as much as 80% of lung cancer cases being diagnosed at advanced stage.^4,5 Most people are diagnosed with advanced lung cancer due to poor access to care, lack of awareness, inadequate health-care infrastructures, and poor referrals to diagnosis.⁶

The significant mortality rate and the disparities in timely detection and care for lung cancer among different population groups necessitate an urgent reassessment of our approach to lung cancer care, tailored to each specific context.

What are the main risk factors for lung cancer and are there differences between population groups?

While smoking may be the primary risk factor for lung cancer, worldwide,⁷ the demographics of the disease can also look different in each region. In Asia for example, there is a higher rate of a specific form of lung cancer mutation called EGFR mutation and higher prevalence among diagnosed patients who are typically young, female, and never-smokers.⁸ 

The incidence of lung cancer in non-smokers is also increasing globally. 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.⁹

Identification of individuals at high risk for proactive, early detection programmes will facilitate early diagnosis and care, reduce overall costs, and help improve patient outcomes, potentially reducing number of lung cancer deaths.

What are the barriers to early detection of lung cancer among high-risk populations across LMICs and how can we overcome them to achieve reduction in number of deaths?

Early detection that provides rapid access to high-quality diagnosis and care offers the best chance to reduce lung cancer deaths. However, many LMICs have limited access to healthcare infrastructures necessary for comprehensive screening programs. Incidental detection of lung cancer is also not commonly integrated with other screening programs that could enhance cost-effectiveness and efficiency. ¹⁰ Where available, many existing screening programs focus on heavy smokers, despite evidence of lung cancer in non-smokers due to factors such as family history and environmental aspects like air pollution.¹¹ Additionally, lung cancer often presents little to no symptoms in its early stages, making it less likely for patients to seek treatment until the disease has advanced. ¹² Differences in socioeconomic status and potential financial burdens for patients add to the problem. While low-dose computer tomography (LDCT) screening has been effective in diagnosing lung cancer in high-risk populations, few countries implement nationwide screening programs due to factors such as high cost and resource availability. ¹³

To overcome these barriers, global health bodies, governments, the medical community, and the private sector need to collaborate to improve equitable access to lung cancer screening in LMICs. First, this involves utilizing risk-prediction tools and models, such as those assessing smoking status, family history, occupational exposures, and other relevant factors, to help determine an individual's eligibility for lung cancer screening. ¹⁴

In addition, this requires more support for resource-stratified solutions and adoption of technologies that can be integrated into screening programs to improve the efficiency of screening, reach the broader population and ensure an integrated approach to care. This can include, for example, incidental detection of lung cancer in routine care through artificial intelligence-assisted chest X-rays — which use AI algorithms to interpret radiology images —to identify patients with suspicious radiographic lung markers and triage to LDCT and other work up for diagnosis.¹⁵

Multi-screening programs, such as integrated lung health screening, support building sustainable healthcare systems by utilizing existing healthcare infrastructure to address common factors that influence health outcomes of lung diseases such as TB, COPD and lung cancer. ¹⁶

Can you elaborate on the need for collaboration between global health bodies, government and other sectors in the transformation of lung cancer outcomes through early detection, and what concrete actions have been taken already?

To effectively address lung cancer burdens across LMICs, global collaborations to drive the prioritization of early diagnosis is key. Governments should look at closely collaborating global health organizations as well as the private sector to prioritize lung cancer screening among the high-risk population and implement resource-stratified approaches.

Earlier this year, the Malaysian Ministry of Health led a global effort to tackle lung-related disease by spearheading the submission of a landmark World Health Assembly (WHA) Lung Health Resolution. The resolution focuses on creating a unified approach to lung health by addressing both the prevention and treatment of lung diseases across different sectors and countries. ¹⁷

Once adopted as a global health priority at next year’s WHA, the Resolution will accelerate a needed policy change across all member states to reduce the overall lung disease burden, including cancer, worldwide.

Recently, the International Agency on Research for Cancer, called for experts and data for the development of the Handbook on Lung Cancer Screening. Once published, the comprehensive reviews and consensus evaluations of evidence will guide implementation of national screening programs. ¹⁸

Could you provide insights on AstraZeneca’s strategy to transform lung cancer care, particularly through collaborations with governments and local healthcare systems?

Sustainably transforming the delivery of cancer care through partnerships is core to our bold ambition of eliminating cancer as a cause of death.

Though the Lung Ambition Alliance (LAA) platform, we bring partners together to accelerate new advances to transform the diagnosis, treatment, and management of lung cancer.

Across the world, the Alliance is running several initiatives to increase screening and early diagnosis and improve quality of care by partnering with advocates and policymakers. In India, for example, we are partnering with the states of Goa and Karnataka to implement resource-stratified strategies to detect lung cancer early and establish pathways for patients to access care and treatment. This involves the use of AI-integrated chest X-rays to detect high-risk lung nodules and fast track patients to LDCT scans for diagnosis. We have completed over half a million scans and detected more than 1,800 high-risk nodules.  In Colombia, through established Centres of Excellence, public hospitals and imaging centres, we are partnering with different states using similar models for detecting high-risk nodules and strengthening of primary care services. To date, over one hundred thousand scans have been completed, and more than 700 high-risk nodules have been detected.

Such collaborations contribute to our global commitment, through the WEF Edison Alliance,  to screen 5 million people globally, by using AI-assisted chest X-rays to improve referral and diagnostic pathways for patients with possible lung cancers. As of now, over 3.4 million scans have been conducted globally, and more than 29,000 high-risk nodules have been identified for diagnostic referral. ¹⁹  

We are continuously working on solutions to bridge gaps in lung cancer care, collaborating with more partners through a comprehensive healthcare system approach. Currently, we are implementing initiatives aimed at establishing a real-time data foundation to improve the delivery of cancer care in our communities. By utilizing the latest technologies and partnering with key industry stakeholders, we aim to create a comprehensive data pathway that will optimize existing healthcare resources and support clinicians in making better-informed decisions. This foundation will help drive improvements in practice and policy, enhancing the standard of care and fostering a more equitable, sustainable ecosystem for patients. ²⁰

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