Smokers who vape and smoke have an increased risk of developing lung cancer by four times, compared to if they just smoked. — Filepic
Malaysia's first-ever clinical practice guidelines (CPG) for the peri-operative management of early-stage resectable non-small cell lung cancer (NSCLC), launched recently, are intended to enhance lung cancer care in the country.
NSCLC is the most common type of lung cancer globally and in our country, making up about 85% to 90% of cases, with adenocarcinoma being the most frequent subtype.
Smokers have a higher risk of getting lung cancer, which accounts for at least 80% of all lung cancer cases. Tobacco smoke contains numerous carcinogens that damage the DNA in lung cells, leading to mutations that can cause cancer.
However, environmental factors such as air pollution, occupational exposure and secondary smoking also contribute to the risk.
“The disease burden is high in Malaysia, so if you screen and pick it up early, what do you do?
“Lung cancer is one of the most common cancers here and yet, we had no guidelines for it.
“We kept following guidelines from the United States and the United Kingdom but not everything that works there works here, as our demography is different.
“The surgery for lung cancer is performed by cardiothoracic and some general thoracic surgeons but there can be variations.
“The purpose of coming up with these guidelines is to standardise care for all patients,” says senior cardiothoracic surgeon Professor Dr Anand Sachithanandan.
Relevant medical specialists and experts collaborated to come up with the country’s first clinical practice guidelines for treating lung cancer.
Published by Lung Cancer Network Malaysia (LCNM), the landmark guidelines have received official endorsement from the Malaysian Thoracic Society, Malaysian Oncological Society, Malaysian Association for Thoracic and Cardiovascular Surgery, and the College of Surgeons, Academy of Medicine Malaysia.
LCNM is a non-profit, non-governmental organisation that unites medical professionals and allied healthcare workers to improve lung cancer care in Malaysia.
Beyond clinical protocols, the CPG is also designed to serve as an educational tool for training future specialists.
Since 2012, Prof Anand, who is the founding president of LCNM, has been advocating for lung cancer screening in Malaysia.
He shares: “First, we started with the use of low-dose computed tomography (CT) imaging, then the use of AI-enabled chest x-rays (AI-CXR) and most recently, the use of blood-based biomarkers circulating tumour (ct-DNA).
“LCNM conducted a large community-level screening project (2021-2023) which demonstrated the feasibility and scalability for using AI-CXR imaging to screen for lung cancer.”
Based on this, the Health Ministry (MOH) has started offering AI-CXR screening at seven government facilities in May this year.
Among the health clinics are Kok Lanas Health Clinic (Kelantan), Kajang Health Clinic (Selangor), Beserah Health Clinic (Pahang), Seberang Perai Health Clinic (Penang) and Pendang Health Clinic (Kedah).
It is one of the key efforts in the National Lung Health Initiative 2025-2030 that MOH has launched to strengthen prevention, screening and treatment for lung diseases.
“With screening, we will detect more incidental pulmonary nodules hence the value of this ICG technique to help surgeons locate precisely such nodules,” says Prof Anand.
The softcopy of the CPG is available for free download at:
https://www.lungcancer.net.my/cpg-for-peri-operative-management-of-resectable-early-stage-nsclc/
