PETALING JAYA: While the need for a nationwide lung cancer screening programme is crucial, the cost still remains a main concern, say health experts.
Public health expert Datuk Dr Zainal Ariffin Omar said a population-wide screening for the rising cases in lung cancer could be explored by the government in the future, but the emphasis should be on the importance of reducing the risk factors.
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“Five top cancers in Malaysia are colorectal, breast, cervical, uterus and lung. We have affordable screening for the first four diseases but not for lung cancer at the moment.
“However, it still could be an option in the future.
“For now, the government should concentrate on prevention methods, which include anti-smoking campaigns,” he said.
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Dr Zainal said the recommended screening for lung cancer would be the low-dose computed tomography (LDCT), which is available at private hospitals.
Since each test would cost between RM1,000 and RM2,000, he said it would not be cost-effective for public hospitals to offer it to the masses.
“It’s not affordable to be given annually, especially by government facilities because it’s quite costly,” he said.
He also said individuals who are in the high-risk group who smoke and have a family history, among others, should take the test for early detection.
“The US Preventive Services Task Force (USPSTF) recommends yearly lung cancer screening with LDCT for people who have a 20 pack-year or more smoking history and currently smokes, or have quit within the past 15 years, and are aged between 50 and 80,” Dr Zainal said.
A report by the Health Ministry found that screening for lung cancer with LDCT reduces lung cancer specific mortality and improves early detection.
However, the National Cancer Council (Makna) said that while LDCT was recommended, the method was not yet applicable for population screening.
“LDCT has high sensitivity of detecting cancer cells; it shows low specificity when used for lung cancer screening among the high-risk group.
“Hence, LDCT may be used for lung cancer screening among the high-risk group in a research environment or for research purposes,” it said in a statement to The Star.
It also said the stigma associated with lung cancer had become another challenge, and screening remained a taboo among Malaysians.
“There is a stigma associated with lung cancer, more so than breast cancer, with many considering it to be self-inflicted.
“Screening for lung cancer is further complicated by the high prevalence of tuberculosis, which may give false positives.
“Other challenges facing a national population-based screening for lung cancer include lack of resources, the cost-ineffectiveness and lack of cancer awareness among the public,” Makna added.
Lung Cancer Network Malaysia founding president Dr Anand Sachithanandan said that for screening to be impactful and cost-effective, a targeted approach was required.
By identifying the high-risk group such as smokers, the screening and treatment for lung cancer can be made more effectively.
However, Dr Anand noted that the rising number of lung cancer cases involving non-smokers, mainly among women, also needed to be addressed.
To ensure a more cost-effective screening, a pre-LDCT triage tool with a simple chest X-ray (CXR) with artificial intelligence (AI) assistance could be explored, he said.
“AI technology has been shown to enhance the diagnostic accuracy of CXRs and can reduce turnaround times.
“An AI-enabled CXR can help identify nodules that may represent early lung cancer. Such individuals can then be swiftly investigated with a definitive LDCT scan.
“A CXR is much cheaper and more widely available than LDCT as a baseline initial screening examination,” said Dr Anand, who is also a consultant cardiothoracic surgeon.
He said targeted screening would be the only way to detect the disease early and ensure proper treatment.
He said to address cost issues, the government could consider the proposed nicotine “sin tax” to be used to fund lung cancer awareness and screening programmes.
“Ideally, revenue from the proposed nicotine ‘sin tax’ should be ring-fenced and used to fund lung cancer awareness and screening programmes in tandem with existing smoking cessation campaigns,” he added.
In April, Prime Minister Datuk Seri Anwar Ibrahim said in Parliament that half of the tax proceeds collected from the sale of vape nicotine products would be channelled to the Health Ministry.