Continue lung cancer screening


RECENT data from the United Kingdom (UK Lung Cancer Coalition and Cancer Research UK) and the United States worryingly suggests a 40% to 70% decline in lung cancer referrals due to the ongoing global Covid-19 pandemic. This is most likely due to a disruption in routine provision of clinical services and an understandable reticence on the part of the public to visit their doctor or to be admitted to hospital for fear of contracting the coronavirus.

Another possible reason for the decline in detection is misdiagnosis of lung cancer as a Covid-19 illness due to shared common presenting symptoms like a cough or breathlessness. The link between coughing and Covid-19 and its associated stigma could also deter potential lung cancer victims from seeking early medical help. We have to be careful that a similar scenario does not occur here in Malaysia.

In contrast to chronic diseases like diabetes or hypertension, lung cancer can progress rapidly if left unchecked and untreated. Evidence shows for early stage lung cancer a delay from diagnosis to definitive treatment (surgery) of more than 40 days results in a 16% increase in mortality. Hence the risk of tumour growth and cancer progression is real and will result in a worse patient prognosis in terms of survival.

Suspected or confirmed cases of lung cancer must not be delayed or deferred without careful consideration. A persistent cough of more than two weeks duration warrants investigation. Similarly, chronic smokers with at least a 20-pack-years’ smoking history may benefit from screening with a low dose computed tomography (LDCT) scan.

Early stage lung cancer (stages one and two) has a 60% to 90% cure rate but if undetected and untreated, metastatic spread and death is inevitable. For confirmed advanced (stages three and four) lung cancer cases already under therapy, it is imperative patients discuss with their doctor further surveillance and treatment plans.

Cancer patients, especially those with lung cancer, do have an elevated risk of a more severe Covid-19 illness if infected; however, screening, diagnosis and treatment of all stages of lung cancer can be performed safely and effectively during this “new normal” if there is strict and sensible adherence to the various SOPs and personal protective equipment measures. Other strategies, such as less invasive surgery, consolidated radiotherapy and precision targeted oral molecular therapy, can help minimise hospital stays and outpatient visits.

The reality is that Covid-19 will remain with us for the foreseeable future until meaningful herd immunity is achieved either naturally or through mass vaccination. The Covid-19 case fatality rate here in Malaysia thankfully remains low (approximately 1%). The treatment of other diseases, especially lung cancer, cannot wait till the pandemic passes.


Cardiothoracic surgeon


Clinical oncologist

Note: The letter writers are co-founders of the Lung Cancer Network Malaysia ( November is World Lung Cancer Awareness Month.

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letters , lung cancer , covid-19


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