Combating Lung Cancer Across the Asia Pacific

Mobilizing Investments to Maximize Health Outcomes

A Special Report from FP Analytics, with support from Roche Asia Pacific

Non-communicable diseases (NCDs) represent a growing, but often under-appreciated, burden on national systems and constitute the leading cause of death globally. In particular, the prevalence of NCDs in low- and middle-income countries (LMICs), where 86 percent of NCD-related premature deaths occur, is increasing and becoming a significant socioeconomic challenge. As vaccinations facilitate more effective control of common communicable diseases such as polio and measles, NCDs are becoming a major driver of disability and mortality, and are projected to account for 75 percent of premature death by 2030 if left unchecked. NCDs undermine individual and community health, exact heavy macro- and micro-economic costs, hold back development, and stymie growth.

Among NCDs, lung cancer is not only one of the deadliest—resulting in almost one-fifth of all cancer deaths globally—but also responsible for the highest economic burdens, with estimates suggesting that the disease could account for $3.9 trillion in global economic costs between 2020 and 2050. In 2022, 60 percent of global lung cancer deaths occurred in the Asia Pacific region, where the disease presents a major obstacle to health security and economic growth. Recognizing this multidimensional challenge, and as part of the broader Sustainable Development Goals (SDG) agenda, in 2015 the United Nations designated SDG 3.4 as an ambitious target for countries to reduce premature mortality from NCDs by one-third. However, that goal is unlikely to be met based on current trends and projections, which suggest losses of healthy life years and populations failing to achieve their full potential within their lifetimes.

FIGURE 1

Lung Cancer Global Mortality and Incidence, 2022

The Asia Pacific region accounts for 60 percent of lung cancer deaths worldwide.

Data note: Mortality and incidence rates are age-standardized per 100,000. Data for Taiwan and Hong Kong are unavailable. Sources: IARC Globocan 2022, World Bank, WHO

Stakeholders across the public, private, and multilateral sectors, especially in LMICs, need to implement policies that can drive progress toward SDG 3.4 and strengthen health systems to better prevent and manage NCDs, including lung cancer. Doing so is particularly crucial in the Asia Pacific region, where over one million people died of lung cancer in 2022, and annual deaths are projected to rise to over two million by 2050 absent strategic and systematic interventions. The impact of lung cancer on individuals, households, and societies is significant, and as such requires a cross-sectoral, life-course approach to its control and prevention. While prevention and early intervention can yield multiple benefits, effective strategies to control lung cancer need to not only tackle risk factors such as smoking and air pollution, but also consider interventions that can address the disease across the entire patient journey. These impacts range from the economic and psychological burden of accessing and undergoing treatment, to the benefits of palliative and end-of-life care, and support for survivors re-entering communal life and the workplace.

Broader investments in health care resilience already underway in LMICs—such as strengthening primary care infrastructure and specialized training of health care workers—can feed into lung cancer prevention, detection, and treatment strategies to reduce the burden of the disease in the long term. In addition, many lung cancer risk factors can be tackled through low-cost interventions such as those outlined in the World Health Organization (WHO) Best Buys—a series of low-cost health interventions aimed at preventing and controlling NCDs in resource-scarce environments.

This special report, produced by FP Analytics with support from Roche, analyzes the impact of lung cancer and lung cancer control policies on the Asia Pacific region, with the goal of identifying cost-effective, impactful interventions to end lung cancer death and disability and reduce the regional, gender, and ethnic inequities that persist. The report is accompanied by, and synthesizes findings from, 13 in-depth case studies focusing on: Australia, China, Hong Kong, India, Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Based on desktop research and analysis of public health data, the report and case studies identify effective interventions and replicable practices to reduce lung cancer mortality, improve the quality of life of lung cancer patients, and eventually prevent the incidence of lung cancer altogether. The 13 case studies facilitate deeper understanding of the status, impact, and planned strategies to address lung cancer in high-, medium-, and low-income countries to gain a better understanding of the shared and divergent challenges and approaches being taken in the Asia Pacific region. While not a comparative study, this special report aims to identify trends, patterns, and overlaps in the lung cancer burden and response across the region. It does so in part through the development of an innovative GRIPs framework to analyze the gains, risks, innovations, and prospects for each country, which are synthesized in a table in each case study.

Recognizing the need for coordinated action by public- and private-sector stakeholders, and health, environmental, and economic interventions, this analysis seeks to identify fruitful avenues for collaboration, particularly in pursuit of innovative, cost-effective approaches to lung cancer control. While the synthesis report and 13 case studies offer a range of insights, key findings and recommendations include:

• Recognize steep socioeconomic costs: Lung cancer exacts a significant socioeconomic burden in all the Asia Pacific countries examined, regardless of income and development status. However, across the region, and within countries, poor, rural, and remote communities suffer the most as a result of lung cancer, and will require the greatest support and investment to shift the disease burden toward earlier, more treatable stages and to reduce mortality.
• Foster cross-sectoral prevention and mitigation: Effective lung cancer control requires a whole-of-society response with cross-sectoral collaboration to identify and fill gaps in care and deploy effective and innovative policies and treatments. Governmental leadership and coordination—through cancer control plans, strategies, targets, and budgets—are key, yet few of the countries analyzed in this report specify budgeting mechanisms or data-driven targets for monitoring and evaluation. The buy-in of the private sector will be key to the creation, enforcement, and funding of policies that effectively eliminate lung cancer, including through smoking cessation and air pollution reduction.
• Prioritize prevention and early action: Prevention and early detection are key to controlling lung cancer, but these approaches are under-utilized, and lung cancer diagnosis in later stages remains common throughout the region. Effective prevention and early detection policies can be integrated into existing health care infrastructure, such as primary health care services and NCD control plans, which can also reduce the cost burden in resource-scarce countries.
• Leverage full range of interventions: Cutting edge, forward-looking screening, diagnosis, and treatment methods will be crucial to long-term control of lung cancer, but low-cost interventions such as ending smoking, improving clean air, ensuring clean cooking policies, and encouraging healthy lifestyles have demonstrable impacts on lung cancer prevention, and need to be maintained alongside investment in new technologies.
• Adopt contextually specific interventions: While this report highlights many of the shared challenges and opportunities that Asia Pacific countries face, no two contexts are exactly the same. In addition to undertaking intra-regional knowledge-sharing and collaboration, when formulating lung cancer control strategies, identifying the best protocols for their specific population and national context will be an important task for ministries of health and local academics and researchers.
• Achieve universal health coverage (UHC): Equitable access to high-quality, effective, innovative lung cancer diagnostics, treatment, and palliative care will require all patients to be able to seek care without fear of costs. UHC, with an emphasis on primary health care alongside specialty care, can address geographic and economic disparities in quality care and also enable prevention by improving overall societal well-being and quality of life.

FIGURE 2

Estimated Change in Lung Cancer Mortality, 2022 to 2050

Without targeted intervention, most countries are projected to experience substantial increases in lung cancer mortality.

Data note: Growth rates are cumulative over time, with 2022 as the base year. Data for Taiwan and Hong Kong are unavailable. Asia Pacific average combines WHO South-East Asia and WHO Western Pacific regions. Sources: IARC Globocan 2022, Authors’ calculations

The scope of the challenge: 60 percent of global lung cancer deaths in 2022 were in the Asia Pacific region

Lung cancer was the deadliest cancer in the Asia Pacific in 2022, with the region experiencing the majority—60 percent—of global lung cancer deaths, a trend projected to continue through 2050. Countries in the region are undergoing rapid industrialization, economic development, and population aging, all of which contribute to increased incidence and diagnosis of NCDs, including lung cancer. China, specifically, is an epicenter for lung cancer and accounted for about 40 percent of the disease’s global incidence and mortality in 2022. Without the implementation of necessary interventions, projections by the International Agency Research on Cancer indicate that the burden of lung cancer could worsen to 2.59 million new cases and 2.04 million deaths annually in the Asia Pacific by the end of 2050 (see Figure 2). Around 80 percent of these projected new annual cases and deaths are set to occur in individuals aged 60 years and older, demonstrating the increasing challenge that lung cancer poses to aging populations in the region.

The correlation between a country’s level of economic development and its lung cancer incidence and mortality rates is complex, as economic growth in the Asia Pacific region has been accompanied by high rates of fossil fuel usage but may also correlate with lower rates of behavioral risk factors such as smoking. Among the countries included in this analysis, those with “very high” human development index (HDI) scores (0.8 and above) and high per capita incomes were associated with a higher number of new lung cancer cases, except for China which had the highest incidence rate in 2022 despite its middle-income status (see Figure 3).

FIGURE 3

Correlation Between Lung Cancer Incidence and Socioeconomic Development Indicators, 2022

Despite higher incidences, patients in higher-income countries have a greater chance of surviving lung cancer than those in low-income countries.

Data note: Incidence and mortality rates are age-standardized per 100,000. Data for Taiwan and Hong Kong are unavailable. Sources: IARC Globocan 2022, World Bank, WHO, Authors' calculations

However, with respect to mortality rates, high-income countries like South Korea, Australia, and Japan had lower mortality rates than middle-income countries like Philippines and Vietnam in 2022. The higher incidence, but lower mortality rates, in these high-income countries could indicate wider availability of screening and early detection measures for lung cancer, greater access to quality cancer care, and generally more robust health systems. This is reflected by the higher five-year net survival of patients in high-income countries such as Japan (33 percent) and South Korea (25 percent), compared to middle-income countries like Thailand (9 percent) and India (4 percent) from 2010 through 2014. Five-year net survival refers to the cumulative probability of a patient surviving for up to five years after diagnosis, after adjusting for mortality from other unrelated causes. While data for countries such as Japan, China, Malaysia, Thailand, and India are not representative of the national population due to internal income and health care inequality, these figures highlight the disparities across countries in the region. As a result, recent data on lung cancer demonstrate the urgency of addressing the disease, given the overall low probability of survival, notwithstanding a country’s economic-development status.

While there is a significant gender disparity in lung cancer incidence, the gap in male and female rates of diagnosis is shrinking, and lung cancer is a leading cause of death and disability among both men and women in the region. After breast cancer, lung cancer was the second-most diagnosed cancer among women in the Asia Pacific in 2022, at 18.1 new cases per 100,000. Among men in the region, meanwhile, lung cancer was the most diagnosed cancer at 35.2 new cases per 100,000 men in 2022, followed by colorectal cancer at 19.8 new cases per 100,000. However, the projected growth of lung cancer among women in the Asia Pacific is particularly concerning. Current data suggest an 84 percent increase in lung cancer-related deaths among women in the region from 2022 through 2045, compared to a slightly lower but still substantial growth of 73 percent for lung cancer-related mortality among men. This growth in lung cancer mortality among women coincides with an increasing trend of lung cancer cases in never-smokers in East Asia. The dramatic gender disparity in smoking rates in the Asia Pacific suggests that women likely represent a significant share of never-smoker cancer patients. Never-smokers are not currently targeted in any risk-based lung cancer screening programs in the region, with the exception of Taiwan, and the association of lung cancer with a history of smoking can lead to never-smokers’ symptoms being attributed to other causes. These factors can hinder early detection and treatment of lung cancer in never-smokers, and they need to be addressed in order to effectively control lung cancer disease in both never- and ever-smokers in the region.

Significant economic toll: Lung cancer could cost the global economy $3.9 trillion between 2020 and 2050

The high incidence and mortality rates of lung cancer in countries across the region result in significant socioeconomic costs at both the micro- and macro-economic levels. While estimates vary by country, model, and data used, and tend to generalize across all types of cancer, they nevertheless consistently reveal the severe, multifaceted impacts of the disease. These include the loss of healthy life years, reductions in workforce and productivity, and financial strain from medical expenses on societies and households, with catastrophic health expenses pushing households into debt and poverty, notably in LMICs. In Europe, lung cancer is projected to account for one-fifth of labor productivity losses from cancers between 2018 and 2040, higher than any other cancer type, and equivalent to USD 286 billion.

In the Asia Pacific region, lung cancer was responsible for over 27 million years of life lost and disability-adjusted life years (DALYs) in 2021, implying that populations could have lived fuller, longer lives if not for lung cancer. In Vietnam, a 2017 study found that over one-third of households with a cancer patient fall into poverty due to out-of-pocket spending, despite the existence of a national health insurance system. Late diagnosis of cancer leads to a lower chance of survival and higher medical costs, as treatments are more expensive in advanced stages. In Indonesia, for example, around 70 percent of cancer patients are diagnosed at late stages (stages III or IV), costing the government IDR 7.6 trillion (USD 530 million) in treatment costs between 2019 and 2020, or approximately 0.04 percent of its 2019 GDP. Indeed, late diagnosis is a phenomenon in lower- and high-income countries: in Australia, for example, 42 percent of lung cancer cases are diagnosed at stage IV. Healthier populations are crucial to stronger, more prosperous economies due to reduced health and social care spending and increased workforce productivity.

The high costs that lung cancer imposes on individuals, households, and economies necessitate a multi-pronged approach to reduce incidence and mortality. Earlier diagnosis of all cancers not only increases five-year survival rates, but also has significant financial benefits, including avoided household expenditure on treatment and caregiving. In 2017, globally, the treatment for cancer patients diagnosed early was found to be on average two-to-four times less expensive than for those diagnosed at a later stage. This is a significant saving, given that NCDs cost the Malaysian economy, to take just one example, the equivalent of over eight percent of its 2020 GDP due to productivity loss, disability, and loss of healthy life years. Prevention, early detection, and rapid treatment pathways are therefore critical to improving both health and economic outcomes. Indeed, the most cost-effective method of treating lung cancer is preventing it altogether.

Governments have a leading role to play in preventing lung cancer by adopting and enforcing laws and policies to address lifestyle risks, including reducing air pollution and controlling tobacco consumption. Tobacco is responsible for 22 percent of all cancers worldwide, and 85 percent of lung cancers, making it the most significant avoidable risk factor for cancer mortality. Reducing tobacco consumption—through cigarettes, vapes, and shisha or hookah—is therefore a clear action target for governments worldwide, and particularly in the Asia Pacific region, where tobacco use at 22.9 percent surpasses the global average at 20.9 percent. While there is significant intra-regional variation—for example, the WHO South-East Asia region has the highest percentage of tobacco users globally at 26.5 percent—almost one-quarter to one-third of men over the age of 15 in the Asia Pacific region reported smoking tobacco daily in 2017. The WHO Best Buys recommend anti-smoking interventions, including increased excise taxes and prices on tobacco, graphic warning labels on tobacco packaging, and government-funded smoking-reduction programs. Implementation of the Best Buys in LMICs is projected to yield nearly USD 7 for every dollar invested, through increased productivity and life expectancy.

However, significant barriers to these policies pose challenges, including conflicts of interest. China’s tobacco industry is state-owned, while South Korea’s national pension system is a major shareholder in a local tobacco company, meaning that both governments benefit significantly from continued tobacco purchase and consumption within their respective populations. The long latency period between the implementation of tobacco control policies and their demonstrated impact in population-level health trends can be discouraging to politicians or government economists seeking an immediate return on investment. The OECD, for example, has found that current lung cancer incidence rates tend to reflect patterns of tobacco use two to three decades prior. A long delay of this kind between policy intervention and population-level impact will require policymakers and funders to analyze success through an extremely long-term lens.

In addition to the high prevalence of smoking in the Asia Pacific region, environmental factors contribute to the increase in lung cancer diagnoses. Air pollution is the fourth-highest risk factor for premature death globally. More than four million people die in the region every year due to long-term exposure to outdoor air pollution, and the WHO reports that over 90 percent of the global population lives in areas where air pollution exceeds its recommended air quality guidelines. This problem is particularly acute in the Asia Pacific region, where rapid economic expansion and industrialization have led to an increase in fossil fuel combustion, and where occupational exposure to carcinogens such as asbestos remains high. India, for example, is home to 21 of the 30 cities with the highest air pollution globally, and its entire population—including in rural areas—lives in areas where air pollution exceeds WHO guideline levels.

Indeed, the high incidence of cancer in never-smokers—usually defined as those who have smoked fewer than 100 cigarettes in their lifetime—across the Asia Pacific suggests that air pollution is a more significant risk factor in the region than elsewhere in the world. Despite low levels of smoking among Asian women—for example, just 3.6 percent of Indonesian women smoke, compared to over 70 percent of men—lung cancer is the second-most commonly diagnosed cancer for this demographic. This high incidence among women may also be due to the widespread use of kerosene, biomass, and coal fuels for cooking. For instance, over half of the population of the Philippines relies on these methods to prepare food. The Clean Cooking Alliance has found that household air pollution from cooking, lighting, and heating over open flames and inefficient stoves causes up to four million premature deaths per year and contributes 16 percent of global air pollution.

Effective policies to prevent lung cancer in the region need to focus on these environmental drivers, for example, by reducing air pollution in cities to meet WHO air quality standards, and through clean cooking replacement schemes, such as those launched in recent years in India and Indonesia. Given air pollution’s transboundary impacts, regional and cross-border collaboration are key to its control and reduction. Hong Kong and the Chinese province of Guangdong, for example—which are governed by separate laws and policies around health, economic activity, and pollution—have set shared emissions-reduction targets for 2025 and 2030, acknowledging that their geographic proximity has created a shared air pollution challenge. Similarly, Singapore has taken the lead in monitoring forest fires and haze, working in tandem with neighboring countries to mitigate air pollution across the region.

Policy actions that address lung cancer risk factors such as air pollution and smoking create spillover effects that aid in the prevention of other cancers and NCDs. These spillover effects underscore the value of investing in preventive measures that target risk factors as well as investing in treatment. For example, smoking is a risk factor not just for lung cancer but for at least 29 noncommunicable diseases, including dementia and cardiovascular disease. Implementing anti-smoking interventions would therefore contribute to a range of health targets, with subsequent economic benefits. A 2019 economic analysis conducted in Thailand showed that the implementation of policy packages aimed at preventing cancer and other NCDs—such as tobacco and alcohol control, salt reduction, and promotion of physical activity, all of which are part of the WHO Best Buys—would not only reduce health care expenses but also yield a return on investment (ROI) of 2.7 for every Thai baht invested.

FIGURE 4

Cancers with the Ten Highest Global Mortality Rates in 2022

Lung cancer exerts the greatest economic burden and loss of years of healthy life among the top ten cancers.

Data note: Economic costs are estimated for the years 2020 to 2050 in international dollars (constant 2017 prices). An international dollar is an artificial currency unit that would purchase a similar quantity of goods and services in a particular country as a U.S. dollar would in the United States. Data for Taiwan and Hong Kong are unavailable. Sources: IARC Globocan 2022, IHME 2021 Global Burden of Disease Study, Chen et al. (2023)

Lung, tracheal, and bronchus cancers are projected to cost the global economy $3.9 trillion between 2020 and 2050. While the most cost-effective way to address lung cancer is to prevent it entirely, prevention policies will take time to yield results and are unlikely to produce an immediate impact on incidence. As a result, policies and systems to facilitate early detection and diagnosis of lung cancer will be key to reducing the social and economic consequences of the disease. For instance, landmark large-scale randomized trials, such as the United States’ National Lung Screening Trial and the Dutch-Belgian lung cancer screening trial (NELSON), demonstrate that low-dose computed tomography (LDCT) screening for lung cancer reduced mortality of high-risk individuals by 20 and 24 percent, respectively. In Japan, increased screenings in recent years have improved the three-year survival rates to 51.7 percent across all stages of lung cancer. Moreover, Australia plans to introduce LDCT scans for high-risk populations every two years by 2025, aiming to save at least 12,000 lives via early detection and treatment.

While encouraging, there are significant barriers preventing greater access to lung cancer diagnostics such as LDCT and other screening methods. In countries with a significant tuberculosis (TB) burden, such as India and Malaysia, LDCT may be less effective as TB can lead to false positives on scans. Importantly, in countries with entrenched health inequities, such as Indonesia, the Philippines, and Malaysia, access to early detection and intervention tools and services such as LDCT screening is unevenly distributed due to high medical costs and under-investment in remote or rural areas.

Indeed, even when offered at no cost, uptake of lung cancer screening is often low, due to the associated travel costs, and potential subsequent impact on household income due to lost earnings and the high cost of care. A similar phenomenon has been noted in the case of cervical cancer screening: despite significant financial resources and publicity dedicated to ending cervical cancer, implementation in LMICs including Malaysia and Indonesia is lagging due to real or perceived costs of screening, long travel time, and the knowledge that a diagnosis could cause significant lost income from patients and any family caregivers. Lung cancer accounts for 16 percent of all global informal cancer care costs—the expenses and lost income that result from cancer patients being cared for by family members or friends, rather than in hospitals, hospices, or other formal care settings. Concerns over the future costs of a diagnosis could therefore be a major deterrent to engagement with early detection efforts.

In addition to these perceived or experienced costs, the stigma attached to lung cancer remains a significant deterrent to attending screening or seeking a diagnosis based on potential symptoms. Lung cancer is often viewed as a self-imposed illness due to its association with smoking and poor lifestyle habits. A 2018 survey undertaken in the United States found that 60 percent of respondents from the general public, and 67 percent of oncologists, agreed somewhat or completely with the statement “Lung cancer patients are at least partially to blame for their illness.” Stigma of this kind, particularly among the medical professionals responsible for lung cancer patients’ care, could undermine early diagnosis and treatment efforts aimed at reducing lung cancer mortality and disability.

A multi-pronged approach: Cancer control plans need to be paired with targeted strategies and innovative interventions for lung cancer

A survey of the national cancer control plans or programs (NCCPs) and laws across 13 Asia Pacific jurisdictions examined in this report reveals a comprehensive approach to cancer management across the region. NCCPs are vital to the planning and implementation of holistic, collaborative strategies that reflect local disease burdens and health care challenges. Without a dedicated strategy in place, cancer treatment and prevention may be deprioritized, especially given the competing health, economic, and social challenges facing countries in the region, such as demographic transition and fossil fuel transition. However, none of the countries analyzed has a dedicated lung cancer control plan. NCCPs in the region are typically designed to address all cancer types, often with targeted strategies for specific cancers, such as cervical, breast, or colorectal, and each NCCP contains notable features that reflect an understanding of local needs.

For instance, China integrates traditional Chinese medicine (TCM) with efforts to fast-track the availability of new cancer drugs, alongside leveraging technology like artificial intelligence to combat cancer, reflecting the local desire to combine traditional and cutting-edge treatment approaches. Similarly, Hong Kong allows patients to integrate TCM into their treatment and palliative care plans, such as using acupuncture for pain relief.

Indonesia’s NCCP emphasizes local and regional ownership of health care policies through participatory processes that seek to amplify patient perspectives and needs, while public hospitals in Singapore conduct multidisciplinary “tumor meetings,” fostering collaboration among experts to optimize patient care, a model used in several other Asia Pacific countries, including Australia. Malaysia has introduced an integrated cancer rehabilitation program in its plan, offering education and physical rehabilitation support as part of cancer recovery.

As part of its commitment to UHC, the Philippines’ cancer law establishes a cancer assistance fund to make treatment more affordable, with an emphasis on ensuring the fund’s sustainability within the act. To ensure that resources reach the local government level, Vietnam’s plan details budget sources comprehensively, including funds from cigarette prevention and control programs, while India’s approach empowers states and municipalities to develop and apply for funding for localized NCD and cancer strategies, as long as they align with national-level disease control targets.

Collectively, these NCCPs demonstrate varied strategies to combat cancer, from innovative funding mechanisms and technology use to prioritizing research and fostering multidisciplinary collaboration. However, they lack specificity in directly addressing lung cancer, and most plans do not mention specific budget sources, nor do they include concrete monitoring and evaluation measures for cancer policies and programs. These gaps can reduce the effectiveness of NCCPs and may undermine good-faith efforts to combat cancer broadly, and lung cancer specifically, and would benefit from the integration of specific budget and monitoring data.

In addition to NCCPs, Asia Pacific countries have devised strategies and approaches that seek to effectively use limited resources to address the lung cancer burden. For example, China, in recent years, has introduced targeted and mobile cancer screening programs to reach high-risk individuals in rural and urban areas by reducing the amount of time, money, and transportation necessary to access screening, all of which can be significant barriers to diagnosis. In Yunnan, home to the largest tin mining industry in the world, the implementation of a cancer screening program has significantly increased the early diagnosis rate, leading to better survival rates and quality of life for patients.

China is also a regional leader in developing and testing therapeutics that could be alternatives to chemotherapy, including immunotherapeutics, which aim to reduce post-operative reoccurrence of cancer and thus improve remission and survival rates. India also seeks to increase access to innovative therapies and diagnostics, for example, through the 2023 launch of free biomarker testing for cancers across the country. Lung cancer-specific testing is available in 18 centers as of June 2024. The Philippines, meanwhile, is a pioneer in collecting excise taxes on tobacco, alcohol, and sugar-sweetened beverages, earmarking the tax revenues to fund its universal health coverage (UHC) and other health programs while driving lower smoking rates in the country, reducing the smoking population by three million between 2012 and 2015.

High-income countries in the region have also implemented effective cancer control measures that encompass prevention and research. In response to the increasing incidence of lung cancer, including among never-smokers—particularly women—in East Asia, Japan offers free chest radiography or x-rays to everyone over the age of 40, either through their workplace or via their regional health service. Consequently, around 30 to 60 percent of cancer cases in Japan are detected through opportunistic screening, which happens when a health care professional offers, or a patient requests, additional tests aside from routine medical check-up.

Streamlining referral pathways and expediting access to treatments after diagnosis improve the chances of surviving lung cancer. In Denmark, reducing the waiting period for cancer diagnosis by 17 days is correlated with an increase in three-year relative survival from 11 percent to 20 percent. Delays in treatments cost lives: postponing surgery by 12 weeks after initial diagnosis increases the risk of recurrence and mortality among patients with early-stage lung cancer. Among countries examined in this report, Japan and China have implemented policies that fast-track the approval processes for cancer drugs that are already approved and available in other countries, increasing patient access to innovative treatments. Demonstrating efficiencies in the patient journey, Japanese patients can select their point of care, choosing from over 400 cancer centers nationwide, with health care expenses for average-income patients capped at USD 850 per month.

Recognizing the disparities in lung cancer diagnosis and management across diverse cultural and socioeconomic landscapes, the Philippine government has collaborated with NGOs and professional organizations in crafting its 2021 Clinical Practice Guidelines for Diagnosis, Staging, and Management of Lung Carcinoma, which aim to standardize care and provide evidence-based recommendations tailored to the country’s available health care resources and facilities. Cancer care in Australia is similarly guided by the Optimal Care Pathways, which lay out frameworks for the diagnosis, staging, and treatment of the country’s most prevalent cancers, including lung cancer, and a specific framework for treatment of Indigenous people.

India has outlined plans to upgrade the facilities and treatment standards of primary and secondary care centers throughout the country, with the aim of reducing regional and urban/rural disparities in care quality. This work includes the creation of 150,000 Health and Wellness Centres since 2017, which offer NCD prevention and diagnosis. Moreover, LMICs, such as Vietnam and India, have recognized their lack of palliative and survivorship care programs and are looking to regional models to enhance their care continuum across the patient journey. In Japan, for example, almost all cancer hospitals (90 percent) had full-time palliative care staff, an interdisciplinary palliative care team, and dedicated palliative outpatient clinics. Employing whole-of-society approaches, Singapore places a strong emphasis on rehabilitation for survivors and palliative care for terminal cases, an aspect of cancer care that is often under-appreciated or neglected. The regional disparities in cancer management call for increased cross-country collaboration on innovative practices that span the entire patient journey.

The role of multistakeholder collaboration: Combating lung cancer will require a whole-of-society approach along all stages of the patient journey

Addressing lung cancer at all stages of the patient journey, from prevention to end-of-life care and survivorship support, will require a multistakeholder approach to ensure that adequate resources—financial, human capital, and beyond—can be dedicated to those who need them. Alongside national ministries of health, social care, and finance, private-sector stakeholders such as pharmaceutical and diagnostics companies and community-based civil society organizations (CSOs) have critical roles to play in leading research, contributing resources, and ensuring that the voices of lung cancer patients and their families are heard. Within countries, the implementation of forward-looking, sustainable health policies, and the creation of resilient health systems—both of which are key to effectively combating lung cancer—requires cross-department collaboration. Ministries of health, finance, environment, education, among others, all have important and complementary roles to play in financing lung cancer detection and care, and in implementing preventive policies that address lifestyle risk factors such as smoking, air pollution, and occupational exposure to carcinogens.

Collaboration with the private sector is also a key strategy for financing lung cancer care, driving innovative research and development, and ensuring that the health care workforce stays up to date with the latest diagnostic and treatment methods. Pharmaceutical companies, medical technology companies, and private research institutions can partner with regional governments, multilateral institutions, public research institutions, and NGOs to address lung cancer, including by scaling up existing programs. For example, Indonesia’s Biomedical Genome Science Initiative (BGSi) brings together government, the private sector, and NGOs to identify relevant biomarkers for faster diagnosis and treatment of Indonesian patients, and includes a focus on breast, ovarian, and colorectal cancers. Malaysia, meanwhile, is addressing the disruption to lung cancer diagnosis and care caused by the COVID-19 pandemic through a public-private partnership that raises awareness of lung, breast, and prostate cancer symptoms and provides vouchers to cover the cost of screening in participating hospitals.

Multilateral institutions such as the WHO and development banks such as the World Bank and the Asian Development Bank can also act as conveners to bring together public- and private-sector stakeholders, shape policy and program design, and deploy their shared resources most effectively. For example, the Asian Development Bank announced an innovation challenge in early 2024 that will scale up solutions to last-mile care for NCDs, including cancer, in partnership with global non-profit PATH, which will combine governmental resources with entrepreneurial research and innovation.

Finally, as the primary users of health services and—in countries where universal health coverage is not implemented—those paying for their care, patients, and family caregivers are critical stakeholders in the design and implementation of effective lung cancer prevention, detection, treatment, and palliative policies. To that end, CSOs can act as facilitating bodies to convene, channel, and amplify the voices of patients and help advocate for their needs. A 2016 survey of 183 organizations operating in 18 Asian countries found that numerous CSOs working on lung cancer are active in the Asia Pacific region, many of which act as a platform for cancer patients and their families to connect with politicians and policymakers. Indeed, over half of those surveyed engage with government decisionmakers, while 46 percent work directly with the private health sector, indicating that CSOs in the region see patient advocacy as a significant aspect of their responsibilities. Of note, the survey found that organizations in countries with lower health care expenditure per capita were more likely to have been established for longer, and to work with over 500 patients per year, suggesting that they are filling a crucial gap in not only advocacy but also patient support.

Looking ahead: eliminating lung cancer in the Asia Pacific

Lung cancer’s deadly impact on populations in the Asia Pacific region positions it as a pressing health, social, environmental, and economic challenge to be addressed. Significant investment, including both public and private, to build strong health care systems will be a key component of any strategy to control lung cancer, through targeted lung cancer-specific interventions and the creation of UHC in line with the SDGs and other UN health targets.

NCCPs will be critical to ensuring the continued prioritization of cancer control but will be most effective if they include clear evaluation mechanisms and frameworks, and if implementing bodies are transparent regarding progress toward stated targets. Clear, data-driven targets for cancer control—and an explicit focus on lung cancer as a major driver of death and disability in the region—will be necessary to maintain and accelerate progress. While all countries analyzed in this report already have general NCCPs and NCD control plans, lung cancer-specific strategy documents are the exception, not the norm. This gap represents a fruitful area for governments to take the lead in lung cancer control and to identify potential non-governmental partners with whom to collaborate in strategic, targeted, and meaningful ways.

While increased incidence of lung cancer is heavily correlated with industrialization and economic development, it is not an inevitable consequence of economic growth in the Asia Pacific region. Through targeted, data-driven policies and strategies, impactful cross-sectoral partnerships, and increased investment in health care resiliency, the countries in this region can dramatically reduce death and disability from lung cancer, and seek to achieve the SDGs, given strong leadership from government. This special report and accompanying case studies seek to contribute to this multistakeholder effort through the identification of impactful, cost-effective interventions that can be adapted to the specific context of countries in the Asia Pacific region and elsewhere.

Beyond the scope of this report, promising areas for future research could include in-depth analysis of innovative new approaches to lung cancer treatment, case studies focusing on other countries within the Asia Pacific region, and cross-regional analyses between the Asia Pacific and other parts of the world significantly impacted by lung cancer and other NCDs, such as Latin America. Research of this kind is itself a critical contribution to effective lung cancer control, particularly when it applies a cross-cutting lens to analysis, looking beyond health impacts to understand the economic and environmental benefits and drawbacks of lung cancer control and incidence. Such work could be supplemented and strengthened by regional convenings, bringing together stakeholders from across multiple sectors to share their expertise, exchange lessons learned, and craft innovative approaches to the ongoing challenge of lung cancer.  

By Angeli Juani (Senior Policy and Quantitative Analyst), Isabel Schmidt (Senior Policy Analyst and Research Manager), and Dr. Mayesha Alam (Vice President of Research), with contributions from Muhamed Sulejmanagic (Graduate Research Assistant). Art direction and design by Sara Stewart, illustrations by Nhug Le.