Country context

As of 2022, Malaysia had a population of just under 34 million people, around 70 percent of whom live in urban areas. Since the implementation of universal health coverage (UHC) in the 1980s, Malaysia has made significant progress in improving health outcomes. Currently, almost three-quarters of the population relies on the public health system, and 98 percent of public health care costs are subsidized under UHC. As a result, health spending represented 10 percent of the 2021 federal budget. However, an aging population and growing incidence of non-communicable diseases (NCDs), including cancer, are driving concerns over health care spending. One in seven Malaysians is expected to develop cancer before the age of 75, and cancer is already the second-leading cause of premature death in the country. High cancer prevalence and mortality have a clear impact on economic growth: the Malaysian government estimates that cancer is responsible for around 14 percent of all productivity loss due to illness and disability. In fact, lung cancer’s economic burden is felt on both the societal and household level: a 2015 study found that 45 percent of Malaysian cancer survivors spend over one-third of their household earnings within the first year of diagnosis.

Lung cancer therefore represents a significant challenge to Malaysia’s health and economic development. As of 2022, the country had an overall lung cancer incidence of 15.1 cases per 100,000, and a mortality rate of 13.1 deaths per 100,000. There is significant gender variation within these trends: incidence among men is 23.2 cases per 100,000 people, compared to just 7.1 cases among women. Similarly, mortality rates diverge based on gender, with a male mortality rate of 20.4 deaths per 100,000, and a female mortality rate of 5.9 deaths per 100,000. Critically, an estimated 90 percent of lung cancer patients are diagnosed at stages III and IV, making early detection and prevention key to reducing both incidence and mortality in Malaysia.

Several factors, including behavioral, environmental, and structural, are contributing to the high lung cancer incidence and mortality rates. Tobacco use remains relatively high: while the overall prevalence of tobacco use in 2022 was 22 percent, among men prevalence was 43.3 percent, compared to just 0.7 percent among women. Air pollution is also a major challenge, as it is to the region more broadly. In 2022, 12 percent of lung cancer and chronic obstructive pulmonary disease (COPD) deaths in Malaysia were related to long-term exposure to particulate matter (PM) pollution. The National Malaysian Ambient Air Quality Standards allow for annual concentrations of PM2.5 and PM10 that are almost three times higher than the WHO guidelines, and the country also suffers from regional transboundary haze events.

Malaysians have low awareness and recognition of lung cancer symptoms, and stigma around lung cancer remains high, deterring people from seeking diagnosis early on. For those who do seek diagnosis and treatment, long wait times for test results can lead patients to abandon their care plans, as can logistical challenges. Around 20 percent of lung cancer patients default on follow-up care due to difficulty in accessing health care centers. Moreover, the high costs of screening and treatments act as a deterrent: a 2019 survey of 180 Malaysian high-risk patients found that although 78 percent would undergo CT scanning for lung cancer if recommended to do so, that number dropped to just 41 percent if required to pay out of pocket, which is currently the case.

Assessing policies and programs

Malaysia’s approach to cancer is guided by the National Strategic Plan for Cancer Control Programme (NSPCCP) 2021–2025, which seeks to address cancer along the patient journey, from prevention to early diagnosis, treatment, rehabilitation, and palliative care. The 2021–2025 Programme is focused on improving monitoring and surveillance of cancer incidence and mortality, and building the human capacity of health care workers. The 2021–2025 NSPCCP sets clear, data-based targets, although these are either generalized to all cancers or specific to breast, colorectal, and cervical cancer, with no disaggregated lung cancer policies or targets.

Overall, the current NSPCCP aims to reduce the risk of premature mortality from cancer by one-third by 2030, in line with the targets of SDG 3.4.1, which would be a reduction from a mortality rate of 5.7 percent in 2019 to 3.8 percent by 2030. Notable features of the NSPCCP include the integration of traditional and complementary medicines, which are still favored by many Malaysians, and the introduction of an integrated Cancer Rehabilitation Programme. This program provides support throughout treatment, and assists in return-to-work or -school plans, offering education, exercise, and nutrition support, and physical rehabilitation services. In addition, Malaysia recently launched a National Palliative Care Policy and Strategy 2019–2030. Currently, only 10 percent of patients in need of palliative care—an estimated 220,000 Malaysian adults and 31,000 children—are receiving it. In response, the palliative care strategy seeks to fully integrate palliative care into the health care system, including for cancer patients, through cross-sectoral collaboration.

Despite the NSPCCP 2021–2025’s focus on prevention and early diagnosis, lung cancer is neglected in the strategy, and gaps remain. There is currently no national lung cancer screening program, despite the existence of screening programs for breast, oral, colorectal, and cervical cancers, which demonstrate that the health service is able to support such activities. Similarly, low-dose computed tomography (LDCT) screening is unavailable through the public health service and can only be accessed via some private facilities. The private health care sector appears to be working to fill some—but not all—of these gaps in prevention and early diagnosis. AstraZeneca Malaysia, for example, has entered into a public-private partnership with the Lung Cancer Network Malaysia (LCNM), and Qure.ai to provide artificial intelligence (AI) x-ray screenings at primary care facilities for early detection of lung cancer. The AI technology enables rapid analysis of x-rays, intended to reduce patient wait times and support faster diagnosis while reducing the rate of patient drop-off, with the aim of improving survival rates by up to 30 percent.

Smoking, including its prevention and cessation, is a key concern for the Malaysian government. The 2023 Control of Smoking Products for Public Health Bill places a ban on advertising tobacco products on TV, radio, and billboards, prohibits advertising or branding on tobacco product packaging, and prohibits the sale of such products to minors. Alongside it, the National Strategic Plan for the Control of Tobacco & Smoking Products 2021–2030 seeks to achieve a smoke-free Malaysia by 2040. It sets the clear goals of maintaining smoking prevalence of women at less than 5 percent, and to reduce overall smoking prevalence below 15 percent by 2025, and below 5 percent by 2040. Like the NSPCCP, the tobacco strategy sets out a clear monitoring framework, including by assigning specific responsibilities to different public- and private-sector actors. If widely implemented and enforced, these policies could help reduce tobacco-related risks factors for lung cancer.

Malaysia is also working to improve its air quality. In 2021, the government committed to cutting greenhouse gas emissions against GDP by 45 percent, compared to 2005 levels by 2030, as part of its revised nationally determined contribution (NDC) plan. In addition, the 2009 National Green Technology Policy seeks to reduce energy consumption while enabling green development, including in construction, the energy sector, and transportation. As part of this push, Malaysia is positioning itself as a regional developer and manufacturer of key components for electric vehicles, particularly developing energy-efficient batteries. To encourage uptake of electric vehicles, owners have been granted an exemption from road taxes between 2022 and 2025, after which a new, lower road tax will be available. While these policies may improve air quality, it will be critical to bring Malaysian air quality standards in line with the WHO guidelines in order to effectively contribute to lung cancer prevention.

FIGURE 2

GRIP: Gains, Risks, Innovations, Prospects in Policies and Programs

Opportunities ahead

Although Malaysia is working to address its cancer burden, gaps and opportunities remain, particularly to tackle lung cancer. The integration of specific, data-driven lung cancer-specific targets into the next NSPCCP is critical to this goal, as it would demonstrate the government’s commitment to lung cancer control, and direct resources to its implementation. The aftermath of the COVID-19 pandemic, as governments and populations seek to return to normal life, represents a key moment for expanding and strengthening cancer interventions—particularly lung cancer. For example, the LCNM and NCSM are partnering with the private sector to launch a “New Normal, Same Cancer” campaign to bring patients back into care pathways disrupted by the pandemic. This campaign includes raising awareness of cancer drivers and symptoms, lobbying the government to improve early detection, and encouraging Malaysians to undergo cancer screenings. It will also provide vouchers to patients to cover the costs of screening and consultation for lung, breast, and prostate cancer in participating hospitals, which would remove a major barrier to early detection and treatment cost.

New and emerging technologies also represent a promising pathway for lung cancer diagnosis and treatment. Instituting a national lung cancer screening program, and expanding access to innovations such as LDCT screening or AI-enabled x-ray screening, could significantly improve early detection rates and increase survival rates as a result. Such public-private partnerships represent a fruitful way for the government to augment its limited resources and ensure that more citizens receive the necessary care. Private health care facilities are also increasingly offering services such as companion diagnostics and immunotherapy treatments, which enable more targeted care for cancer patients, while academia is focused on expanding research into next-generation sequencing to identify high-risk individuals. Nevertheless, given the high cost of private health care in Malaysia, public sector leadership and investment will be key to the widespread deployment of these potentially beneficial technologies and, ultimately, curbing lung cancer.