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Lung cancer was the leading malignancy worldwide in terms of both incidence and mortality in 2022.1Bray F. Laversanne M. Sung H. et al.Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2024; 74: 229-263Crossref PubMed Scopus (472) Google Scholar Asia bears the highest disease burden of lung cancer, with 63.1% of newly diagnosed lung cancers and 62.9% of lung cancer deaths occurring in the region.2Cancer fact sheets: lung cancer.https://gco.iarc.who.int/media/globocan/factsheets/cancers/15-trachea-bronchus-and-lung-fact-sheet.pdfDate accessed: May 11, 2024Google Scholar However, the continent exhibits significant internal heterogeneity. For example, while Eastern Asia and South-Central Asia (the geographical definition of the United Nations) collectively account for 20.5% and 26.1% of the global population, they exhibit contrasting rates of lung cancer incidence, contributing 50.1% and 5.2% of new cases, respectively (Fig. 1).3Ferlay J. Ervik M. Lam F. et al.Global cancer observatory: cancer today. Lyon, France: International Agency for Research on Cancer.https://gco.iarc.who.int/todayDate accessed: May 11, 2024Google Scholar In light of these disparities and the imperative to alleviate the global burden of lung cancer, effective implementation of preventive, screening and therapeutic strategies for better lung cancer control across Asia is of utmost importance. While some obstacles for lung cancer control are universal, such as smoking cession, uptake of lung screening and accessibility to the newly proved therapy, there are specific challenges in this region. Lung cancer in Asia is characterized by a high proportion occurring in non-smokers. The pathogenic mechanisms indicate that genetic susceptibility and environmental carcinogens including PM2.5 may play crucial roles.4Chen Y.J. Roumeliotis T.I. Chang Y.H. et al.Proteogenomics of non-smoking lung cancer in East Asia delineates molecular signatures of pathogenesis and progression.Cell. 2020; 182: 226-244.e217Summary Full Text Full Text PDF PubMed Scopus (181) Google Scholar It is generally believed that air pollution, primarily emanating from factories, power plants, and vehicles, is the major cause responsible for lung cancer in non-smokers. However, these factors are among the most difficult ones to manage, especially in developing countries. Screening is the second most effective measure for cancer control. Although the efficacy of low-dose computed tomography (LDCT) screening in smokers is proven, its implementation in Asia is limited due to the high cost, which is unaffordable in many countries. Additionally, the indications, intervals, and efficacy of LDCT screening in non-smokers are not yet fully established.5Lam D.C. Liam C.K. Andarini S. et al.Lung cancer screening in Asia: an expert consensus report.J Thorac Oncol. 2023; 18: 1303-1322Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar The Lung Cancer series in Asia, jointly published in eClinicalMedicine, The Lancet Regional Health—Southeast Asia, and The Lancet Regional Health—West Pacific, comprises three exceptional articles elucidating the distinct patient demographics, alongside the environmental and socioeconomic characteristics related to lung cancer in Asia. These comprehensive reviews hold the potential to set the stage for developing region-specific interventions aimed at reducing the burden of lung cancer and improving treatment quality for patients across Asia. The first paper discusses the impact of extreme weather events, predominantly caused by profound climate changes over the past decade, on the screening, diagnosis, and management of lung cancer patients across Asia.6De Guzman R.B. Malik M. Singh N. Loong H.H. Mohan A. Lung cancer in Asia: the threat and impact of climate change.eClinicalMedicine. 2024; https://doi.org/10.1016/j.eclinm.2024.102680Summary Full Text Full Text PDF Scopus (1) Google Scholar Influences on lung cancer treatment may include, but are not limited to, treatment delays, challenges in pharmacokinetics, and disruptions in the drug supply chain. Given that many Asian countries are low- and middle-income countries, disparities in healthcare infrastructure and fragmented healthcare systems will render them more vulnerable to extreme weather events, thereby posing additional challenges in this region. The second paper discusses several aspects of differences in lung cancer, including epidemiology and risk factors in Asia versus other regions.7Noronha V. Budukh A. Chaturvedi P. et al.Uniqueness of lung cancer in Southeast Asia.Lancet Reg Health West Pac. 2024; https://doi.org/10.1016/j.lansea.2024.100430Summary Full Text Full Text PDF Scopus (1) Google Scholar It also addresses the complexities of its management; for example, the difficulties in accessing molecular testing and new anticancer therapies, the impact of endemic infectious diseases such as tuberculosis on cancer diagnosis, staging, and treatment, and the challenges in the implementation of LDCT lung cancer screening programs. The third paper delves into the contemporary landscape of gene testing, novel drug development, and the regulatory approval framework in Eastern Asia.8Liu S.M. Jin Z.Y. Deng J.Y. et al.Drug development and evidence for lung cancer targeted therapy in Eastern Asia.Lancet Reg Health West Pac. 2024; https://doi.org/10.1016/j.lanwpc.2024.101090Summary Full Text Full Text PDF Scopus (1) Google Scholar Countries in this region, typically endowed with better healthcare infrastructure and skilled personnel relative to other Asian counterparts, have a greater chance to access cancer clinical trials, which would facilitate earlier regulatory approval and reimbursement of these emerging drugs. Concurrently, they also exhibit the capability to independently lead the development of novel therapeutic agents. Given the disparities in lung cancer presentation between Asia and Western countries, it is crucial for management guidelines and public health policies to acknowledge these differences.5Lam D.C. Liam C.K. Andarini S. et al.Lung cancer screening in Asia: an expert consensus report.J Thorac Oncol. 2023; 18: 1303-1322Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar For instance, a substantial portion of lung cancer patients in Asia, particularly females, are non-smokers. If LDCT screening programs exclusively target heavy smokers, the efficacy of reducing lung cancer mortality in Asia could be compromised. Addressing this concern, a pivotal study in non-smoking lung cancers was conducted in Taiwan.9Chang G.C. Chiu C.H. Yu C.J. et al.Low-dose CT screening among never-smokers with or without a family history of lung cancer in Taiwan: a prospective cohort study.Lancet Respir Med. 2024; 12: 141-152Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar Based on the results, when the national LDCT screening program was launched in 2022, the Taiwanese government decided to extend screening eligibility to individuals with a family history of lung cancer in addition to heavy smokers. Similarly, while NCCN guidelines recommend broad molecular profiling upfront in advanced non-small-cell lung cancer patients, researchers propose a sequential approach in Eastern Asia. Starting with EGFR mutation testing followed by next-generation sequencing proves to be a more cost-effective strategy due to the high prevalence of EGFR mutation in the region.10Yang S.C. Yeh Y.C. Chen Y.L. Chiu C.H. Economic analysis of exclusionary EGFR test versus up-front NGS for lung adenocarcinoma in high EGFR mutation prevalence areas.J Natl Compr Canc Netw. 2022; 20: 774-782.e4Crossref PubMed Scopus (8) Google Scholar Lung cancer is the most important global threat in oncology. While certain measures to control lung cancer, such as anti-smoking campaigns, are universally applicable, others may necessitate adaptation to address region-specific challenges or requirements. Approximately half of all new lung cancer cases in 2022 were diagnosed in Asia; however, this figure is likely underestimated due to deficiencies in the cancer registry systems of many Asian countries. Accessibility to LDCT screening, molecular testing, and targeted therapy and immunotherapy remains limited across much of the Asian population. Consequently, health inequalities are poised to emerge as a significant concern in this region, mirroring the challenges observed in Western countries. Chao-Hua Chiu: Conceptualization, Data curation, Visualization, Writing—original draft. Pan-Chyr Yang: Conceptualization, Data curation, Validation, Visualization, Writing— review & editing, Supervision. Chao-Hua Chiu and Pan-Chyr Yang declare no conflict of interest related to the content of the manuscript.
Chiu et al. (Mon,) studied this question.