Take a deep breath: Lung cancer in Malaysia

While lung cancer shares the stage with colon cancer as the common form of cancer in men, lung cancer has a higher mortality rate because it is often detected too late, says Dr Anand Sachithanandan, consultant cardiothoracic surgeon at Subang Jaya Medical Centre.

FEBRUARY 3, 2019

When it comes to treatment, Dr Anand Sachithanandan emphasises the need for early detection of lung cancer.

“In Malaysia, at initial presentation and diagnosis of lung cancer, only 3% of people are in stage one and 7% in stage two. The remaining 90% of lung cancer patients were diagnosed in either stages three or four.”

He adds, “According to the Malaysian Study on Cancer Survival 2018, the five-year relative survival rate for lung cancer across all stages is 11%. Hence, lung cancer is the worst performing of all cancers, and the median time of survival after being diagnosed is only 6.8 months.”

Spreading The Word

“From the results of several local surveys, it was noted that around 90% of people know that smoking causes lung cancer, which is good. However, 50% to 60% of participants mistakenly think only men get lung cancer, and about 70% think that lung cancer is a communicable disease,” says Dr Anand.

“These results tell us that awareness on lung cancer in Malaysia is still quite low. We need to help the public be more aware of the disease, so they are better informed to self-refer earlier on to medical professionals should they feel something is wrong.”

For primary care doctors, Dr Anand has some advice, “These doctors see many patients with various ailments daily, hence some may overlook the differential diagnosis of lung cancer and provide patients with ‘normal’ treatments such as cough mixture or antibiotics.

“Doctors need to be more aware and think more about the possibility of lung cancer so they can do thorough checks and refer their patients to a specialist.”

Lifetime risk of lung cancer.

Receive The Right Care

When it comes to treatment, Dr Anand emphasises the need for early detection of lung cancer. “There are two goals when treating lung cancer. The goal of treatment for early stage cancer is curative, where we hope to cure the patient.

For curative treatment, Dr Anand recommends surgery as the best treatment option if the patient is fit enough, as it will remove the cancerous part of the lung. “It is the best chance to cure the disease, and it presents the patient with his best chance for long-term survival.”

After surgery, follow-up screenings are done for a minimum of five years to ensure total eradication of the cancer from the body.

Multimodality in treatment is practised, as some patients require further treatment before or after surgery such as chemotherapy and radiotherapy to ensure complete tumour clearance and minimise the chances of recurrence.

Patients with later stages of lung cancer will usually be treated with palliative or symptomatic intent, where treatment focuses on controlling the tumour.

Rarely is surgery performed to relieve the patients of their pain or distressing symptoms, such as if the tumour is eroding into the chest wall, they are coughing up blood, and they have fluid around their lungs.

Lung cancer survival rate in Malaysia.

Changing Minds, Changing Lives

Recent policy changes passed by the government to ban smoking from eateries and restaurants show that efforts are being made towards increasing public awareness on the dangers of smoking.

Dr Anand also provides some advice to reduce the risks of lung cancer:
♦ Non-smokers should know that they have the right to inhale smoke-free fresh air.
♦ Make a sincere and concerted effort to quit smoking. Better still, don’t start smoking in the first place.
♦ Eat in moderation and exercise regularly.
♦ Go for health screenings.

However, he recognises that prevention itself is not enough as there is still a problem with stigma and misconceptions relating to lung cancer, which affects the way the public and even doctors view lung cancer patients.

He explains, “There is the common assumption that all lung cancer patients are smokers, and that they have brought it upon themselves. Our role is not to judge, but to treat these people. While we can advise them against smoking, this is not the right time to chastise them for smoking.”

Dr Anand adds that people have to realise that an increasing number of non-smokers and women are getting lung cancer. Some factors include:
♦ Cooking with a wok
Cooking fumes at high temperatures in a confined space may contribute to lung cancer.
♦ Second-hand smoke
Long-term exposure to second-hand smoke inadvertently makes people passive smokers.
♦ Third-hand smoke
Cigarette residue on furniture and surroundings may also cause lung cancer.

He continues, “We should not be complacent because anyone could get lung cancer depending on our lifestyle choices or genetic predisposition. The only things you can do is to not smoke, live a healthy lifestyle, and go for screening if you are in a high-risk group.”

For more information, call 03-5639 1212.

https://www.star2.com/health/2019/02/03/lung-cancer-malaysia

Let’s look at lungs, closely

Lung cancer is the third most common cancer in Malaysia, accounting for 19.8% of all medically certified cancer mortality in this country (Second Report of the National Cancer Registry, Cancer Incidence in Malaysia).

Monday, 26 Mar 2018

Catch it early: The importance of early diagnosis cannot be emphasised enough – early detection of lung cancer remains the cornerstone of treatment success.

Since most lung cancer patients are diagnosed when they reach an advanced, incurable stage, mortality rates in Malaysia remain high – over 75% of lung cancer cases are diagnosed at either stage III or IV, and often, patients can only be offered palliative but expensive therapy.

It is a well known fact that individuals who have had family members diagnosed with cancer are prone to developing the disease themselves.

And while genetics may predispose certain people to lung cancer, cigarette smoking remains a major risk factor.

Local data suggests 92% of Malaysian male lung cancer patients have a significant history of smoking.

Lung cancer occurs mostly in men over age 50, and the incidence in those under age 40 is relatively lower (approximately 5%).

In spite of the statistics, cigarette smoking in Malaysia starts early, with a whopping 36.9% of children between ages 14 and 15 using e-cigarettes and vaping devices.

Despite the Government’s best efforts to deter Malaysians from picking up the habit – including a National Strategic Plan to make Malaysia smoke-free by 2045, the prevalence of smoking in Malaysia is exceptionally high.

Smoking not only harms the health of an individual or family, but has serious implications on our national treasury.

The morbidity and therapy of smoking-related diseases account for approximately RM440mil annually, and is thus a major economic burden on our personal and national healthcare finances.

The high prevalence of lung cancer in Malaysia and the fact that smoking is the most common, preventable cause of death, mandates serious consideration for disease screening.

Screening for lung cancer ups the chances of early diagnosis, facilitating early effective intervention.

There is no question that the earlier a lung cancer is diagnosed and treated, the better the patient’s chance of survival.

Studies from the United States, UK and Europe have shown that screening for lung cancer increases the chances of early diagnoses.

Published studies evaluating the efficacy of a lung cancer screening programme indicate the need to target screening of individuals of the highest risk to make the programme cost-effective.

Our collective challenge, therefore, is to identify that high-risk group here in Malaysia.

A pilot study targeting a smaller “at risk” based on local epidemiology of the disease should be undertaken to determine precisely who should be screened.

Of course, a national anti-smoking policy that prevents tobacco use is far more effective than a screening programme.

After all, we are all familiar with the adage, prevention is better than cure.

Some might argue that national resources and efforts should be prioritised for preventative strategies instead, but this will only address a future generation.

Even if all cigarette smokers were to quit smoking today, it would take 20 years before the resulting decrease in mortality from lung cancer becomes evident.

Lung cancer screening does not compete or contradict efforts to promote smoking cessation.

Lung cancer is a major and costly health concern and the leading cause of cancer-related deaths in this country.

Due to the long latency phase of lung cancer, smoking cessation will have minimal impact for many decades.

The importance of early diagnosis cannot be emphasised enough – early detection of lung cancer remains the cornerstone of treatment success.

A well-executed and comprehensive screening programme may potentially save many lives and billions of ringgit in the long term, although admittedly evaluating cost-effectiveness is not straight forward.

It is imperative, however, that appropriate clear guidelines and quality assurance programmes are established by a dedicated multi-disciplinary interest group prior to embarking on a national screening programme.

The case for lung cancer screening in Malaysia is persuasive and the decision time is now.

https://www.thestar.com.my/news/nation/2018/03/26/lets-look-at-lungs-closely-screening-for-lung-cancer-in-malaysia-are-we-there-yet/

‘Cancer victims seeking alternative treatment a worrying trend’

KUALA LUMPUR: The Government has expressed concern over the trend of cancer patients seeking alternative treatments that have not been scientifically proven, says Deputy Prime Minister Datuk Seri Dr Wan Azizah Wan Ismail.

Friday, 27 Jul 2018

“Such unproven methods actually worsen their health.

“While it is good that cancer was detected at its earliest stage, seeking proper medical treatment is vital.

“It could be a question of trust. As a result, patients who sought alternative treatments only approach medical specialists when the cancer has spread,” she said at the launch of the War on Cancer campaign here yesterday.

The campaign is an initiative by the College of Physicians of Malaysia, Academy of Medicine of Malaysia, Academy of Family Physicians of Malaysia and Academy of Sciences Malaysia.

It provides a platform for various government medical-related agencies and higher learning institutions to raise awareness on cancer among the public through research, improved cancer management and supporting cancer patients and their families.

Dr Wan Azizah, who is also Women Development, Family and Community Minister, said the Health Ministry’s statistics for 2016 showed that cancer was the third highest cause of deaths at government hospitals at 13.6%, compared to 8.9% in 1996.

She said the follow-up management after early detection of cancer should be emphasised.

“This includes curative and follow-up treatment that is carried out on evidence-based protocol.

“The Government is committed to finding the best way to prevent the spread of cancer. The gap in the prevention and elimination of cancer must be closed,” she added.

https://www.thestar.com.my/news/nation/2018/07/27/cancer-victims-seeking-alternative-treatment-a-worrying-trend