By Zakwan Khidzir,

Lung cancer has long carried a grim distinction in Malaysia. It remains the leading cause of cancer-related death among men and the second leading cause among women after breast cancer. For years, survival outcomes have lagged behind global benchmarks. The current five-year relative survival rate stands at approximately 11 per cent, with an estimated 95 per cent of cases detected at late stages, Stage 3 or Stage 4, when treatment options are more limited and outcomes significantly poorer.

Yet 2025 marks a pivotal year, with major developments that signal a more coordinated and ambitious national response.

Speaking on BFM 89.9’s Health & Living segment titled “Public Health: Progress in Lung Cancer Care”, Prof. Dr. Murallitharan Munisamy, Managing Director of The National Cancer Society of Malaysia (NCSM) described the newly launched Malaysian Lung Cancer Clinical Practice Guidelines (CPGs) as a “compass” for cancer care.

“They give direction on how to operationalise every aspect of care,” he said.

Until recently, Malaysia relied heavily on international guidelines that did not fully account for local realities including the high incidence of lung cancer among never-smokers and the prevalence of genetically driven cancers in Asian populations.

The new consensus-driven CPGs, published by the Lung Cancer Network Malaysia (LCNM) after more than a year of multidisciplinary collaboration, aim to harmonise standards of care nationwide. Importantly, they also empower patients by clarifying what their treatment journey should look like and what level of quality care they are entitled to expect.

The guidelines outline 21 key evidence-based statements focusing on perioperative care for resectable non-small cell lung cancer (NSCLC) — specifically clinical Stage 1, Stage 2 and carefully selected Stage 3 cases.

They emphasise three core principles:

1. Timeliness of Intervention

The CPGs recommend a maximum interval of four to six weeks from consultation to definitive treatment. While acknowledging systemic constraints across public and private healthcare sectors, the guidelines set this as a benchmark to prevent early-stage disease from progressing during delays.

2. Precision Diagnostics

Molecular biomarker testing is no longer optional. Dr Muralli described it as “a crime” for patients to be unaware of such testing after diagnosis. The guidelines call for reflex molecular testing — automatically initiated at diagnosis — to ensure swift turnaround times and enable personalised treatment strategies. This includes testing for key biomarkers that guide targeted therapies.

3. Multidisciplinary Team (MDT) Approach

Optimal care requires multimodal planning. Every case, the guidelines state, should be discussed in a tumour board setting before treatment begins, ensuring surgeons, oncologists, pathologists and radiologists jointly determine the best course forward.

Improving survival requires what experts call a “stage shift”, detecting more cases at earlier, more treatable stages.

Dr Muralli outlined how NCSM is operationalising the CPG principles through technology-driven screening and financial access solutions.

Leveraging AI for Smarter X-rays

Malaysia already conducts approximately 5.5 million chest X-rays annually. Rather than creating entirely new screening systems, NCSM is enhancing the quality of existing imaging by integrating artificial intelligence to improve detection accuracy.

AI-assisted readings can flag suspicious nodules, including interstitial pulmonary nodules that may progress to cancer if left undetected. This approach aims to catch abnormalities earlier without significantly increasing healthcare system burden.

LungShield: Closing the Financial Gap

Complementing early detection efforts is LungShield, a micro-insurance product offered at approximately RM100 per year. Traditional insurance policies typically do not cover screening and early diagnostic investigations. LungShield fills this gap.

If an AI-assisted X-ray identifies abnormalities, LungShield covers follow-up tests, including:

• Low-dose CT (LDCT) scans
• Biopsy procedures
• Staging CT scans (chest, abdomen and pelvis)
• Molecular testing for biomarkers such as EGFR, ROS1 and ALK

By aligning financial coverage with CPG recommendations, the system seeks to make guideline-concordant care more equitable.

For patients with advanced disease, Dr Muralli confirmed that NCSM has secured external charitable funding to provide high-cost immunotherapies to at least 400 public sector patients — helping narrow the treatment-access gap.

Malaysia’s lung cancer reforms are unfolding within a larger global and national policy framework.

In May last year, the World Health Assembly adopted a global resolution on integrated lung health, a motion spearheaded by Malaysia’s Ministry of Health. Rather than addressing lung diseases in isolation, the resolution calls for a unified approach to respiratory health, encompassing infectious diseases, occupational exposures and cancer.

At the national level, the Ministry of Health Malaysia has launched the National Lung Health Initiative 2025–2030. The initiative aims to reduce deaths from tuberculosis (TB), chronic obstructive pulmonary disease (COPD) and lung cancer by 30 per cent by 2030.

A cornerstone of the strategy is the nationwide deployment of AI-powered screening tools at public health clinics. Instead of fragmented pathways, patients will be routed into disease-specific care streams based on risk factors such as smoking history, occupational exposure or genetic predisposition.

Despite technological advances and new standards of care, prevention remains the most powerful intervention.

Tobacco control is central yet enforcement of smoking regulations, Dr Muralli noted, can be “lackadaisical.”

To combat this apathy and push for societal transformation, Dr. Muralli outlined Malaysia’s large-scale prevention programmes assisted by NCSM. This includes JomLapor, JomSihat and JomQuit. 

JomLapor is a citizen reporting portal that now handles about 500 reports a day on non-compliance with smoking bans, which are compiled and sent to authorities to ensure action.  Meanwhile, JomSihat is a programme that visits every secondary school in the country to educate children about the exposure risks of vape and tobacco. Finally, JomQuit is a large-scale online cessation programme that connects 600–700 people daily with providers across the country.  

Together, these programmes aim to shift public behaviour while strengthening policy enforcement.

The convergence of robust clinical guidelines, AI-enabled screening, financial protection mechanisms and prevention campaigns marks one of the most comprehensive lung health efforts Malaysia has undertaken.

While challenges remain, the combination of robust guidelines, innovative screening solutions, and proactive prevention strategies offers a clear roadmap. These movements provide hope and are leading to progress in where we are in terms of treatment of this particular cancer, with the ultimate goal of improving Malaysia’s five-year survival statistics.