Why lung cancer persists

Lung cancer remains one of the common types of cancers in the Philippines, ranking second in terms of number of cases. 

Yet, it remains the deadliest form of cancer not only in the country, but worldwide, and experts stressed that it is precisely because the disease progresses quietly, without pain, until it is already too advanced for many patients.

In a recent discussion on Thursday, experts said that while breast cancer is more common, far more people die from lung cancer, and this is tied to the anatomy of the human body and the late arrival of symptoms.

Dr. Tony Ramos, a lung cancer specialist and a thoracic oncology expert explained that breast cancer is easier to detect since the breasts are accessible, visible, and abnormalities can be felt through self-examinations. Breast lumps also tend to be painful. 

Lung cancer, on the other hand, develops inside the chest, protected by the ribcage, and it does not have as many nerve endings, the reason being why a tumor can start to grow without causing any pain.

In fact, Ramos noted that early-stage lung cancer can reach a 10-year survival rate of around 90 percent, with most patients later dying of other causes, not the cancer. 

To avoid missing treatable disease Ramos emphasized that all doctors in practice should consider lung lesions as cancer unless proven otherwise.

Risk factors

According to the National Cancer Institute, smoking is the leading cause of lung cancer, with tobacco smoke containing over 7,000 chemicals, many of which are known to cause cancer. Inhaling second-hand smoke can also increase a person’s risk of developing lung cancer by 20 to 30 percent. 

However, the other risk factor is one’s family history of cancer. 

“We’re seeing that in non-smokers. We even have a term for it: ‘never-smoked individuals,’ especially among women,” Ramos said.

Vaping also remains under scrutiny. A vape is a device that simulates tobacco smoking consisting of an atomizer, a power source, and a container. Instead of smoke, the user inhales the vapor. 

Ramos admitted that “they lost the battle” when e-cigarettes were aggressively marketed, but continued the fight through research.

“The marketing then was going to be a step down from smoking. It's going to be a good substitute, a healthy substitute for smoking— it’s not.”

Latest data from the Global Cancer Observatory in 2022 logged 23,728 new cases of lung cancer in the Philippines, accounting for 12.6 percent of all new cancer cases. It also caused 20,953 deaths the same year, representing 18.5 percent of all cancer-related deaths. 

Can the prevalence of lung cancer be reduced? 

Laryngeal cancer survivor and global anti-smoking advocate Engr. Emer Rojas said it can be through early detection. 

Rojas emphasized that the problem is not that technology does not exist. It’s that life-saving tools are not reaching Filipinos early enough. Artificial Intelligence (AI), in fact, has been integrated with x-rays currently being piloted in the De La Salle University Medical Center. 

A low-dose chest CT scan (LDCT) is also the standard for lung cancer screening because it can detect nodules long before they cause symptoms, but LDCT is on the pricier side, and most Filipinos are afraid of the costs that may follow after check-ups. 

“We Filipinos, we don’t get check-ups, we don’t go to the doctor. When you’re already sick and finally go to the doctor, your first question isn’t ‘Will I get better?’—it’s ‘How much will it cost?’ That’s what scares us,” Rojas said.

Such cost-driven hesitation is among what keeps Filipinos from getting screened early. Thus, experts are pushing PhilHealth to include the LDCT scans in the screening tests that are reimbursable under the YAKAP program. 

“Many Filipinos will benefit from this. For example, if I’m high-risk and I don’t have PhilHealth, I really can’t afford to get the scan done. But if PhilHealth covers it, then it becomes our job to encourage people. At least it won’t be because of a lack of money,” Ramos said. 

Yet, even when PhilHealth extends coverage to LDCT, patients cannot benefit if institutions refuse or are unable to honor it. 

AstraZeneca Philippines Medical Affairs Director Dr. Cyril Tolosa urged more diagnostic centers and institutions to enroll in PhilHealth’s accreditation system so that cancer-related services can be reimbursed. He noted that wider accreditation would ensure patients can access follow-up scans and treatment without delays or out-of-pocket costs. 

The experts also highlighted that access alone may not be enough, as many regions still lack equipment, specialists, or hospitals capable of handling screening and diagnosis, hence the need for a more coordinated system. 

Under the current set-up, patients are often referred from one specialist to another, losing time as the disease progresses. They aim for multidisciplinary teams where pulmonologists, oncologists, surgeons, and radiologists may evaluate patients together, allowing faster diagnosis and treatment plans. 

In the end, reducing the prevalence of lung cancer hinges on a single goal: ensuring Filipinos can detect the disease early and affordably enough to survive it.