Lung cancer toll rises as detection lags

Lung cancer remains one of the most common types of cancer in the Philippines, ranking second in the number of cases. Yet it remains the deadliest form of cancer not only in the country but worldwide, and experts have stressed that this is precisely because the disease progresses quietly, without pain, until it is already too advanced for many patients.

In a recent roundtable, experts maintained 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 thoracic oncology expert, explained that breast cancer is easier to detect since the breasts are accessible, visible, and abnormalities can be felt through self-examination. 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, which is why a tumor can grow without causing 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 the treatable disease, Ramos emphasized that all doctors in practice should consider lung lesions as cancer unless shown 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 secondhand smoke can also increase a person’s risk of developing lung cancer by 20 to 30 percent.

Another risk factor is a 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 is also 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 vapor.

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

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

The 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 Emer Rojas said it can be reduced through early detection.

Rojas emphasized that the problem is not that the technology does not exist. It’s that life-saving tools are not reaching Filipinos early enough. Artificial Intelligence (AI) has even been integrated with X-rays, currently being pilot-tested at 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 checkups.

“We Filipinos, we don’t get checkups, 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 LDCT scans in the screening tests 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 cancer-related services can be reimbursed.

He noted that wider accreditation would ensure that patients can access follow-up scans and treatment without delays or out-of-pocket costs.

Experts also pointed out that access is only part of the problem — many regions still lack proper equipment, specialists, and hospitals equipped to handle thorough screening and diagnosis. They stressed the need for a more coordinated system.

Under the current setup, patients are often referred to one specialist after another, losing time as the disease progresses. They aim for multidisciplinary teams where pulmonologists, oncologists, surgeons, and radiologists may evaluate patients together, allowing for 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.