Healthcare equity—Lung cancer in the Asian‐Pacific regions

Screening for lung cancer is a hot topic in the Asian-Pacific region. However, the implementation has been slow and the take-up rate of lung screening needs improvement and persuasion to the public. Low-dose CT thorax (LDCT) has become established as an effective tool for lung cancer screening. The access to LDCT Thorax, and hence a lung screening program, is not yet made widely available to cater for the increasing demands of early detection of lung cancer in the Asian-Pacific region. Efforts should be ploughed in to encourage high risk individuals (heavy smokers or subjects with family history of lung cancer) to come forward for lung screening in the appropriate and available healthcare settings. Compared to decades ago when the systemic treatment of advanced-stage lung cancer relied on the use of platinum-based chemotherapy, we now have an increasing armamentarium of different targeted therapy and immunotherapy. While the use of these different newer therapies in different lung cancer stages and settings have been shown to confer significantly better treatment and survival outcomes, their use could be limited not only by the market availability but by their high costs especially when these newer therapeutics were first approved to enter the local market. In some regions, therapeutic costs are sometimes borne in whole or in part by the local government or representing agency, or other non-government charitable organization. The use of appropriate targeted therapy hinged on the detection of the corresponding oncogenic driver mutations, like the epidermal growth factor receptor (EGFR) gene mutations, in either lung tumour tissues or by means of liquid biopsy on analysis of blood (plasma) or pleural fluid, based on advanced molecular technology like next generation sequencing (NGS). These molecular diagnostic methods are very useful in guiding the choice of targeted therapy in advanced-stage lung cancer. Some of these molecular tests are still very expensive, limiting their accessibility in some health care systems. While looking forward to increasing availability of new diagnostic technology and newer therapeutics, perhaps another way out is to introduce competing technology or therapeutics. This is usually achieved through research and education, with exploration of more collaborative research activities, and this is also the mission and vision of APSR and Respirology. None declared.