Tracy Leong

Lung Cancer Screening: Hurdles in Asia-Pacific Region Noni Novisari Soeroso Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia Abstract Lung cancer is the leading cause of cancer-related death worldwide, and Asia carries a disproportionate share of the burden: over 60% of new cases and deaths occur there, and the Western Pacific Region alone accounts for nearly half of global cases. Although low-dose computed tomography (LDCT) has been shown to reduce lung cancer mortality, only 22% of countries in the Western Pacific have implemented screening programs. This review summarizes the main barriers to implementation across the Asia-Pacific region. First, high costs and limited reimbursement, especially in low- and middle-income countries. Second, inadequate infrastructure, including too few CT scanners and shortages of trained radiologists and thoracic specialists. Third, low public awareness and cultural barriers such as fear, stigma, and fatalism. A distinctive regional challenge is the high proportion of lung cancer in never-smokers, particularly Asian women, which makes Western smoking-based screening guidelines a poor fit. In addition, endemic tuberculosis increases false-positive LDCT findings, and no validated risk-prediction models exist for non-smoking Asian populations. Healthcare financing disparities, fragmented cancer registries, and vulnerability to climate-related disruptions further complicate implementation in low-resource settings. Addressing these barriers will require regionally adapted screening criteria that include non-smoking risk factors, investment in infrastructure and workforce training, integration of screening with tuberculosis and smoking-cessation programs, and sustained policy advocacy to secure government funding. Overcoming them is essential to reducing the large and growing burden of lung cancer across Asia-Pacific. Keywords: Lung cancer screening - Asia-Pacific - low-dose computed tomography - health equity - never-smokers - implementation barriers