Lung cancer is likely undercounted across sub-Saharan Africa, and the pattern has implications for Thailand as smoking shifts to lower-income markets and non-communicable diseases rise. Experts say better data and stronger health systems are essential to curb this deadly disease. Global cancer assessments indicate roughly 1.8 million deaths each year, underscoring why gaps in Africa’s reporting matter for Thai planners and communities alike.
Undercounting matters for prevention. Lung cancer is highly preventable through reduced smoking and early detection, yet many cases are detected late in low-resource settings when treatment options are limited. Clinicians in better-resourced areas note that higher observed rates often reflect stronger detection rather than greater regional severity, highlighting a global health issue: as infectious diseases come under control, non-communicable diseases like cancer rise in importance in lower-income countries, demanding new funding and health-system capacity.
Factors driving undercounting and late diagnosis. Early tumors often cause little pain, so symptoms such as coughing or shortness of breath may be mistaken for tuberculosis, which remains common in parts of Africa. TB therapy is sometimes pursued first, delaying cancer diagnosis and allowing disease progression. Coexisting infections, including TB and HIV, may raise lung cancer risk and complicate treatment decisions. Incomplete death certification further obscures true burden, leaving policymakers with a skewed view of where to invest resources.
Weak civil-registration systems compound the problem. Many countries lack reliable data on births and deaths and causes of death, making it hard to detect shifts in disease patterns. Autopsies, often limited by cultural and religious considerations, would clarify causes of death. Without solid mortality data and cancer registries, governments may deprioritize lung cancer and other non-communicable diseases, sustaining a cycle of neglect that clinicians observe on the ground.
The clinical picture in well-resourced settings remains stark. A large hospital in South Africa reported that about 94 percent of lung-cancer patients were diagnosed at an advanced, incurable stage in 2019. This reflects late presentation rather than a lower disease burden elsewhere. Over the past decade, researchers have repeatedly noted that officially low mortality from lung cancer in sub-Saharan Africa likely results from data gaps and limited health-system capacity.
Tobacco trends are central. Smoking rates vary by country, but tobacco companies are increasingly targeting lower-income markets as prevalence falls in wealthier nations. Inexpensive cigarettes, aggressive marketing, and regulatory gaps are expanding smoking in urban poor communities, setting the stage for higher future lung-cancer mortality unless strong tobacco control and cessation support are in place. Public-health leaders warn that without decisive action, low- and middle-income countries could see rising death tolls in the coming decades.
Adaptive screening offers promise in constrained settings. Regions are exploring screening guidance and private insurers covering low-dose CT scans for high-risk individuals. Yet CT programs demand resources and may not be feasible for many public systems. A scalable approach uses chest X-rays with artificial intelligence to flag suspicious images for follow-up. Trials in Asia show AI-assisted screening can detect actionable findings at scale when paired with robust treatment pathways. Any screening requires capacity to diagnose and treat abnormalities, or ethical concerns arise about screening without follow-up care.
What this means for Thailand. Thailand has strong tobacco-control efforts and universal health coverage, but faces a significant tobacco burden alongside rising non-communicable diseases. Evidence points to substantial tobacco use and tobacco’s role as a leading preventable cause of death. Thailand’s civil-registration system is solid, yet accurate cause-of-death data and cancer registries require ongoing investment to detect evolving patterns. The African experience highlights three priorities for Thai policymakers: strengthen tobacco control and cessation services, empower primary-care clinicians to recognize lung cancer amid competing diagnoses such as TB, and improve death-certification and cancer registries to reveal trends early.
Primary care improvements for Thailand include targeted training to heighten suspicion for lung cancer among smokers, people with prior TB, and those living with HIV. Pilot AI-assisted chest X-ray triage in provincial hospitals, linked to clear biopsy and oncology referral pathways, could offer a practical, scalable solution. Maintaining strict tobacco-control measures—taxes, advertising bans, and point-of-sale restrictions—along with expanded cessation support will help reduce future burden. These strategies align with international guidance on tobacco control and cancer prevention.
Cultural considerations matter for implementation. Just as autopsies face sensitivities in some communities, Thai attitudes toward death, family involvement, and post-mortem practices influence surveillance approaches. Policymakers should prioritize non-invasive improvements, such as enhanced clinical diagnostics, verbal autopsy methods when full autopsies are not acceptable, and stronger clinical recordkeeping. Community engagement that respects religious and family norms will be essential to build trust in screening and surveillance programs.
Looking ahead. Global projections suggest that without prevention and early detection, lung cancer cases and deaths will rise. The African experience shows how data gaps and diagnostic hurdles can turn a preventable disease into a late-stage, high-cost health challenge. For Thailand and other nations with mixed urban-rural health systems, the path forward is clear: invest now in prevention and early diagnosis, or face higher treatment costs and avoidable deaths later. Strengthening registries, expanding clinician training, enhancing cessation support, and piloting scalable screening tools will help Thailand avoid late-stage outcomes observed elsewhere.
Practical steps for Thai health authorities and civil society include: expanding tobacco taxation and advertising bans, broadening access to evidence-based cessation services (including in stress-prone urban communities), training frontline clinicians to consider lung cancer when TB treatment fails, piloting AI-assisted chest X-ray triage with clear diagnostic pathways, and investing in cancer registries and death-certification quality. Community-focused campaigns can explain the link between smoking and lung cancer in plain language and offer cessation support that accounts for social and economic stressors. International partners should focus on funding not only detection technologies but also the downstream capacity to diagnose and treat cases found through screening.
The takeaway for Thai readers is simple: a low official rate does not always reflect a light disease burden. Hidden epidemics emerge where data and diagnosis are weak. The best defense is prevention—strong tobacco control and cessation—paired with pragmatic, locally appropriate steps to detect disease earlier. By strengthening data systems, training clinicians, expanding cessation support, and piloting scalable screening tools, Thailand can avoid the late-stage, palliative-care scenarios observed elsewhere. If action is taken now, many Thai families may be spared the devastation associated with advanced lung cancer.