Lung cancer in Asia

Pan Chyr Yang
National Taiwan University College of Medicine, Taipei, Taiwan

Lung cancer remains the leading cause of cancer-related death globally. Although tobacco smoking is still the primary risk factor, smoking rates have decreased significantly due to widespread cessation programs. Conversely, lung cancer among never-smokers is rising, becoming the fifth leading cause of cancer mortality, especially among Asian women. Asia bears the largest lung cancer burden worldwide, accounting for more than 60% of new cases and deaths in 2022. Notably, Eastern Asia has the highest age-standardized incidence rate globally. Asian lung cancer demonstrates a distinct epidemiological and mutational profile, characterized by a notably high prevalence of EGFR mutations, particularly among non-smokers. This suggests critical roles for genetic susceptibility and environmental factors.

Recognizing these regional disparities is essential for effective lung cancer management. Standard guidelines developed from Western populations, such as LDCT screening focusing exclusively on heavy smokers, may miss many cases in Asia, especially among female non-smokers. Addressing this issue, Taiwan followed a pivotal TALENT studies expanded its national LDCT screening eligibility in 2022 to include individuals with a family history of lung cancer alongside heavy smokers.

Similarly, while NCCN guidelines suggest comprehensive upfront molecular profiling for advanced non-small-cell lung cancer patients, an alternative sequential strategy—beginning with EGFR mutation testing followed by broader next-generation sequencing—is proposed for Eastern Asia. This approach is more cost-effective due to the region’s high EGFR mutation prevalence. Tailored preventive, screening, and treatment strategies are therefore crucial for reducing the lung cancer burden in Asia