Lung cancer is a leading cause of deaths due to cancer worldwide, and its impact is particularly severe in low- and middle-income countries (LMICs). These settings often face challenges such as limited diagnostic infrastructure, delayed access to care and low public awareness – factors that contribute to late-stage diagnoses and consequently poorer outcomes. Detecting lung cancer earlier is proven to reduce mortality from the disease, and low-dose computed tomography (LDCT) screening has been shown to be a particularly effective way of achieving early-stage diagnoses.
In many LMICs, there is also a significant gap between policy commitments and implementation. While national strategies and guidelines may exist, they are not always translated into accessible, routine services for high-risk populations.
How can LMICs work to close this gap? A rounded approach is key: developing cancer control plans that fit local realities, and implementing a range of earlier detection methods. Through sustained commitment and by using a mix of technologies tailored to specific populations and economies, LMICs can make meaningful progress in lung cancer care and successfully detect lung cancer earlier in more people.
Brazil’s grassroot efforts inform policy change
Brazil is emerging as a compelling example of how grassroots initiatives and pilot programmes can shape national policy in lung cancer screening.
Across the country, regional screening programmes for lung cancer are laying the groundwork for national change. The Propulmão project in the Northeast Region, for example, focuses on prevention, earlier detection and care; it is intended to serve as a reference model for other regions and insights have already begun informing national guidance.
Building on this decade-long experience, the Propulmão Institute is being established in Bahia as Brazil’s first national reference centre for lung cancer screening and integrated care. Supported by the Bahiana Foundation for Cardiology and Cancer Control (FBCCC) and funded by the Bristol Myers Squibb Foundation (BMSF), the institute will be officially launched later in in November 2025. It builds upon the Brazilian Early Lung Cancer Screening Trials (BRELTs 1, 2 and 3), conducted in multiple regions of the country, which have provided crucial evidence on the feasibility and impact of LDCT screening in diverse settings, including a mobile unit for remote areas.
Propulmão exemplifies how local pilots can inform national guidance. By generating real-world evidence and demonstrating tangible benefits, the project is helping to inform practice. Its outcomes are already influencing broader public health strategies, particularly in integrating lung cancer screening into routine healthcare.
In 2024, Congresswoman Flávia Morais introduced a bill that proposes the creation of a national policy for lung cancer screening and early diagnosis within Brazil’s public health system. A public hearing to discuss implementing the bill was approved in May 2025, and the bill is currently under review by the Health Committee of the House of Representatives. If enacted, the bill would establish a legal framework for nationwide LDCT screening for high-risk populations.
Complementing these policy efforts is a new law that officially establishes ‘White August’ (Agosto Branco) as a permanent national campaign for lung cancer awareness. This initiative aims to promote prevention, early diagnosis and access to treatment, reinforcing the country’s commitment to tackling lung cancer through both policy and public engagement.
Brazil’s experience illustrates how LMICs can leverage grassroots innovation, regional pilots and legislative action to build robust national policies for lung cancer screening. The country’s multi-pronged approach offers valuable lessons for other nations seeking to advance cancer care in settings where resources may be constrained.
Regional collaboration advances lung cancer care across Asia Pacific
Lung cancer is disproportionately concentrated in Asia Pacific, with the majority of new cases developing in people living in the region. Many health systems face distinct challenges, including environmental exposures, health system capacity and differences in disease patterns. Consequently, it is essential that strategies for improving lung cancer outcomes are tailored to the specific needs and contexts of each country in the region.
Asia Pacific Policy Review and Engagement (ASPIRE) for Lung Cancer and the Asia Pacific Coalition against Lung Cancer (APCLC) developed a policy consensus statement for the region. Created in collaboration with regional experts and advocates, the statement outlines coordinated strategies spanning the entire care pathway – including prevention, earlier detection, diagnosis, treatment and stigma reduction – to support progress in diverse contexts across the region. A dedicated session with patient advocacy groups also ensured that lived experiences were incorporated into the recommendations, grounding policy guidance in real-world needs.
The resulting document provides actionable steps for policymakers across the region. It offers tailored solutions to help diverse health systems implement changes, measure progress and address existing gaps in lung cancer care. This regional framework demonstrates how collaborative policy development can equip health systems with practical tools to advance care in a coordinated and context-sensitive way.
Building a foundation for lung cancer screening in Ethiopia
Ethiopia is taking early steps toward establishing a national screening programme for lung cancer, with recent efforts focused on developing tools, protocols and partnerships to support earlier detection.
Within the National Cancer Control Plan 2025–2029, LDCT screening is recommended for high-risk populations in Ethiopia. A locally developed tool for risk assessment has been developed to guide eligibility for lung cancer screening in the country. The tool helps to identify individuals aged 40–70 years who meet one or more criteria – including exposure to carcinogens and cigarette smoking, prior tuberculosis and family history of lung cancer. This tool reflects Ethiopia’s effort to tailor screening criteria to local risk factors and epidemiological patterns.
In April 2025, the Mathiwos Wondu – YeEthiopia Cancer Society (MWECS), in collaboration with Tikur Anbessa Specialized Hospital (TASH) and Saint Paul’s Hospital Millennium Medical College (SPHMMC), officially launched a lung cancer screening initiative during a workshop at TASH. The programme is based on the International Early Lung and Cardiac Action Program (I-ELCAP) and is supported by the BMSF.
The initiative uses LDCT screening and standardised, multidisciplinary protocols to improve earlier detection and diagnosis. Following the initial launch, a second workshop was held at SPHMMC in June 2025, to expand the programme and align on evidence-based screening practices. At the time of this workshop, 12 participants had been enrolled in the programme, with 120 more scheduled for LDCT screening at TASH, marking a promising start to Ethiopia’s efforts to detect lung cancer earlier.
From policy to action
The examples from Brazil, the Asia Pacific region and Ethiopia demonstrate that when commitment is matched by coordinated action, it is possible to successfully advance lung cancer screening, earlier detection and diagnosis – even in resource-constrained settings. Whether through grassroots pilots, regional consensus frameworks or national screening initiatives, LMICs are finding context-specific ways to close the gap between policy and practice.
As momentum builds, continued collaboration, investment and knowledge-sharing will be key to sustaining progress and ensuring that lung cancer screening and care become accessible to all who need it.
