Preventing lung cancer screening from becoming another global cancer equity divide

Lung cancer remains the leading cause of cancer death worldwide,  despite significant technological progress in diagnosis and treatment. 

Advances in surgery, radiotherapy, immunotherapy, and targeted therapies have improved outcomes for many people diagnosed with the disease, while low-dose CT screening can detect tumours before symptoms develop. 

While detecting a cancer early is key to improving outcomes, less invasively, and at a lower cost, it is particularly important for cancers such as lung cancer, where symptoms often appear in later stages of the disease. 

When these technological gains remain concentrated in high-resource settings, however, gaps in and limited access to cancer care in low-resource settings are often exacerbated..

The Bristol Myers Squibb Foundation (BMS Foundation), an independent charitable organisation and a UICC partner, works to strengthen health systems to ensure people can benefit from innovations as they become available. The BMS Foundation is part of the UICC-led Lung Cancer Collaboration, which brings together organisations working across policy, research, advocacy, care delivery, and industry to improve outcomes for people at risk of or living with lung cancer.

“We firmly believe that where someone lives should not be a factor in whether they survive a preventable, detectable, or treatable disease,” says Catharine Grimes, President of the Bristol Myers Squibb Foundation. “Our strategic goal, however, is much bigger than supporting individual projects or partners. We want to fund and demonstrate models of care that governments and health systems can adapt, adopt, and ultimately sustain for themselves.” 

Lung cancer became a priority for the BMS Foundation because it illustrates the challenge of bringing technological advances to medically underserved populations.

Several countries around the world are expanding lung cancer screening, reflecting growing evidence that detecting lung cancer before symptoms appear can significantly reduce mortality. 

South Korea, Croatia, and Taiwan have operated national screening programmes for several years. The United Kingdom has transitioned from regional pilots into the official NHS Lung Cancer Screening Programme, while France has recently laid the groundwork for its own population-wide roll-out via the IMPULSION pilot programme. Last year, Australia was the first to roll out a programme explicitly designed with an equity-first model, integrating specialised mobile screening trucks to reach remote communities and working in close partnership with the National Aboriginal Community Controlled Health Organisation (NACCHO).

The mission of the Bristol Myers Squibb Foundation is to improve global health – to ultimately ensure that more people can benefit from such services and address the multiple barriers to care that prevent many people from accessing them even when they exist. 

“In many lower-resource settings, awareness of lung cancer remains limited among both communities and healthcare providers,” Grimes says. “For years, a hospital in sub-Saharan Africa diagnosed only a few cases of lung cancer annually. It’s not that people didn’t have lung cancer, but clinicians simply were not looking for it. Symptoms overlapped with tuberculosis, imaging capacity was limited, and few specialists were trained to distinguish between the two diseases.”

When the BMS Foundation and a grantee partner began reviewing patients who were not responding to tuberculosis (TB) treatment and assessing them for lung cancer instead, the numbers changed significantly, with around 120 cases in 2025 and an estimated 150 by the end of this year.

“Together, we raised the suspicion index. We raised awareness amongst both the providers and the community and as a result, they  began to focus on a lung cancer workup, expanding beyond infectious causes, such as TB, from the early onset of symptoms,” says Grimes.

She describes the BMS Foundation’s approach as implementation science, generating evidence not only about what works, but about how to make it work within real-world health systems. 

“Rather than funding screening programmes in isolation, the BMS Foundation focuses on strengthening the systems required to make screening and early diagnosis work in practice. That means everything from community awareness and workforce development, all the way to referral pathways, navigation, diagnosis, and treatment.”

Prioritising investment in lung cancer services

“Diseases that remain invisible rarely become public health priorities,” Grimes says, when explaining how to make the case to governments to address their lung cancer burden. “Building surveillance systems and diagnostic services is also essential, as improving diagnostic capacity can also strengthen cancer services more broadly,” Grimes explains. 

“In Eldoret, Kenya, support for multidisciplinary lung cancer services has contributed to improvements in radiology, epidemiology, and cancer diagnosis across the health system. We’ve also learned that by increasing radiology capacity to diagnose lung cancer, we don't just improve lung cancer diagnosis, we improve the entire health system's ability to diagnose cancers writ large.”

A separate challenge involves eligibility for screening. Existing guidelines are largely based on age and smoking history, reflecting landmark trials that demonstrated the effectiveness of low-dose CT screening. Yet increasing numbers of lung cancers are being diagnosed among people who have never smoked.

“The BMS Foundation is supporting research into additional risk factors, including air pollution and exposure to indoor cooking fuels, to help countries develop screening eligibility cirteria that reflect the specific risk factors that their geographies and populations face.”

“As the pace of innovation quickens, more and more patients may potentially be left behind,” Grimes says. “We're really working to make sure we’re strengthening those health systems such that when there is a new treatment or intervention, that those breakthroughs will actually reach patients in medically underserved settings, not only in the countries best equipped to implement them.”

As a member of the UICC-led Lung Cancer Collaboration, the BMS Foundation sees its work as contributing to the evidence base needed to turn global commitments into practical action. Grimes points to the adoption of the lung health resolution by the World Health Assembly in 2025 as an important milestone in bringing lung cancer more firmly onto the global health agenda and encouraging greater attention to early detection, diagnosis, and care.

“Global resolutions create momentum, but it’s the local implementation that creates the impact,” Grimes says. “Our role is to help translate those global commitments into local action.”