Lung Health Initiative Screening Detects More Tuberculosis Than Cancer In Early Rollout

KUALA LUMPUR, Nov 20 — The Ministry of Health’s (MOH) Lung Health Initiative (LHI) has detected significantly more tuberculosis (TB) than lung cancer in its early rollout, with most abnormalities flagged to date involving TB or other non-cancerous lung diseases.

MOH National Head of Respiratory Medicine Dr Mat Zuki Mat Jaeb said about 3,000 people have undergone screening since LHI’s screening component began rolling out in July.

“We didn’t expect to see many cancer cases, but what we saw was more TB,” Dr Mat Zuki told CodeBlue on the sidelines of the “Unpacking the Chronic Respiratory Disease Epidemic” media workshop, held in partnership with the World Health Organization (WHO) and Pace University Center for Global Health last Wednesday (November 12). 

“When you do X-ray with AI reporting, it doesn’t only report cancer nodules. It reports on infection, fibrosis, and other abnormalities. We can diagnose other diseases early, even in patients without symptoms.”

Dr Mat Zuki said many TB cases detected through screening are mild and asymptomatic, which he described as good news compared to the severe pulmonary TB cases still presenting at hospitals.

“The screening is not only for lung cancer but for lung diseases,” he said. “Depending on what is detected, patients are referred for further evaluation. For COPD, spirometry is going to be made available throughout the country, and that is good progress.”

Integrated Pathways Under Lung Health Initiative

LHI is MOH’s new national framework for lung health under the 2025-2030 plan, integrating prevention, screening, diagnosis, treatment, and rehabilitation for TB, chronic obstructive pulmonary disease (COPD), asthma, and lung cancer. 

The policy aligns with the World Health Assembly (WHA) resolution that Malaysia helped champion calling for integrated lung health strategies. 

LHI replaces previously fragmented pathways in primary care and hospitals. Patients now enter through either public health clinics (klinik kesihatan) or private clinics and are routed into disease-specific pathways depending on risk factors.

“If they smoke, they follow one pathway. If they don’t smoke but have a family member with TB, they follow the TB pathway,” Dr Mat Zuki said. “Previously, health clinics, hospitals, and the private sector operated separately. Now it’s more systematic and coordinated.”

He said meaningful analysis of screening patterns will require at least one year of data, and up to three to five years for trend evaluation.

Pilot sites currently involve seven public health clinics and six referral hospitals across Kedah, Penang, Selangor, Kelantan, Sabah, and Sarawak. Screening uses AI-assisted chest X-rays targeting high-risk groups such as smokers and individuals exposed to harmful particulates.

MOH has set an ambitious target to reduce deaths from TB, COPD, and lung cancer by 30 per cent within five years, or by 2030.

Severe Spirometry Shortage Limits COPD Diagnosis

A major system gap highlighted by LHI is the shortage of spirometry in primary care. Only about 15 per cent of public health clinics currently have spirometers.

“We aim to have spirometry available at close to 50 per cent of klinik kesihatan by next year,” Dr Mat Zuki said. He added that MOH is replacing ageing CT scanners and expanding respiratory specialist staffing.

LHI’s integrated pathway will also detect other chronic lung diseases that are commonly missed, such as interstitial lung disease, bronchiectasis, and sleep apnoea. 

“Before this, everything looked very nice on paper, but implementation was difficult,” Dr Mat Zuki said. “Now we are putting everything together.”

In parallel with MOH’s programme, the National Cancer Society Malaysia (NCSM) is conducting community and corporate lung screening through mobile pop-up sites. 

NCSM’s model includes AI-assisted chest X-rays paired with a micro-insurance product that covers follow-up diagnostics like CT scans and biopsies. Individuals with abnormal findings may be referred into MOH’s diagnostic pathway or private follow-up services.

“For private screening programmes, they have a private pathway, but they can also go into a government pathway as well,” Dr Mat Zuki said.

MOH plans to expand LHI nationwide over the next three to five years, with at least one klinik kesihatan in each district designated as a “satellite” site for integrated lung disease screening.

“This is the beginning,” Dr Mat Zuki said. “You will start seeing more equipment and more facilities being added. It’s not only good for lung health, it’s good for the whole system.”