TEMPO.CO, Jakarta - The Indonesian Respiratory Doctor Association (PDPI) revealed that lung cancer has begun striking young adults as early as 20 years of age. Meanwhile, the average age of cancer patients in Indonesia currently sits around 40, lower than the global benchmark reported by the World Health Organization (WHO) at roughly 45 years.
"There are even individuals just 20 years old who have been diagnosed with lung cancer," said Erlang Samudro, Head of the Thoracic Oncology Working Group at PDPI, during a media discussion on Tuesday, August 18, 2026.
Uneven Access to Advanced Screening
According to the pulmonologist, lung cancer screening implementation across Indonesia is still far from optimal. Screening for lung cancer should be conducted in stages based on individual risk levels. High-risk groups typically undergo low-dose computed tomography (LDCT) scans to detect minor nodules or pulmonary lesions.
"Our screening should be tailored to specific risk groups so patients can be referred for timely intervention, including surgery," he said.
Erlang noted that one of the main obstacles is the limited availability of LDCT technology, particularly outside major urban centers. "It is not distributed evenly, so mass screening cannot be done throughout Indonesia," he said.
Alongside equipment shortages, financial constraints pose another barrier. Erlang explained that if every high-risk individual were to undergo LDCT, healthcare expenditures would rise dramatically.
Limitations of Chest X-Rays
Amid limited access to LDCT, chest X-rays are one of the primary diagnostic tools utilized in the government's Free Health Check (CKG) program. Chest X-rays can identify potential nodules or pulmonary abnormalities that subsequently require further examination.
However, Erlang cautioned that chest X-rays face limitations when utilized as a main lung cancer screening tool. "With X-rays, we may miss [crucial indicators] during screening because certain locations cannot be detected, such as areas behind the heart or covered by the scapula," he said.
This screening gap is also related to post-examination service readiness. Erlang pointed out that access to thoracic radiology, bronchoscopy, pathology services, and follow-up therapies is unevenly distributed across the country. Furthermore, not all high-risk populations receive standard screening due to a lack of regulations governing LDCT implementation. "Without strong follow-up protocols, there is a risk of identifying findings without a clear path forward," Erlang said.
High Rates of Late Detection
He added that most patients come at advanced stages of the illness. According to his estimates, approximately 70 to 80 percent of lung cancer patients in Indonesia are diagnosed at stages III or IV. This late detection forces reliance on systemic therapies while lowering chances for curative treatment.
Catching cancer at an early stage enables eligible patients to undergo surgery, definitive radiotherapy, or perioperative care. "It is crucial to screen high-risk individuals so small nodules or lesions can be spotted while tumors are still small, so that follow-up with surgery can be done," Erlang said.
Overcoming Symptoms and Social Stigma
In addition to suboptimal screening infrastructure, early detection is further complicated by atypical symptoms. Chronic coughing, shortness of breath, and chest pain often mimic other respiratory conditions like tuberculosis (TB) or chronic obstructive pulmonary disease (COPD).
Social stigma presents yet another challenge. Certain patients hesitate out of fear of being judged for smoking habits or simply fear confronting a cancer diagnosis. Meanwhile, navigating referral pathways, radiology, biopsies, and biomarker testing requires time. "So, both diagnosis and treatment are delayed," Erlang said.
A Growing National Challenge
PDPI President Arif Riadi Arifin stated that lung cancer has become a pressing national health challenge. Citing Global Cancer Observatory (GLOBOCAN) data from the International Agency for Research on Cancer (IARC), he noted that lung cancer accounts for 2.4 million new cases globally, driving 18.7 percent of worldwide cancer deaths.
In Indonesia, lung cancer ranks as the second most common form of cancer, with roughly 38,900 new cases diagnosed annually. He further noted that over 90 percent of Indonesian lung cancer patients only learn of their condition after the disease has already reached an advanced stage. "This is certainly a major clinical challenge stemming from delayed diagnoses," Arif said.
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