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Early and accurate diagnosis of TB and lung cancer vital: No excuse for misdiagnosis!

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r Natthaya Triphuridet, Pulmonologist and Assistant Director for Medical Affairs at Chulabhorn Hospital, Bangkok, Thailand.
r Natthaya Triphuridet, Pulmonologist and Assistant Director for Medical Affairs at Chulabhorn Hospital, Bangkok, Thailand.
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(CNS): Early and accurate diagnosis is a public health imperative for both diseases of epidemic proportions in Asia Pacific: tuberculosis (TB) and lung cancer. But since TB of the lungs (pulmonary TB) imitates lung cancer in many aspects including risk factors, symptoms, signs and radiographic findings, often misdiagnosis has a serious public health consequence! "Symptoms of cough, haemoptysis, chest pains, weakness, weight loss, fever and night sweats are common in both active pulmonary TB and symptomatic lung cancer. In the meantime, radiographic findings of TB can mimic lung cancer such as mass-like lesion, pulmonary nodule, mediastinal lymph node enlargement or pleural effusion" said Dr Natthaya Triphuridet, Pulmonologist and Assistant Director for Medical Affairs at Chulabhorn Hospital, Bangkok, Thailand.

Dr Natthaya is also one of the faculty members for IASLC Asia Pacific Lung Cancer Conference (APLCC 2016) which will be held in Chiang Mai, Thailand during 13-15 May 2016.

Dr Sumitra Thongprasert, Conference Chair of APLCC 2016 and Special Content Editor of Journal of Thoracic Oncology, lamented that in the whole of South East Asia lung cancer is a major public health problem due to its high incidence and death rate - 90% of patients with lung cancer will die soon. In Thailand, lung cancer rates rank number one in men, and in women it is next to breast cancer. Dr Sumitra is also an Emeritus Professor at Maharaj Nakorn Hospital and Medical College, Chiang Mai University and senior Medical Oncologist at Bangkok Hospital, Chiang Mai.

TB in lung cancer patients?

But is there any association between TB and lung cancer? "An increased prevalence of active TB was reported in lung cancer patients (8--10 times higher compared with general population). Preexisting TB is an independent risk factor for lung cancer (no direct association). As an immuno-suppressive disease, lung cancer may promote TB infection or reactivation of latent TB infection, or cause new exogenous infection" explained Dr Natthaya Triphuridet.

"One-third of the world's population is infected with latent TB. The WHO South-East Asia region accounts for 41% of the global TB incidence. In 2014, TB prevalence in this region was 5.4 million cases while TB incidence was around 4 million. Thailand is one of the 22 high-burden TB countries. The burden of lung cancer is no less alarming. Lung cancer is the most common cancer in the world as well as the most common cause of death from cancer worldwide. The survival rate of lung cancer is strongly related to the stage of the disease. With delayed or late detection of lung cancer, there is a significant decrease in survival rate" said Dr Natthaya Triphuridet.

SDG 2030 target to end TB, reduce lung cancer by 1/3rd

UN member-countries have committed to Sustainable Development Goals (SDGs), which includes the target to end TB and reduce the burden of non-communicable diseases (including lung cancer) by one-third by 2030. But this SDG target will not be met if we continue to delay or misdiagnose either of the two: TB or lung cancer. Early and accurate diagnosis of both, TB and lung cancer, is as critical as providing standard treatment and care. WHO and national TB programmes have laid out diagnostic algorithms for TB which are backed by scientific evidence.

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