Special edition: Early detection in Brazil is a game changer for lung cancer care

Summary

Podcast Summary: This Week in Global Development

Special Edition – Early Detection in Brazil Is a Game Changer for Lung Cancer Care

Published: May 19, 2026

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Episode Overview

This special edition of “This Week in Global Development” explores the transformative impact of early detection initiatives on lung cancer care in Brazil. Host David Ainsworth sits down with thoracic surgeon and public health advocate Dr. Santos to discuss how mobile CT screening units, capacity-building among community health workers, and system integration are changing the lung cancer landscape—both in Brazil and potentially worldwide. The conversation also addresses key challenges, global implications, stigma, cost effectiveness, and recent policy progress.

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Key Discussion Points & Insights

1. Integrated Approaches to Early Lung Cancer Detection

• Fragmented Healthcare:
  Dr. Santos highlights the challenge of fragmented health systems and the critical need to connect community initiatives with hospital infrastructure:
  “You bring the truck and [it] is disconnected with the healthcare system. We need to connect them all the time. This is maybe the most important challenge.” [00:15]
• Role of Information Flow:
  He uses the analogy of a surgeon suturing information to ensure patients are followed throughout the process. [00:50]

2. Training & Empowering Community Health Workers

• Multiplier Effect of Local Training:
  Dr. Santos explains that training primary care and community health workers multiplies impact beyond medical professionals, reaching hundreds or thousands and leveraging trusted local networks:
  “That knowledge is spread across the entire community. Over time that individual may influence the health decisions of hundreds or even thousands of people.” [01:34]
• Engaging Non-Medical Stakeholders:
  Even pharmacy employees and local businesspeople are involved in identifying high-risk individuals, especially smokers within their communities. [02:00]
• Trust and Information Spread:
  Word-of-mouth remains more influential than top-down lectures—neighbors trust neighbors, which fosters acceptance and participation. [03:52]

3. Personal Motivation and Advocacy

• Dr. Santos’ Journey:
  He shares his transition from high-tech surgery work in the US back to public health advocacy in Brazil, focusing on prevention over high-end interventions:
  “I realized that to have an impact in a social service, I need to work with education, prevention.” [06:44]
  • Academic shift: Moved from surgery to advocacy and launched public prevention projects starting in 2012. [05:04–07:35]

4. Global Applicability of Brazil’s Model

• Relevance Beyond Brazil:
  Dr. Santos affirms that the issues of access, trust, and early detection are common worldwide, and Brazil’s lessons are valuable for resource-limited settings in Africa, Asia, and even remote parts of wealthy nations:
  “Global health improves when knowledge moves across borders. That’s what we believe.” [08:52–09:27]

5. The Stigma of Lung Cancer & Expanding Awareness

• Challenging Misconceptions:
  There’s a strong stigma associating lung cancer solely with smoking and personal failure. Dr. Santos dispels this myth:
  “20% [of lung cancers] is not smoker related. Pollution is also causing lung cancer…the exposure of radon…so you need to be aware.” [11:41]
  • Non-smoker cases, pollution, family exposure, and genetic risk all play roles.
  • Stresses the need for public awareness beyond the narrow focus on smoking.

6. Cost-Effectiveness and Sustainability

• Addressing Cost Concerns:
  The notion that mobile CT screening is “too expensive” is challenged with data and context:
  “We’re spending almost 2 billion reais on lung cancer care…So it’s a test that will cost probably around $100 or so. So this is not expensive when you think where the money is going by now.” [13:57]
  • Early detection ultimately saves on end-stage care and increases survival rates.
  • Cost-effectiveness proven in Brazil, US, and Europe.

7. Policy Advances: A Landmark Update

• Legislative Progress:
  Dr. Santos closes with the breaking news that the Brazilian Chamber of Deputies has just approved a bill advancing lung cancer prevention and early diagnosis:
  “Yesterday, Brazilian Chamber of Deputies approved a bill addressing lung cancer prevention and early diagnosis with the public health system here in Brazil… We believe this was a first step to have lung cancer screening approved.” [17:12]

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Memorable Quotes with Timestamps

• “We need to keep like a surgeon doing suture in those information pieces to make sure that the information will follow the patient all the time.” — Dr. Santos [00:52]
• “Community health workers and primary care teams are often the first point of contact…by empowering them…patients can be referred for evaluation earlier, improving the chances of timely diagnosis.” — Dr. Santos [03:52]
• “Surgery is also prevention…when you do surgery, we are removing a problem before [it becomes] a big problem.” — Dr. Santos [07:40]
• “Global health improves when knowledge moves across borders.” — Dr. Santos [09:24]
• “Lung cancer is the most lethal type of cancer in all the world. In Brazil it's not different." — Dr. Santos [10:17]
• “20% is not smoker related…you need to be aware of that. Pollution is also causing lung cancer.” — Dr. Santos [11:41]
• “The decision of making lung cancer screening is based on, is this cost effective or is it not cost effective? And the answer is yes.” — Dr. Santos [14:42]
• “Yesterday, Brazilian Chamber of Deputies approved a bill addressing lung cancer prevention and early diagnosis…” — Dr. Santos [17:12]

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Important Segments & Timestamps

• [00:00] Integrating mobile screening & health system infrastructure
• [01:34] Training and empowering community health workers
• [05:04] Dr. Santos’ journey from surgery to public health advocacy
• [08:52] Global relevance and knowledge transfer
• [10:17] Lung cancer as the world’s most lethal cancer
• [11:41] Broadening awareness: risk factors beyond smoking
• [13:57] Addressing cost of early detection and impact on healthcare spending
• [17:12] Breaking news: Policy milestone for lung cancer screening in Brazil

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Episode Wrap-Up

The conversation highlights Brazil’s innovative, community-led approach to lung cancer early detection, emphasizing a holistic mix of mobile technology, education, and system integration. Dr. Santos’s personal journey underscores the power of prevention-focused medicine, while his policy update signals real progress. The episode closes with a reminder that local adaptation and global knowledge sharing are crucial for future improvements in cancer care everywhere.

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For more on this topic, explore the DEVEX content series “Strengthening Care Systems: Driving Sustainable Change Across the Lung Cancer Continuum.”

Transcript

[A]

Belong to the community. So we have to educate them. It's a big part of the process. And of course the medical community, we work with several specialists from radiologists, pulmonary doctors, thoracic surgeons like I am, and all the infrastructure that hospital needs. The truck needs to be integrated to these infrastructures. It's not something that you bring the truck and is disconnected with the healthcare system. We need to connect them all the time. And this is maybe the most important challenge that you need to face because the healthcare is sometimes fragmented so the information doesn't flow well and you need to fix. We need to keep like a surgeon doing suture in those information pieces to make sure that the information will follow the patient all the time.

[B]

And I mentioned your work with the Bristol Myers School foundation and a major part of your strategy, of your approach to that work is, and I'm sure your other work too is training people who aren't necessarily doctors in helping with diagnoses and treatment and so forth. Can you tell us a bit more about the impact of sort of empowering these primary care workers and non medical professionals to recognize these red flags of serious disease?

[A]

Yeah, well, when you train a community health worker or a primary care professional, that knowledge is spread across the entire community. So over time that individual may influence the health decisions of hundreds or even thousands of people. So capacity building at the local level multiplies the impact. So we'll talk sometimes with features with, you know, employees of the pharmacy or even local business individuals that they are doing an actual job working with the healthcare system so they know the community. If you ask the question, hey, you guys know someone that is smoking here? There's over 50. We have here a program that can give a benefit to these individuals. So sometimes if you're in a room with 20 or 30, they will raise the head, hey, I have at least 10 neighbors that I can put in the program. So this is something that the doctors will never show by themselves. We need the help of the community to promote prevention.

[C]

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[B]

I don't know if this word will translate well, but do people ever worried about being snitches if, you know, like telling other neighbors and being called out for that?

[A]

Well, yeah, I would say that the word mouth by mouth, when you go and you speak about something that brings a benefit, that type of information spread is spread much more efficiently than if you do like a lecture or something in a technical way. So community healthy workers and primary care teams are often the first point of contact with the health system. So by empowering them to recognize the early symptoms and risk factors, patients can be referred for evaluation earlier, improving the chances of timely diagnosis. Alan?

[B]

Yeah, and I guess the point of it all is that people trust their neighbors, people trust their friends, people trust their community. So it's probably going to, that's going to be beneficial to this whole network of information that you're providing. Essentially I just wanted to take a step back for a second and get a bit into the personal set. How did you get into this? You were a surgeon or you are a surgeon but you were performing surgeries. And what made you get into the sort of the advocacy and sort of that bigger picture of you?

[A]

That's a great point. I was doing part of my training in the US I trained minimally invasive surgeon in Pittsburgh at University of Pittsburgh Medical Center. I did transplantation, also lung transplantation for a couple years in the same center. Then I went to Boston for a couple years also doing robotics and all these high technology environment. That's the way that I was doing my academic work. I was in the US doing high relevance work. And then I decided to come back to Brazil in 2010 in walking a very high profile hospital here, also called Albert Einstein Hospital. And then they suggest that we could do a project on public service. And I was thinking what is the relationship between my work as a surgeon and the public service that I could do with the support of the Ministry of Health here in Brazil. So for sure I was not claiming to be like, I like to do like a robotic for everyone or doing like genetic tests for the whole population because we have enough reality that many, many patients, they need to find the essential part of the treatment which is the diagnosis. So I felt oh my program here My academic work should be related to prevention. That's why I put the first project in 2012 for a grant, a federal grant, which started in 2012. From 2016 was my PhD thesis. My academic work just flipped to prevention work in Brazil. And when you talk about prevention is so big this network that's necessary. We need to talk about advocacy, we need to talk about awareness, we need to talk about exactly what we're talking here in this podcast. And that's why as a surgeon, I realized that to have an impact in a social service, I need to work with education, prevention. But of course, all this leads to by the end of this line of care that leads to surgery in a way that you can treat patients efficiently. We can remove the cancer most of the time without chemotherapy or any other needs for extra treatments. Of course, the advanced cases will continue. Unfortunately, this program just start the surface of this big ice bag which is the lung cancer problem. But I hope that give you an answer. Your question was really personal in terms of why as a surgeon I can. I would say that Alan, surgery is also prevention. When you do surgery, we are removing a problem before becomes like a. A big problem. Well, we are fixing the function of, of of the organs that not working well. So surgery is prevention. That's why surgeons we need to be involved on lung cancer screening.

[B]

And in. So you've worked in the US you've worked in Brazil. What do you think are. Do you see sort of this approach that you're taking in Brazil of bringing the treatment to the patients essentially, do you see that as relevant in other countries? Maybe they're similarly resourced countries or even if they're not similarly resourced, do you see this as a global phenomenon that can make a difference?

[A]

Absolutely. The context may differ, but the challenges, access, trust that we're talking here and the early detection are shared by many, many countries. It's very interesting when I'm part of the ISLC Global Committee, I was invited recently by the BMS foundation to participate in this multicountering committing. And the discussions are very, very similar. All the challenges are very similar. So the lessons that we learn in Brazil can inform strategies in other regions include parts of Africa, Asia or even North America in more remote areas. Global health improves when knowledge moves across borders. That's what we believe.

[B]

And I think what you're also saying is it kind of goes both ways. It has to go across borders, but it also has to really go into the local communities and into sort of just. Everyone needs to understand the challenges that lung Cancer can bring, but not just lung cancer, obviously all healthcare issues, but this in particular. And I know that lung cancer is, I understand it's the largest cause of deaths of all cancers. Is that right? I think it is, yeah.

[A]

It's the most lethal type of cancer in all the world. In Brazil is not different, I would say. And this is changing because in the 50s, infections were the big problems in Brazil, in many countries. And then the cardiovascular disease becomes a huge problem in the 80s and 90s. But now when the population is, is getting older, cancer has become the major, the main cause of death in the world. And lung cancer among the types of cancer is the most lethal one, more than breast, prostate and colon even combined.

[B]

Wow. And I think it's also there's a stigma because I think everyone assumes that the only way you get lung cancer. Not everyone assumes it. Many people assume the only way you get lung cancer is if you smoke. And if you smoke, that's a personal failing. And all of that is incorrect. Right? All, all of that is, is, is wrong. And it's important to make sure that no, you, you can get it even if you don't smoke. And it's not. Yeah, a lot of people do smoke and that's not a personal failing. And we need to treat that anyway. And the community needs to treat that anyway. So I think, um, do you come across that is, is it, is it people say like, oh, I don't smoke, so therefore I can't get this.

[A]

Well, yeah, this is a misconcept because 80% of the cases are related to smoking or, or former smokers or people that are exposed to, to the other people that are smoking on your side, you know, family, inside the cars, inside the buses. But 20, 25, 20% around is not smoker related. So we need to be aware of that. Pollution is also causing lung cancer. The exposure of radon, which is derivative from the uranium exploring in many regions, even here in Bahia, the place that I live, there is a still active mine of exploration of these radiation uranium. Right. So a lot of cases are showing now in young woman, Asian woman, for instance, that are also non smokers and young patients. So you need to be aware of that because symptoms of the respiratory symptoms like cough, cough of blood, chest pain, weight loss, without any cause established need to be investigated. So lung cancer is not only for smokers. This is a big discussion by the global medical community how we can expand the lung cancer screening for those people that are under risk. But for doing that, we need to understand what the risk Factors are especially the genetic part. So this is also like a constant research to find on liquid biopsies, genetic backgrounds that can lead for the need of CT scan. So this is not only for smokers, but smokers are the main population target that we can find because they are on the higher risk population by now.

[B]

And I just want to end with one. Yeah, I'm sure that people think about, you know, when they hear about these mobile CT units, they think, oh my goodness, it sounds great, but maybe it's too expensive. And what would be your reaction to that?

[A]

Well then you need to figure out what's the total cost. In Brazil we're spending almost 2 billion reais on lung cancer care. And we are spending a lot of money on ICU care, advanced cases, taking care of patients in stages that not necessarily we are find the cure, we are doing palliation. So it's a test that will cost probably around $100 or so. So this is not expensive when you think where the money is going by now. So the calculation and the cost effectiveness, which is the point that you are making here, there are a few publications now already here in Brazil are showing that's cost effective, offering lung cancer screening for the whole population. And those cost effectiveness studies, they are already published in the U.S. and also in Europe. So the decision of making lung cancer screening is based on this is cost effective or it's not cost effective. And the answer is yes. And in the public system is even more more cost effective in Brazil now than in the private because the private system is offering already more expensive drugs like immunotherapy and target therapy. I'm not saying that we don't need to offer those drugs. We need to keep going and offer all these advanced drugs for the advanced cases. Right. But we, we need to also calculate and do a better way of using our money which is to promote the early detection.

[B]

Absolutely. And it sounds like all the different pieces of this are so important. Not just the mobile CT units, but the community training and partnering with organizations and local communities and so forth. But I'm afraid that's all the time we have for today. It's been a fascinating conversation. I'm learning a lot about the value of early diagnosis and cancer care and these great advances that are happening, including what you've been speaking about today. I'm sure we go much deeper into the topic today, but since we can't, I want to encourage our listeners to also check out the DEVEX content series that we have called Strengthening Care Systems Driving Sustainable Change. Across the lung cancer continuum. Yeah. Thank you to the Bristol Myers Squibb foundation for their partnership for both this conversation today. But also that ongoing content series. It's got some really interesting information in it that builds on or this has built on that, but it just really complements what we've discussed today. So I want to thank you all for listening. And last but not least, thanks to you, Dr. Santos, for joining us today. It's been a real pleasure.

[A]

Thank you, Alan. And let me give you a very good new. It's very new that came from yesterday here in Brazil. So yesterday, Brazilian Chamber of Deputies approved a bill addressing lung cancer prevention and early diagnosis with the public health system here in Brazil. The final tax approved is focused more in general guidelines, but we believe this was a first step to have lung cancer screening approved. So the whole health public system here in Brazil. So it's a good news that I want to give to you at the end of this conversation. I hope we can have more opportunities to have this conversation. I really enjoy the opportunity to be here invited by you and the BNS foundation, which is our biggest supporter here promoting lung cancer screening in our country. And I hope we can make this happen even more and more with the proper institutes. Thank you very much.

[B]

Great. Always stand out. Good news. Appreciate it.

[A]

Sat.