By Devex Partnerships //26 August 2026
Originally published on Devex
In Brazil, lung cancer is a leading cause of cancer mortality, with approximately 85% of cases diagnosed at an advanced stage. Much of this diagnostic delay stems from systemic fragmentation: While the country’s decentralized Unified Health System, or SUS, has built one of Latin America’s largest and most digitally-integrated tuberculosis, or TB, care networks, its oncology landscape remains disconnected from primary healthcare — making late-stage diagnoses a major driver of regional healthcare gaps. Institutionalizing integrated care models offers a critical opportunity to maximize limited resources, break down system silos, and save lives in lower-resource settings.
In this interview, Helen McGuire, PATH’s global lead for noncommunicable diseases, and Camilo Manchola-Castillo, senior director at Global Health Strategies in Latin America, discuss a six-month landscape assessment funded by the Bristol Myers Squibb Foundation, or BMS Foundation. They explore how positioning Brazil’s established TB platform as a gateway for early lung cancer detection can transform patient outcomes across the region.
This conversation has been edited for length and clarity.
Why are Brazil’s existing TB platforms such a natural entry point for improving lung cancer detection?
Helen: TB and lung cancer are closely linked in both their risk factors and clinical presentation. This overlap can lead to delayed or missed diagnoses. In addition, people who have had TB are at increased risk of developing lung cancer due to lasting lung damage. Despite these connections, lung cancer is often not considered within TB services.
For example, when a patient presents with an abnormal chest X-ray and is diagnosed with TB, they typically receive treatment and follow-up through established systems. However, when TB is ruled out, abnormal findings may not always lead to further investigation. As a result, opportunities to diagnose lung cancer can be missed.
By building on its established TB and primary health care infrastructure, Brazil has a unique opportunity to close this diagnostic gap. The country has a strong TB platform embedded within the SUS, with comprehensive services spanning surveillance and case detection through their advanced primary health care network.
At this time many countries are looking for ways to maximize limited resources, strengthen primary health care, and deliver more people-centered services. Integrating TB and lung cancer care helps health systems respond to the reality that people do not experience diseases in isolation.
Your assessment has spanned three states in Brazil: Rio de Janeiro, Pernambuco, and the Amazonas. Can you share how you identified these and how contrasting local realities shape how you assess true system readiness for integrated care?
Camilo: The three states were selected as a result of our initial conversations and strategic support with the [Brazil] Ministry of Health. We recognized the need to focus on regions where the epidemiological need was greatest and where the lessons learned could help inform national policy.
Amazonas has the highest TB incidence in the country, while Pernambuco is also recognized as a high-burden state. Rio de Janeiro was included because of its relevance within the national TB landscape. When considering lung cancer, although comprehensive data are limited, estimates from the National Cancer Institute indicate that these geographies are also significantly affected by the disease.
Brazilians often say that there is not just one Brazil, but many Brazils. For example, many municipalities in Amazonas can only be reached by river, presenting a very different reality from Rio de Janeiro and Pernambuco. We wanted this diversity of contexts to be reflected in our selection.
Another important consideration was the strength of primary healthcare. Brazil is internationally recognized for its primary healthcare system, and we wanted to understand how well it functions across these very different settings in Amazonas, Pernambuco, and Rio de Janeiro.
One of the goals of this project is to develop an integrated, human-centered model of care. How are frontline providers and patients shaping that model?
Helen: The engagement with frontline providers, with people living with lung cancer and/or TB, and the Ministry of Health is critically important and starts from day one. The teams began by understanding the context across three states and mapping stakeholders that influence policy, programs, data systems, and clinical services for TB, lung cancer, and primary healthcare. From there, they met with stakeholders to understand their perspective on the feasibility of integrated services and how they envision integration being operationalized in their state.
The BMS Foundation has made a strong investment in the time and resources required to understand the context, explore the problem with stakeholders and start to codesign a solution or integrated model of service delivery that is contextualized to each state.
The existing TB platform in Brazil provides a mature and functioning system of disease detection and care that is linked to primary healthcare — this provides the structure, information systems and an accessible service delivery platform to support and advance lung cancer detection and linkage to specialized treatment.
What lessons from Brazil could inform efforts in other Latin American countries and beyond?
Helen: We’ve been working on this initiative in Brazil and India, and have identified some common barriers like policy gaps that lead to fragmentation, lack of coordinated referral pathways, data system gaps, and catastrophic expenditures for cancer patients limiting access to care.
These common challenges provide opportunities for transferable lessons that can be adapted to other areas such as opportunities to leverage existing platforms, workflows, and diagnostic infrastructure to build in integration points. Strengthened awareness and education within communities, and training for providers and community workers, increases demand for services and supports uptake and commitment to integrated models.
I would say that the translatable lessons are the value of having the conversations with stakeholders to understand what they’re experiencing each day, what their observations are, what the data tells them and what they envision for the future. This can help inform a much stronger approach that can then be tested in-country and strengthened with data and iterative adaptation.
Camilo: An initial lesson learned is that a consolidated primary healthcare system is a very powerful tool to tackle various diseases and health conditions.
The second lesson is the importance of understanding the geographical context and tailoring care to local realities. TB and lung cancer are strongly influenced by social drivers of health, such as poverty, living conditions, access to healthcare, and smoking patterns. Because these factors vary across states and municipalities, integrated care models cannot follow a one-size-fits-all approach.
The third is that integrating the clinical algorithms can be more powerful than expanding infrastructure. The challenge is less about the absolute number of scanners and more about equitable distribution, timely access through the SUS, and ensuring that abnormal findings lead to appropriate follow-up.
Another important lesson is the need for interoperable digital health systems. Today, patient information is often stored across multiple disconnected systems, making it difficult to coordinate care. By integrating electronic health records with disease surveillance systems and referral tracking, healthcare teams can better coordinate patient care and ensure that abnormal findings are followed through.
And just to finalize, you need to have interprofessional support and training among physicians, nurses and psychologists. Community health workers are also an essential part of the team. Their role is key because they have a deep understanding of the communities they serve and help the broader healthcare team better understand local realities, barriers to care, and the stigma associated with diseases. Having this kind of interprofessional dialogue and continuous learning across the team is vitally important for initiatives like this to be successful.
Visit Strengthening Care Systems — a series in collaboration with the Bristol Myers Squibb Foundation on raising awareness of the scale of the global lung cancer burden and the systems-level changes required to address it.
