Background: Lung cancer remains the leading cause of cancer-related mortality globally, accounting for approximately 2.5 million new cases and 1.9 million deaths annually (Siegel et al., 2025; GLOBOCAN, 2024). In Libya, the disease ranks first among all malignancies, with 952 new diagnoses (11.8% of new cancer cases) and 796 annual deaths (16.9% of all cancer-related fatalities) according to GLOBOCAN 2024 estimates (International Agency for Research on Cancer, 2024). While the past decade has witnessed transformative advances in lung cancer therapeutics—including targeted therapies, immunotherapies, and precision medicine approaches—in high-income countries, the Libyan healthcare system faces substantial challenges in delivering contemporary oncological care. The 5-year relative survival rate for lung cancer patients in Libya is estimated at 2.3%, among the lowest globally and incomparable to rates exceeding 20% in developed nations (Siegel et al., 2025; Al-Ferjani et al., 2025).
Purpose: This paper provides a systematic analysis of clinicopathological characteristics, diagnostic delay patterns, and therapeutic accessibility for lung cancer patients in Libya, comprehensively examining the barriers that impede effective cancer care delivery across multiple oncology centers.
Methods: This cross-sectional retrospective analytical study employed a systematic review approach integrating published studies conducted by Libyan universities (2017–2024), official data from the National Cancer Registry and National Anti-Cancer Authority, clinical cohort data from Benghazi Medical Center (n=348 patients, 2017–2022; and n=53 patients, 2016–2025), Misrata Oncology Center (n=187 patients, 2018–2024), Tripoli Central Hospital (n=256 patients, 2017–2024), and Zawia Teaching Hospital (n=94 patients, 2019–2024), and data extracted from the WHO Eastern Mediterranean Regional Office database. Quantitative indicators assessed included clinicopathological characteristics, diagnostic stage distribution, pathological classification rates, treatment modality availability, and medication availability patterns. Descriptive statistics (frequencies, percentages, means, medians, standard deviations) were computed using SPSS version 26, with 95% confidence intervals calculated for key proportions. Qualitative data underwent thematic analysis to identify recurrent systemic patterns (Braun & Clarke, 2006).
Results: Analysis across all four oncology centers revealed consistent patterns. The male-to-female ratio was approximately 9:1, with a mean age of 61.2 years (SD=10.8). Adenocarcinoma was the predominant histological subtype (45.3%; 95% CI: 42.1–48.6%), followed by squamous cell carcinoma (20.8%; 95% CI: 18.2–23.7%). The most alarming finding was the exceptionally high frequency of advanced-stage disease at diagnosis: 94.7% of patients (95% CI: 93.2–95.9%) presented at Stage III or IV, with only 5.3% (95% CI: 4.1–6.8%) diagnosed at Stages I or II. Pathological classification with comprehensive TNM staging was performed in only 7.6% of cases (95% CI: 6.1–9.4%). Molecular biomarker testing (EGFR, ALK, ROS1, PD-L1) was conducted in <5% of cases (95% CI: 3.6–6.7%), entirely outsourced to foreign laboratories. Surgery was available to 5.3% of patients (those with early-stage disease). Chemotherapy constituted the primary systemic therapy for 78.4% of patients (95% CI: 75.8–80.9%), while radiotherapy services were accessible to only 15.2% of patients who could benefit (95% CI: 12.6–18.2%). Targeted therapies and immunotherapies were effectively unavailable through public healthcare facilities. Medication stock-outs affected chemotherapeutic agents in 47–62% of months across all centers.
Discussion: The severely compromised treatment landscape stems from multiple interdependent factors: (1) the “diagnostic catastrophe,” with 94.7% of patients diagnosed at Stage III/IV, rendering curative surgical intervention impossible for the vast majority; (2) critical shortages of pathological diagnostic capacity, with comprehensive staging performed in only 7.6% of cases; (3) near-total absence of molecular testing capacity, with all biomarker analysis outsourced abroad; (4) consistent shortages of essential chemotherapeutic agents and supportive medications; (5) critical shortages of specialized oncology personnel across all categories; (6) inadequate radiotherapy infrastructure with aging equipment and limited geographic distribution. These factors collectively create a treatment environment where evidence-based, personalized oncology care remains largely unattainable for the majority of patients.
Conclusion: Substantial and sustained investments in diagnostic infrastructure, pathological capacity building, establishment of reliable pharmaceutical supply chains, comprehensive training of oncology specialists, and implementation of early detection programs are urgently required to improve outcomes for lung cancer patients in Libya.
Keywords: Libya; Lung Neoplasms; Clinicopathological Profiles; Diagnostic Delay; Treatment Accessibility; Pathological Staging; Healthcare Infrastructure.
Citation: Elbai, S., Abuzreda, A., Elayati, K., Albay, B., & Albay, M. (2026) Lung Cancer in Libya: A Cross-Sectional Analysis of Clinicopathological Profiles, Diagnostic Delay Patterns, and Treatment Accessibility. J Prim Health Glob Health 1(1):1-15.