Published in PLOS One on 2025-10-23, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Nathan Estifanos, Gudina Egata, Adamu Addissie, Rahel Argaw Kebede, Amsalu Bekele, Negussie Deyessa, Xingyu Xiong
Source: PLOS One • DOI 10.1371/journal.pone.0332952
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
There is limited evidence regarding lung cancer awareness in developing countries. In Ethiopia, 92.2% of lung cancer patients present at facilities with late stages, leading to poor treatment outcomes. This emphasizes the importance of early detection. Symptom awareness is crucial for reducing delays. This study aimed to identify latent classes of lung cancer symptom awareness and their predictors, guiding class-specific interventions.
A population-based cross-sectional survey was conducted from October to December 2023 among a randomly selected 2388 adults in Addis Ababa, Ethiopia. A face-to-face interview was conducted using the validated Lung Cancer Awareness Measure (Lung CAM). Latent class analysis and latent class multinomial logistic regression were used to identify classes and predictors of class membership.
Three distinct classes of participants were identified: “poor awareness” (Class 1: 38%), “fair awareness” (Class 2: 37.5%), and “good awareness” (Class 3: 24.5%). The average symptom awareness score was 7.8 out of 14. The most commonly recognized symptom was coughing up blood (72%), while changes in the shape of fingers were the least recognized (20%). Being male, employed, having a higher education level, using out-of-pocket money for health expenses, and knowing someone with cancer significantly increased the odds of belonging to the “good awareness” class, with adjusted odds ratios ranging from 1.66 to 12.60.
Only one-fourth of participants were classified as class 3, denoted as “good awareness,” indicating a significant gap in symptom awareness. Respiratory symptoms were mostly well-known. Class membership varied across sociodemographic and related characteristics. Hence, there is a need for class-specific educational intervention and a focus on non-respiratory symptoms.
Introduction
Lung cancer remains the leading cause of cancer morbidity and mortality globally in 2022 [1]. According to the Global Observatory of Cancer 2022 report, Eastern Africa has an age-standardized incidence rate of 3.9 and 2.7 per 100,000 for males and females, respectively [1]. It ranks among the top five most common cancers in men aged 15 and older, with an incidence rate of 3.5 per 100,000 in Ethiopia in 2015 [2].
In Ethiopia, tobacco use, an established risk factor, has been increasing [3]. Additionally, Ethiopia exceeds the World Health Organization (WHO) guideline [4] for the concentration of particulate matter < 2.5 microns [5], and around 95% of the population depends on polluting fuels [6]. The nation is one of the 30 countries facing a significant challenge with tuberculosis, alongside comorbidities like the human immunodeficiency virus and chronic pulmonary diseases [7,8].
Lung cancer symptoms include respiratory symptoms such as a persistent cough, chest pain, shortness of breath, and coughing up blood, as well as non-respiratory symptoms like unexplained weight loss, loss of appetite, shoulder pain, and changes in the shape of fingers/nails [9,10]. In Ethiopia, a significant proportion (92.2%) of lung cancer patients seek medical attention at health facilities during advanced stages [10]. The majority of patients (over 90%) diagnosed with lung cancer exhibit symptoms at the time of diagnosis [11]. Notably, cough is the most prevalent symptom [12].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Nathan Estifanos, Gudina Egata, Adamu Addissie, Rahel Argaw Kebede, Amsalu Bekele, Negussie Deyessa, Xingyu Xiong. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Delayed health-seeking behavior and its associated factors among cancer patients in Ethiopia: A systematic review and meta-analysis, 2025
- Evidence brief: Spatial autocorrelation and determinants of low uptake of breast cancer screening among women of reproductive age: A mixed-effect multilevel analysis of Tanzanian population-based survey
- Evidence brief: Satellite clinics to bring pediatric cancer care closer to patients in Ethiopia: Perceived relevance, opportunities and anticipated challenges
