Family physicians' competencies for early lung cancer detection in an atypical epidemiological context in Cuba: a mixed-methods study

In the world of medicine, the most effective way to fight a disease is often to find it before it causes serious harm. This is the core idea behind early detection: spotting a problem while it is still small and manageable, rather than waiting until it has grown too large to control. For lung cancer, this concept is vital because the disease is often silent in its early stages, only revealing itself when it has already spread. In many parts of the world, the primary driver of this disease is the habit of smoking, and medical training has long focused heavily on identifying smokers as the people most at risk. However, the reality of disease is not always uniform. In some places, the causes of illness are different, and the people who get sick are not the ones doctors expect. When a region has a unique pattern of disease, the standard rules for finding it may no longer apply, and the doctors on the front lines need new tools to recognize the specific dangers that exist in their own communities.

This reality is playing out in Guantánamo, Cuba, where a researcher recently set out to understand how well local family doctors are prepared to catch lung cancer early. The situation there is unusual. While smoking is a known cause of lung cancer everywhere, the data in Guantánamo tells a different story. Here, the vast majority of lung cancer cases occur in people who have never smoked. Instead, the leading cause appears to be work-related exposure, where people breathe in harmful substances in their jobs. This creates a difficult challenge for family physicians, who are the first point of contact for patients. If these doctors are trained to look for lung cancer only in smokers, they might miss the signs in the many non-smokers who are actually at the highest risk in this region. The researcher wanted to know if these doctors had the right knowledge and skills to handle this specific local reality, or if they were still relying on old habits that no longer fit the facts on the ground.

To find the answer, the researcher conducted a thorough investigation involving nearly 280 family physicians across a large medical center in Guantánamo. They did not rely on just one method to get the full picture. Instead, they combined three different approaches to see where the truth lay. First, they asked the doctors to fill out a detailed questionnaire about what they knew, how they felt about early detection, and what they actually did in their daily work. Second, they looked at the actual medical records of hundreds of patients who had risk factors, checking to see if the doctors were following up on these risks or if the records were incomplete. Finally, they held group discussions with doctors and clinic administrators to hear their thoughts and concerns in their own words. This mix of surveys, file reviews, and conversations allowed the researcher to cross-check the information and see if what people said matched what they were actually doing.

The results revealed a striking gap between what the doctors believed and what they were able to do. Almost all of the physicians, more than 90 percent, agreed that finding lung cancer early is important and that it saves lives. They were motivated and willing to help. However, when the researcher looked at their actual knowledge and actions, the picture changed dramatically. Less than half of the doctors were familiar with the official medical guidelines that tell them how to screen for cancer. Even more concerning was their understanding of risk. While nearly 90 percent of the doctors correctly identified smoking as a danger, only about one-third could name the specific work-related hazards that are the main cause of lung cancer in Guantánamo. This is a critical failure because, in this region, nearly two-thirds of all lung cancer cases are linked to occupational exposure. The doctors were looking for the wrong clues.

The gap between attitude and action was even wider when the researcher examined the medical records. They found that 92 percent of the files were outdated, meaning they did not contain current information about the patients' health status. In the few cases where a patient had a known risk factor, the doctors followed up with them systematically in only 3.8 percent of instances. This means that for the vast majority of at-risk patients, there was no organized plan to keep watching them for signs of disease. The doctors were not ignoring their patients out of laziness or lack of care; rather, they seemed to be operating without a clear map. The group discussions confirmed this, with doctors and administrators pointing to heavy workloads and a lack of practical, local guidelines as the main obstacles. They expressed a strong desire for better training, specifically asking for workshops and real-life examples that addressed the unique risks of their community.

The study concludes that the doctors in Guantánamo are not failing because they do not want to do a good job. They are failing because their training and the tools they use are not adapted to the specific disease patterns of their region. They are trying to solve a local problem with a global solution that does not fit. The researcher suggests that to fix this, cancer education for primary care doctors must be completely redesigned to focus on the local reality. This means teaching doctors to look for lung cancer in non-smokers, to recognize the signs of workplace exposure, and to use simple, practical steps to follow up with at-risk patients. The doctors are ready to learn, but they need a curriculum that reflects the world they actually practice in, rather than the world that exists in textbooks written for different places. Until that change happens, the early detection of lung cancer in this region will remain out of reach for the people who need it most.