“lung cancer is the leading cause of cancer-related deaths in North America and Europe, and its incidence is rising elsewhere,” ensuring an increasing number of lung cancer deaths worldwide. Unfortunately, we can substitute “remains the leading cause” for “is the leading cause.” In 1997 alone, 178,100 new lung cancer patients were diagnosed in the United States. Lung cancer is rising at an exponential rate in women and in under-served populations. Children and young adults continue to smoke in alarming proportions. That's the bad news.
The encouraging news is that lung cancer and tobacco abuse are getting the attention necessary to actually open pocket books for related clinical and benchwork research. Advocacy groups for lung cancer, virtually unheard of in 1996, are taking a more proactive stance in the education of patients, families, and primary care physicians. An unprecedented resurgence in early detection, screening, and lung cancer prevention is gaining momentum, which could eventually translate into stage migration. New imaging techniques are being validated for increased sensitivity that may even change surgical staging practices. Aggressive multimodality therapy is moving into clinical trials for patients with earlier stages. Even the staging system (biologic staging) is different! Scientists are beginning to lay out an evolutionary molecular model of airway carcinogenesis. This model may predict or describe either the earliest event that could signal the development of lung cancer, or the event in the spectrum that is the latest, but reversible, so that it would be possible to indicate who will move on to neoplasia.