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Lung cancer is the most common cancer and greatest cancer killer worldwide (1). With up to 85% of lung cancers caused by tobacco smoke, it is a largely preventable disease (2). Since the US Surgeon General’s report on the health hazards of smoking in 1967 (3), ongoing and comprehensive tobacco control has resulted in declining smoking and lung cancer rates in many high-income populations. Nevertheless, because of population growth and ageing, combined with the 20–30-year lag between population-level tobacco exposure patterns and changes in lung cancer mortality rates, the burden of lung cancer is likely to remain high for many years (especially in lowmiddle income countries). In countries with more recent trends for increased tobacco uptake, lung cancer mortality is continuing to rise and 40% of all lung cancers now occur in China and India (1). Primary prevention with sustained tobacco control is an effective long-term strategy for reducing the burden of lung cancer but there is potential to supplement tobacco control with interventions that might be effective in reducing mortality in the shorter term. Modelled predictions have suggested it could take more than 50 years to see an elimination of the smokingrelated health burden in relation to tobacco-free endgame scenarios (4). Further, in many high-income countries, as smoking cessation rates increase, the lung cancer rates among former smokers become significantly higher than in current smokers, reflecting the irreversible genetic impact of tobacco smoking and a lifetime of continued elevated lung cancer risk (5). Thus, although primary prevention with sustained tobacco control is an effective long-term strategy for reducing the burden of lung cancer, the full benefits of these interventions will not be realised for many years to come, and, in the interim, lung cancer screening might have potential to make a significant impact. |
