The changing epidemiology of lung cancer with a focus on screening

#### Summary points Lung cancer is a global public health problem of epidemic proportions, and the number of people affected is expected to grow in the near future. Worldwide, in 2002 more than 1.3 million people were newly diagnosed with lung cancer.1 It is the leading global cause of death from cancer, and it accounts for 18% of all deaths from cancer and more than one million deaths a year since as far back as 1993.2 3 Lung cancer is the 10th leading overall cause of death, and it is expected to move to fifth place as its incidence rises in developing countries. Lung cancer is a disease that seems to fit the profile for a successful screening programme. However, developing an efficacious screening test that meets the established criteria for screening has proved elusive, despite evidence from many screening trials, and screening remains controversial. This review aims to shed light on the questions surrounding screening for lung cancer. Active cigarette smoking is the main cause—it accounts for 85-90% of all lung cancers.2 w1-w5 In addition, exposure to secondhand cigarette smoke; pipe and cigar smoking; occupational exposure to agents such as asbestos, nickel, chromium, and arsenic; exposure to radiation, including radon gas in homes; and exposure to air pollution are all established …