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INTRODUCTION

Lung cancer is the leading cause of cancer death in the world. The International Agency for Research on Cancer (IARC) GLOBOCAN reported a global lung cancer burden of 2.2 million new cases and 1.8 million deaths in 2020 alone.1 These statistics emphasize the harsh reality that lung cancer is a common and highly fatal disease. Nonetheless, the past decade has witnessed remarkable advances in tobacco control, screening and early detection, and treatment, which are contributing toward progress in curtailing the global lung cancer epidemic.

Globally, lung cancer is the second most commonly diagnosed cancer. It is the leading cause of cancer incidence and mortality in men. In women, it is the third leading cause of cancer incidence after breast and colorectal cancers, and the second leading cause of mortality after breast cancer (Fig. 108-1).2 Lung cancer is much more common in areas with a high or very high human development index (HDI), such as in Western Europe, the United States, and Japan.2 The positive association with HDI level mirrors the maturity and extent of the tobacco epidemic in different areas and is stronger in men than in women.3 Lung cancer incidence and mortality in both women and men in high- and very high-HDI countries historically have been several-fold higher than in countries with low or medium HDI. This will inevitably change given that 80% of current adult smokers live in low- and middle-income countries.4 The highest lung cancer incidence rates in men are now observed in Eastern and Southern Europe, Eastern and Western Asia, and Micronesia/Polynesia, while in women the highest incidence rates are still observed in North America and Western and Northern Europe.2 Mortality rates unfortunately closely follow incidence, reflected in an estimated global mortality incidence ratio (MIR) of 0.85.5 Globally, some improvement has been seen in 5-year lung cancer survival rate, which in most countries is now reported in the range of 10% to 20%.6 However, compared with the other common solid tumors—breast, colon and prostate cancers—lung cancer outcomes are poor despite the development of a wide array of new therapies, demonstration of lung cancer screening benefit, and advancements in surgical and radiation technologies. Not surprisingly, survival rates are worse in low-income countries without such resources, but poor outcomes still persist even in high-income countries, with 5-year survival in cancer registries in the United Kingdom, Germany, the United States, and Japan reported at 13%, 18%, 21%, and 33%, respectively.6

Figure 108-1

Most common type of cancer mortality by country in 2020 among (A) men and (B) women. The numbers of countries represented in each ranking group are included in the legend. (Reproduced with permission from GLOBOCAN 2020. © WHO 2020. All rights reserved.)

For the purposes of this chapter, the term lung cancer includes both non–small-cell lung cancer (NSCLC) ...

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