FIRS The Global Impact of Respiratory Disease – Second Edition | Page 25

Lung cancer
Scope of the disease
Cancer is a major global problem, with about
14.1 million new cases and 8.2 million deaths
in 2012, based on GLOBOCAN estimates [9].
Of the major cancers, lung cancer remains the
most common in the world, with an estimated
1.8 million new cases in 2012. Most (58%) of
these occurred in the less developed regions.
Lung cancer is also the most fatal cancer
globally. In 2012, 1.6 million people died from
lung cancer, accounting for 19.4% of the total
deaths attributable to cancer [9]. The ratio of
mortality to incidence is 0.87. If lung cancer
has spread to other organs, the 5-year survival
is only about 13% [40].
Tobacco smoke causes most cases of lung
cancer by damaging DNA and mutating
protective genes. Lung cancer risks correlate
with the amount and duration of smoking.
Since DNA-damaged genes accumulate over
time, lung cancer may occur years after people
begin or quit smoking. There are now more
former smokers than smokers worldwide, but
former smokers are not free from cancer risk.
Lung cancer can also occur in people who
have never smoked, which is especially
true for Asians. Other risk factors include
passive exposure to tobacco smoke, biomass
fuel, diesel exhaust, radon, asbestos,
and other environmental and workplace
carcinogens. Although asbestos is now
banned from commercial use and production
in most countries, these fi bres persist in the
environment, including insulation and fi re-
retardant materials inside and on the surface
of many buildings, and remain present in prior
manufacturing sites. Some countries where its
24
use is banned still produce and market it to
other countries.
Prevention
Lung cancer is largely preventable through
tobacco control. Public programmes that
reduce smoking are effective, but more are
urgently needed, especially in countries where
smoking is increasing because the incidence
of lung cancer follows increased smoking.
Environmental causes of lung cancer, such as
radon and asbestos, can be monitored and
reduced. Producers of asbestiform materials
should have increased regulations to minimise
or eliminate exports of their carcinogenic
material. Countries must not be allowed to
export asbestos to poorer countries. Other
known modifi able risk factors, such as biomass
fuels, diesel exhaust and air pollution, must
also be addressed. Research is needed to
determine other causes of lung cancer and
how to translate this knowledge into effective
health policy.
Treatment
Care of patients with lung cancer has become
complex and is optimally provided by an
expert multidisciplinary team when available.
In lower-income countries, access to care
and cost-effective treatments can reduce the
human burden and societal impact of lung
cancer.
To guide
prognosis,
diagnostic
stage lung
treatment and to determine
lung cancer patients undergo
and staging processes. Early-
cancer is treated with curative-
Forum of International Respiratory Societies