Clinical Review

Science, medicine, and the future: Lung cancer

BMJ 1997; 314 doi: (Published 01 March 1997) Cite this as: BMJ 1997;314:652
  1. Tariq Sethi, lecturer in respiratory medicinea
  1. a Rayne Laboratory Respiratory Medicine Unit University of Edinburgh Medical School Edinburgh EH8 9AG
  1. Correspondence to: Department of Vascular Biology, Scripps Research Institute, La Jolla, CA 92037, USA.

    Lung cancer, the most prevalent cancer in the Western world, is mainly caused by smoking. Nevertheless, only 20% of smokers develop lung cancer and while prevention is important, environmental factors are expected to contribute to the predicted rise in the incidence of lung cancer in the next 25 years. Survival of lung cancer is still poor, and new treatments are urgently needed. This review examines potential new therapeutic developments which have arisen from a greater understanding of the molecular and cellular biology of lung cancers.


    Lung cancer is the commonest fatal malignancy in the developed world. Cancer accounts for a quarter of deaths in England and Wales, and lung cancer accounts for 1 in 3 deaths from cancer in men and 1 in 6.5 in women. Mortality from lung cancer now exceeds that from breast cancer among women in Scotland. During the past 20 years medical and surgical intervention has resulted in little change in the five year survival for lung cancer, with roughly 90% of affected patients dying within one year of diagnosis. The epidemic proportions of the disease are contrasted sharply with the general failure of conventional treatment. Nevertheless, I feel optimistic that this frustrating and dismal situation will change in the next 25 years. Firstly, there is a genuine desire to do something about lung cancer, and, secondly, with a greater understanding of the molecular and cellular biology of lung cancer the rational development of new and specific antitumour drugs is a realistic goal.

    Cigarette smoking is by far the most important single factor in causing lung cancer and is directly responsible for at least 90% of lung cancers. Asbestos exposure is the main occupational cause of lung cancer, although several atmospheric pollutants and other industrial products are also important. Prevention will continue to play an important …

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