Lung cancer-celebrating progress and acknowledging challenges.

®ovember is lung cancer awareness month in most countries of our readership. Unfortunately, this month slips by with most people including health care workers, not even realizing that the month has been set aside to recognize and affirm the fight against this deadly disease. The lack of recognition is made more striking by the fact that November follows October—breast cancer awareness month, which is widely celebrated globally. Thus, November is a good month for Journal of Thoracic Oncology to reflect on the accomplishments in research, screening, prevention, and treatment of this disease. The most accurate global data on lung cancer are about 5 years old. These data indicate that lung cancer is the most common cancer in the world, with an estimated 1.61 million new cases a year, representing 12.7% of all new cancers. It is also the most common cause of cancer death, accounting for 18% of the total or 1.38 million deaths. 1 To put these numbers in perspective, the equivalent mortality statistic from acquired immuno-deficiency syndrome, arguably the most devastating human epidemic in recent memory was 2 million deaths. Given these data, why are all nations, governmental and nongovernmental agencies not spending significant resources and efforts in preventing this disease? Lung cancer is one of the few cancers for which the major cause has been identified. The causative link between tobacco use and lung cancer was established over 60 years ago. 2 Approximately 90% of lung cancers occur in smokers or those with a history of smoking. Global lung cancer incidence rates closely mirror smoking prevalence. 1 Since the introduction of manufactured cigarettes just over 125 years ago, global tobacco use has risen steadily. Currently, it is estimated that there are more than one billion smokers worldwide, roughly a quarter of the world adult population. 3 Tobacco control programs are being established in the major industrialized countries. However, in many developing countries, the consumption of cigarettes is increasing rapidly in both sexes, attributable to population growth and the increased targeting of tobacco marketing in these areas, particularly to the youth. The most successful approach to combating deadly diseases has been prevention, screening, and early detection. Although the supporting data are still debated, screening is currently established in three common cancers, breast, colorectal, and prostate cancer. For the first time in the United States, a large, randomized controlled trial, the National Lung Screening Trial (NLST) screened over 50,000 adults at high risk for lung cancer (current or former smokers aged 55 to 74 years with a ≥30 pack-year history of cigarette smoking and ≤15 years since quitting), with low-dose computed tomography scans (LDCT) or singleview posterior anterior chest radiography. This study demonstrated a relative reduction of death from lung cancer with low-dose screening of 6.7% and a reduction in all-cause mortality of 20% in the LDCT group compared with the chest radiography group. 4 On the basis of this study, a number of academic societies have recommended screening for lung cancer with LDCT. The American College of Chest Physicians, the American Society of Clinical Oncology, the American Thoracic Society, the American Association for Thoracic Surgery, the American Cancer Society, and the National Comprehensive Cancer Network have recommended screening with eligibility criteria similar to that of NLST. The International Association for the Study of Lung Cancer (IASLC) Task Force on computed tomography (CT)