Published ahead of print on June 16, 2005, doi:10.1164/rccm.200504-531OE
Am. J. Respir. Crit. Care Med., Volume 172, Number 5, September 2005, 523-529
A more recent version of this article appeared on September 1, 2005
Submitted on April 5, 2005
Accepted on May 25, 2005
100 Years of Lung Cancer
Stephen G Spiro1* and Gerard A Silvestri2
1 Department of Thoracic Medicine, Middlesex Hospital, London, UK,
2 Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
* To whom correspondence should be addressed. E-mail: stephen.spiro{at}uclh.org.
A hundred years ago lung cancer was a reportable disease which has now risen to be the commonest cause of death from cancer in both men and women in the developed world, and before long in the developing world as well. The disease has no particular symptoms or signs for its detection at an early stage. Most patients therefore present with advanced stage IIIB or IV disease. Screening tests began in the 1950's with annual chest x-ray and sputum cytology but found no improvement in overall mortality compared to control subjects. The same question is now being asked of spiral low dose CT scanning.
There have been big refinements in the staging classification of lung cancer and advances in stage identification using minimally invasive technology. Post surgical mortality has declined from the early days of the 1950s but 5 year cure rates have only barely improved. The addition of chemotherapy to radical radiotherapy, together with novel radiotherapy techniques is gradually improving the outcome for locally advanced inoperable non-small cell lung cancer (NSCLC). Chemotherapy offers modest survival improvement for patients with NSCLC, the modern agents being better tolerated resulting in an improved quality of life. The management of small cell lung cancer which appeared so promising at the beginning of the 1970's has hit a plateau with little advance in outcome over the last 15 years.
The most important and cost effective management for lung cancer is smoking cessation but for those with the disease novel agents and treatment approaches are urgently needed.
Key words: Lung Cancer, history, staging, treatment
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