• Lung cancer
• lung cancer chemotherapy
• mesothelioma
• non-small cell lung cancer
• small cell lung cancer

Three papers published in this issue of Thorax address the issue of the late diagnosis of lung cancer.1–3 The most recent international population-based survival data for lung cancer again show the UK at the bottom of the scale with a predicted 8.8% of those diagnosed between 2005 and 2007 being alive at 5 years compared with 14.4% in Norway, 16.3% in Sweden and 15–20% in areas of Australia and Canada.4 It has been estimated that, in England, around 1300 lives per year would be saved if our survival matched the best in Europe.5 It is well known that late diagnosis is the major reason why lung cancer outcomes are generally so poor and this is illustrated by the fact that, in the UK, more than 70% of patients have advanced stage (IIIB or IV) disease at the time of diagnosis.6 Huge attention has therefore been focused on the possibility of screening asymptomatic individuals and the most recent findings of the National Lung Cancer Screening Trial7 would appear promising.

In considering reasons underlying the consistent finding of poor UK survival rates, most attention has been given to shortcomings in treatment in secondary care and there is no doubt that there are wide variations in treatment and survival within the UK itself.6 What is not yet known is the extent to which later stage at diagnosis in the UK may explain these survival differences. Some have proposed that at least part of the explanation may be a higher rate of comorbidities in the UK,8 although the evidence for this is limited. One recent study, however, suggests that late diagnosis in the UK is a major factor. Holmberg et al9 …