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The principal reason lung cancer outcomes are poor is that most patients are diagnosed with what, with current technologies, is incurable disease. Despite unprecedented recent advances in the understanding of the biology, oncogenesis and immunology of cancer, and the subsequent development of innovative systemic therapies for lung cancer, the long-term prognosis for patients beyond stages I and II remains poor. The cost of the new agents, largely indicated for people with advanced disease and good performance status (PS), is such that the International Agency for Research on Cancer recently said that ‘No country can afford to treat its way out of the cancer problem’.1 In any case, many patients with advanced disease are ineligible because of poor performance status.
Although lung cancer survival rates have been improving in England since 2006,2 the latest data from the Concord study still rate the UK behind many other nations.3 Later diagnosis is likely a major factor explaining the consistent observation that the proportion of patients that have early stage disease at the time of diagnosis in the UK is less than in many comparator countries.4 In a recent study comparing older patients with non-small cell lung cancer (NSCLC) in England with those in the USA, 15% were diagnosed at stage I in England compared with 25% in the USA.5
To address these issues, we need to consider ways in which we can detect lung cancer at an earlier stage to increase the curative treatment rate, and where cancer is detected at a later stage, provide rapid work-up to minimise deterioration in fitness to maximise the impact of systemic therapy. Essentially this means: screening of people at relatively high risk of lung cancer; using public and professional awareness campaigns to promote the earlier referral of patients with symptoms suspicious …
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