• lung cancer
• thoracic surgery

Inequalities in lung cancer care between the richest and poorest in society attract attention and rightly so; the disease is most prevalent and survival poorest in those who are deprived.1 Through improved awareness, earlier diagnosis and higher rates of curative treatment, predominantly by surgical resection, we have seen improvements in lung cancer survival over the last decade. Unfortunately, there is evidence to suggest that deprived people are less likely to benefit from any of these interventions compared with the more affluent. Socioeconomic deprivation is associated with reduced participation in lung cancer screening trials.2 This is due, at least in part, to perceptions that lung cancer is an uncontrollable, self-inflicted, smokers’ disease.3 Encouraging results from a study of ‘Lung Health Checks’ in Manchester suggest that it is possible to reach more deprived people if the service is designed appropriately.4

Survival differences between the most and least deprived patients with lung cancer may be related to comorbidity; it is well recognised that overall survival from cancer is worse in poorer people.5 In lung cancer specifically, this may reflect differences in treatment rates and, even without the specific effects of socioeconomic variation, there are geographical variations in lung cancer treatment rates, attributed by some to varying practice between multidisciplinary teams (MDT).6 In this issue of Thorax, Belot et al 7 add to the growing body of evidence that the higher …