The global burden of lung cancer: current status and future trends
Lung cancer is the leading cause of cancer-related death worldwide. However, lung cancer incidence and mortality rates differ substantially across the world, reflecting varying patterns of tobacco smoking, exposure to environmental risk factors and genetics. Tobacco smoking is the leading risk factor for lung cancer. Lung cancer incidence largely reflects trends in smoking patterns, which generally vary by sex and economic development. For this reason, tobacco control campaigns are a central part of global strategies designed to reduce lung cancer mortality. Environmental and occupational lung cancer risk factors, such as unprocessed biomass fuels, asbestos, arsenic and radon, can also contribute to lung cancer incidence in certain parts of the world. Over the past decade, large-cohort clinical studies have established that low-dose CT screening reduces lung cancer mortality, largely owing to increased diagnosis and treatment at earlier disease stages. These data have led to recommendations that individuals with a high risk of lung cancer undergo screening in several economically developed countries and increased implementation of screening worldwide. In this Review, we provide an overview of the global epidemiology of lung cancer. Lung cancer risk factors and global risk reduction efforts are also discussed. Finally, we summarize lung cancer screening policies and their implementation worldwide.
Key points
- Lung cancer is the leading cause of cancer death globally, with incidence and mortality trends varying greatly by country and largely reflecting differences in tobacco smoking trends.
- Cigarette smoking is the most prevalent lung cancer risk factor, although environmental exposures, such as biomass fuels, asbestos, arsenic and radon, are all important lung factor risk factors with levels of exposure that vary widely across the globe.
- Lung cancer incidence and mortality rates are highest in economically developed countries in which tobacco smoking peaked several decades ago, although these rates have mostly now peaked and are declining.
- Reductions in lung cancer mortality in economically developed countries reflect decreased incidence (mirroring declines in tobacco smoking) and improvements in treatment of patients with advanced-stage disease, including immunotherapies and targeted therapies.
- In low-income and middle-income countries at the later stages of the tobacco epidemic, both lung cancer incidence and mortality are increasing, thus highlighting the importance of tobacco mitigation policies for reducing the global burden of lung cancer.
- Low-dose CT-based lung cancer screening reduces lung cancer mortality, although adoption of lung cancer screening programmes has been slow, with limited uptake compared with other cancer screening programmes.
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Authors and Affiliations
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Amanda Leiter
- Division of Hematology and Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Rajwanth R. Veluswamy
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Juan P. Wisnivesky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA Rajwanth R. Veluswamy
- Amanda Leiter
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R.V. has acted as an adviser and/or consultant to AstraZeneca, Beigene, BerGenBio, Bristol-Myers Squibb, Merck, Novartis, Novocure and Regeneron, and has received research grants from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, and Onconova Therapeutics. J.P.W. has acted as an adviser and/or consultant to Atea, Banook, PPD and Sanofi and has received research grants from Arnold Consultants, Regeneron and Sanofi. A.L. declares no competing interests.
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Leiter, A., Veluswamy, R.R. & Wisnivesky, J.P. The global burden of lung cancer: current status and future trends. Nat Rev Clin Oncol 20, 624–639 (2023). https://doi.org/10.1038/s41571-023-00798-3
- Accepted : 20 June 2023
- Published : 21 July 2023
- Issue Date : September 2023
- DOI : https://doi.org/10.1038/s41571-023-00798-3
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