AJRCCM: 100-Year Anniversary. The Shifting Landscape for Lung Cancer: Past, Present, and Future

Abstract

The past century has witnessed a transformative shift in lung cancer from a rare reportable disease to the leading cause of cancer death among men and women worldwide. This historic shift reflects the increase in tobacco consumption worldwide, spurring public health efforts over the past several decades directed at tobacco cessation and control. Although most lung cancers are still diagnosed at a late stage, there have been significant advances in screening high-risk smokers, diagnostic modalities, and chemopreventive approaches. Improvements in surgery and radiation are advancing our ability to manage early-stage disease, particularly among patients considered unfit for traditional open resection. Arguably, the most dramatic progress has occurred on the therapeutic side, with the development of targeted and immune-based therapy over the past decade. This article reviews the major shifts in the lung cancer landscape over the past 100 years. Although many ongoing clinical challenges remain, this review will also highlight emerging molecular and imaging-based approaches that represent opportunities to transform the prevention, early detection, and treatment of lung cancer in the years ahead.

Figure 1.

Timeline depicting historical milestones in lung cancer epidemiology, screening, diagnosis, and treatment. Events related to epidemiology are in yellow; screening and diagnosis are in green; treatment is in blue. ALK = anaplastic lymphoma kinase; CMS = Centers for Medicaid and Medicare Services; CXR = chest X-ray; EGFR = epidermal growth factor receptor; EML4 = echinoderm microtubule–associated protein-like 4; LDCT = low-dose computed tomography; NLST = National Lung Screening Trial; NSCLC = non–small-cell lung cancer; PET = positron emission tomography; SBRT = stereotactic body radiation therapy.

Figure 2.

Future opportunities to impact the prevention, detection, and treatment of lung cancer. CT = computed tomography; LDCT = low-dose computed tomography.