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Lung cancer remains the most common cancer worldwide and the leading cause of cancer death in the United States and in the world, with an estimated 224,390 cases and 158,080 deaths in the United States in 2016 (1). Lung cancer is caused by cigarette smoking in the vast majority of cases, and trends in smoking prevalence have led to declines in lung cancer deaths in the United States and in other high-income countries. Research of mechanisms of lung cancer tumorigenesis and response to therapy has been translated into new precision medicine strategies that have revolutionized lung cancer treatment. Concomitant advances in lung cancer clinical research have led to widespread implementation of lung cancer screening in the United States. In this review, we highlight advances in these areas that promise to continue to reduce lung cancer mortality.
Epidemiology
Similar to other high-income countries, rates of lung cancer incidence and deaths are declining in men and women in the United States, in concert with trends in smoking rates. Several of the observed differences in lung cancer incidence and mortality among different sex, racial, and ethnic groups that suggested disparities in lung cancer susceptibility, diagnosis, and treatment may in fact be predominantly attributable to smoking prevalence trends. DeSantis and colleagues showed that the disparity in lung cancer death rates between black and white men has decreased from 40% to 20% over the past 20 years, and it has been eliminated in adults younger than 40 years of age; this reduction also parallels declines in smoking prevalence, which have been more rapid in black individuals than in white individuals (2). Patel and colleagues showed that among women enrolled in the prospective Women's Health Initiative cohort, Hispanic women had lower lung cancer incidence than non-Hispanic women, but there were no racial/ethnic differences in mortality (3).
Independent of smoking, there is a persistent difference in 5-year lung cancer survival after diagnosis stage for stage in black individuals compared with white individuals, with an overall 5-year survival rate of 14% in black individuals versus 18% in white individuals (2). Fewer lung cancers are detected at early stage, and studies indicate that treatments differ for earlystage disease, after accounting for socioeconomic confounders. These issues will be important to address directly as widespread lung...