ABSTRACT
The continuous increase in the incidence of lung cancer, which is now the most frequent cancer type in men in most European countries and rapidly increasing in women, makes the understanding of the etiology, prevention, and treatment of this disease more important than ever. Although the key etiological factor, smoking with its many carcinogens, has been known for years, the long lag between exposure and the clinical symptoms of the tumor has hampered the initiation of preventive programs in this disease. In addition, reducing tobacco consumption has major economic and political ramifications. In spite of the increasing knowledge of the biology of the disease and the development of new active cytostatic drugs and targeted therapies against lung cancer, the long-term survival rate remains low, implying that the treatment of lung cancer will continue to be a major therapeutic challenge for many years to come. Data from the Eurocare database imply that there are fairly large variations in survival within Europe, and that despite improvements in both the diagnosis and treatment, the overall prognosis for patients with nonsmall cell lung cancer (NSCLC) has hardly improved over time. In contrast, the introduction and improvement of chemotherapy since the 1970s have given rise to an improvement in survival in small cell lung cancer (SCLC) (1). In the most recent update of the Eurocare study, including data from 83 cancer registries on 2.7 million cancer patients, the fiveyear survival for all lung cancer patients has increased from 9.2% in 1990-1994 to 10.2% in 1995-1999 (2) and 10.9% in 2000-2002 (3).
