Survival from lung cancer in England and Wales up to 2001

With over 38 000 new cases each year, lung cancer is the second most common form of cancer in the United Kingdom after breast cancer (Cancer Research UK, 2008a) and it is the most common cancer cause of death (Cancer Research UK, 2008b). Tobacco smoking is undoubtedly the major aetiological risk factor, the risk being around ten times higher in long-term smokers compared with non-smokers (Doll and Peto, 1981). Men are more likely to be affected, although the number of women with lung cancer has been increasing. This reflects changes in smoking habits over the last century (Quinn et al, 2001). Smoking cessation before middle age avoids more than 90% of the lung cancer risk attributable to tobacco (Peto et al, 2000). Lung cancer can be broadly classified into two main types: non-small-cell lung cancer (NSCLC), which accounts for about 80% of cases, and small-cell lung cancer (SCLC), which accounts for the other 20%. Approximately 70% of patients with NSCLC present with advanced (Stage III/IV) disease (Ihde and Minna, 1991; Ihde, 1992). At diagnosis, about 60% of patients with SCLC have extensive disease, defined as disease not contained within a hemithorax, with metastases involving one or more sites such as the brain, liver, bone or bone marrow (Carney, 2002).