Primary prevention consists mainly of refraining from smoking

Refraining from smoking is the most effective prevention of lung cancer. Details about the individual and collective interventions for preventing and/or quitting smoking are given in the EUphacts Tobacco smoking and Smoking policies.

Smoking cessation

Quitting smoking will substantially reduce the risk of lung cancer in long-term smokers. The proportion of the risk of lung cancer avoided by quitting smoking before age 40 ranges between 80 and 90%. Quitting before the age of 50 leads to avoiding approximately 60-70% of the excess risk of lung cancer (Crispo et al., 2004). This implies that ex-smokers remain at higher risk than those who never smoked.

Ultimately, only the success of efforts to prevent youth from starting to smoke tobacco will determine the future of the lung cancer epidemic in the EU..

Protective factors

Observational studies have provided consistent evidence for a protective role of cruciferous vegetables, such as broccoli and cabbage, against lung cancer. These vegetables are rich in isothyocyanates, to which the protective effect is attributed. The protective effect seems to depend on interaction with genes that regulate the elimination of isothyocyanates from the body (Brennan et al., 2005).

The evidence for chemoprotective effects of vitamin A and its analogues, retinoids, in lung cancer development is inconclusive. The majority of trials could not prove any chemoprotective effects for lung cancer.

Secondary prevention is controversial

Screening or early detection of lung cancer via conventional procedures, such as chest radiography and sputum examination does not lead to reduction in mortality from lung cancer. Newer screening options, such as low-dose spiral CT, are more effective in detecting small, asymptomatic lesions that have good survival rates when surgically resected (Bach et al., 2003). The I-ELCAP study (Henschke et al., 2006) reports an estimated 10-year survival rate of 88% among patients with an early stage lung cancer detected on spiral CT, who then underwent further diagnostic procedure and surgical treatment.

The available research however remains inconclusive about the potential benefits of spiral CT screening in terms of reduction of the lung cancer mortality and the cost-effectiveness of the intervention. Moreover, surgical resection of the lung is a very invasive procedure that not all patients can undergo. The risk of overdiagnosis and over-treatment are of high concern and have not been addressed appropriately as yet. More evidence is needed to convincingly answer the question whether spiral CT screening is a viable intervention for reducing the lung cancer mortality, and whether it may become a regular screening procedure for population at risk, as mammography did.

Treatment options are scarce and survival rates low

In spite of advances in diagnosis of lung cancer, most patients are still diagnosed at an advanced stage and curative treatment is rarely possible.The three therapy options for lung cancer are: surgery, radiation and chemotherapy. The choice of therapy depends on several factors, such as the histopathologic type, the stage of the disease and the patient’s condition.