Current and future perspectives in lung cancer prevention

Abstract

Smoking is one of the leading causes of morbidity and mortality worldwide. Tobacco smoke contains thousands of different heterogeneous substances, dozens of them classified as carcinogenic for humans, including tobacco-specific nitrosamines (TSNAs), metals and polycyclic aromatic hydrocarbons, among others. Deleterious effects of tobacco consumption occur not only in active smokers, but also in people passively exposed to secondhand and thirdhand smoke, the latter including children (1). There are diverse disorders associated with tobacco smoking, including cardiovascular and respiratory conditions, and cancer in multiple sites and organs (e.g., urinary bladder, stomach, lung). Lung cancer is one of the most concerning disorders associated with smoking and the first cause of cancer mortality worldwide. In 2018, an estimated 1.76 million people died of lung cancer, a higher figure than the sum of the second and third top causes of cancer-specific mortality (i.e., colorectal and stomach) (2). Lung cancer shows an overall 5-year survival rate from diagnosis of around 15–20% (3), one of the lowest among all types of cancer, result of a frequent late diagnosis in advanced stages, when the prognosis is poorer, due to the commonly unspecific initial symptoms. This survival rate has remained almost invariable for years.