Guidance

Context

Context

Over 46,000 people were diagnosed with lung cancer in the UK in 2015. An estimated 89% of lung cancers are preventable, with 86% of these linked to smoking, 13% to occupational exposure, 9% to dietary factors and 7.8% to air pollution. Lung cancer can be linked to more than one cause.

In 2015 in the UK, over 35,000 people died from lung cancer. The overall mortality rate from lung cancer has decreased by 9% over the last decade. However, while there has been a decrease of 19% in mortality rates in men, there has been an increase of 2% in women. This is linked to lifestyle factors such as smoking and is driven by an increased incidence of lung cancer in older women.

In the UK, lung cancer is more common in people of European family origin than in people of African or Asian family origin. It is strongly linked to socioeconomic deprivation. There are many risk factors for lung cancer, including age, genetics, lifestyle (especially smoking) and occupation. Lung cancer is estimated to cost the UK economy £2.4 billion per year.

Note: all statistics in this section are from Cancer Research UK's Lung Cancer Statistics.

Current practice

Lung cancer is diagnosed and staged using a variety of tests, including chest X‑rays, CT or positron-emission tomography CT (PET‑CT). Lung cancer samples are commonly acquired for diagnosis using bronchoscopy, endobronchial ultrasound (EBUS) or a percutaneous procedure (guided by CT or ultrasound).

Lung cancer has 2 main types:

  • non-small-cell lung cancer (NSCLC), which is more common and spreads more slowly

  • small-cell lung cancer (SCLC), which is rarer and spreads more quickly.

Treatment depends on the type, size, position and stage of the cancer, and the person's health. Possible treatments include radiotherapy, systemic anti-cancer therapies, surgery, supportive care cryotherapy, photodynamic therapy and ablation.

Since 2011, when the NICE lung cancer guideline was last updated, there have been changes in the way that lung cancer is diagnosed and treated. The Royal College of Physicians' National Lung Cancer Audit annual report 2016 identified that only 72% of people have pathological confirmation of their lung cancer. There is also inconsistency in the availability of molecular testing in lung cancer diagnosis.

NHS England has taken steps to shorten the time to treatment, as well as improve access to and uptake of radiotherapy, and stereotactic ablative radiotherapy (SABR) is routinely used for certain subgroups of people with early-stage NSCLC. There are now a variety of licensed immunotherapies and biological targeted therapies for treating advanced NSCLC, and NICE has published technology appraisals covering many of these.