Introduction

Lung cancer has a significant impact on national mortality in the UK, accounting for 6% of all deaths and 22% of deaths from cancer. It has one of the lowest survival outcomes of any cancer with fewer than 25% alive at 1 year and only a 7% 5-year survival. These 5-year figures have changed little over the past 30 years, although there has been an improvement of around 10% in 1-year survival, probably due to more widespread use of palliative therapies.

Over the past century, lung cancer has gone from a rare disease to being the most common cancer in men and the third most common in women, reflecting smoking habits. The direct link with tobacco use was made in the 1950s in the famous epidemiological study by Doll and Hill (1950); and although smoking prevalence in the population has continued to fall over the past five decades, lung cancer remains a major public health issue. At smoking's peak in the 1940s, 82% of men smoked some form of tobacco; this number fell to a population prevalence of 26% in 2002.

There has previously been a somewhat nihilistic view of lung cancer treatment both among health professionals and patients themselves, with referrals often late and only for palliation of symptoms. Significant changes have occurred more recently with the development of lung cancer services in the UK. In particular, multidisciplinary team (MDT) collaboration and rapid-access chest clinics have had an impact on referral patterns.