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Semin Respir Crit Care Med
DOI: 10.1055/a-2703-4793
Preface

Lung Cancer Progress and Promise: Shaping the Future of Care

Authors

  • M. Patricia Rivera

    1   Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester Medical Center, Rochester, New York

  • Catherine R. Sears

    2   Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana
    3   Division of Pulmonology/Pulmonary Oncology, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana

Funding None.
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M. Patricia Rivera, MD
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Catherine R. Sears, MD, ATSF

Lung cancer was a rare disease before the 20th century, during which time mass commercialization made cigarettes inexpensive and available, and further social acceptance led to widespread use. Lung cancer incidence increased paralleling cigarette smoking trends with a lag of 25 to 30 years.[1] Although lung cancer is the second most common cancer, it is the cause of the highest cancer mortality in both men and women.[2]

Throughout the 20th century, progress in the management of lung cancer was achieved through successive refinements in surgical techniques, chemotherapeutic regimens, and radiation therapies, resulting in modest yet steady improvements in survival.[1] In contrast, the past two decades have ushered in a paradigm shift, characterized by transformative advances in prevention, early detection, and treatment that have contributed to significant reductions in both lung cancer incidence and mortality.[2] [3] These changes have been led by extensive public health initiatives aimed at reducing cigarette consumption, efforts that began decades earlier and have only recently translated into observable declines in lung cancer burden.[4]

One of the most important advances has been the work done in early detection. Lung cancer screening trials have been pivotal in changing how early detection is approached for the deadliest cancer affecting humans. Historically, lung cancer was often found at advanced stages when treatment options were limited, and survival rates were exceptionally low. Large-scale randomized clinical trials, such as the National Lung Screening Trial[5] and the Dutch–Belgian Lung-Cancer Screening Trial,[6] have provided groundbreaking evidence that low-dose CT screening can detect lung cancer earlier, when it is more treatable, thereby reducing lung cancer mortality. These studies not only established the scientific basis for national screening guidelines but also emphasized the importance of targeted screening for high-risk groups. By shifting the focus from late-stage diagnosis to early detection, lung cancer screening trials have paved the way for saving thousands of lives and continue to shape public health policies worldwide.

The advancement in our scientific understanding of oncogenes and the immune regulation of lung cancer has been transformative, fundamentally shifting the landscape of diagnosis and treatment. For decades, lung cancer was approached as a single, monolithic disease, treated with broad therapies that offered modest benefits. The identification of actionable genetic alterations shattered this paradigm by revealing that lung cancer is, in fact, a collection of distinct molecularly defined subtypes.[7] [8] This breakthrough not only deepened our understanding of the biology of lung cancer but also enabled the development of highly effective targeted therapies, providing a personalized therapeutic approach that dramatically improves survival and quality of life for patients. Immunotherapy has transformed the landscape of lung cancer treatment by harnessing the body's own immune system to recognize and attack tumor cells. The introduction of immune checkpoint inhibitors, aimed at regulating lung cancer immune evasion, has led to improved survival and even decades-long disease-free status, even in those with widely metastatic disease.[9] This breakthrough has redefined standards of care and opened the door to novel treatment combinations and strategies, not only in advanced non-small cell lung cancer but also in earlier stages of the disease, aiming to improve outcomes further. Finally, advances in surgical, radiation, and multimodality therapies have led to further personalization of treatment, reduced toxicity, and enhanced outcomes.[10] The advances across the continuum of lung cancer care have challenged long-held beliefs about lung cancer and changed our approach to early detection, diagnosis, staging, and treatment.

However, advances also bring new challenges and opportunities. With the decrease in cigarette smoking, there is an emerging understanding that other exposures, particularly environmental exposures as well as e-cigarette vaping, which vary globally, and clinical and demographic risk factors play a larger role in lung cancer development than previously identified.[2] [11] Further, the demographic makeup of those presenting with lung cancer is rapidly changing, with lung cancer more likely to be diagnosed in younger females than males for the first time.[2] The rapidity with which these changes have occurred highlights the need to disseminate evolving knowledge, diagnostic, and therapeutic strategies more quickly than typically occurs to improve patient care. Furthermore, although the benefits of lung cancer screening are clear, its implementation in the United States and globally has lagged, lacked specificity, and identified unanticipated effects in specific populations and implementation practices.[12] [13] [14] [15] Despite the advances across the continuum of lung cancer care, access to guideline-concordant care and to advanced diagnostic and therapeutic interventions is not shared by all individuals diagnosed with lung cancer equally.[16] [17] Now more than ever, there is an increased need for pulmonologists to be active participants in the multidisciplinary care of patients with lung cancer.

In this edition of the Seminars in Respiratory and Critical Care Medicine, we explore the evolving characteristics of lung cancer in the 21st century. We cover “Emerging Trends in Global Lung Cancer Burden,” including risk exposures, changing demographics, and the evolution of the lung cancer burden worldwide.[18] [19] We include an “Update in Lung Cancer Screening,” which provides a comprehensive overview of the current state, existing gaps in implementation, follow-up, and outcomes, as well as research that may address these gaps, and review “Lung Cancer Screening in Special Populations,” highlighting the unique challenges in lung cancer screening for high-risk populations who are not currently eligible under current guidelines.[20] Recognizing the complexity of radiologic manifestations of lung cancer, “Cystic Lung Cancers—an Overview,” outlines the radiologic features and recommendations on the management of these largely unrecognized lesions, which are at high risk for developing into aggressive non-small cell lung cancer. The manuscript “Advances in Invasive Diagnostics in Lung Cancer” discusses innovations in interventional bronchoscopic techniques and liquid biopsies, and how these developments impact our approach to diagnosing lung cancer. The “Revised TNM Staging for Lung Cancer” manuscript outlines the rationale behind the changes and discusses the potential research and clinical implications of the revised TNM system. Recent, revolutionary changes in the standard of treatment care in lung cancer are highlighted, including (1) “Molecular Markers in the Era of Precision Care in Lung Cancer,” an area of great importance given the improved outcomes in those receiving correct targeted therapies, (2) “Surgical Therapy for Stage I Lung Cancer: Lobar versus Sublobar Resection,” an in-depth examination of current studies and their implications for future surgical resection, and (3) “Advances in Multimodality Management of Non-Small Cell Lung Cancer,” an area that has undergone significant changes over the past few decades. We include “Small Cell Lung Cancer Updates,” outlining recent advances in molecular characterization, current treatment recommendations, and future directions that may offer improved outcomes in small cell lung cancer. Given that pulmonologists play an indispensable role at the heart of multidisciplinary lung cancer care, this issue includes an “Update on Cancer Therapy-Related Pneumonitis,” the recognition and appropriate treatment of which is critical due to the exponential increase in the use of immune checkpoint inhibitors and antibody–drug conjugates for cancer treatment. Finally, we discuss the impact of the above changes and improved knowledge of lung cancer care in a manuscript focused on “Lung Cancer Survivorship.”

Pulmonologists are increasingly relied upon to be part of lung cancer diagnostic decision-making, cancer cell molecular characterization, and staging, and to aid their colleagues in explaining complex medical decisions to patients with lung cancer. We hope that this collection will provide pulmonologists and others who read this with a toolkit to improve the care of those with lung cancer in our practice.



Publication History

Received: 10 September 2025

Accepted: 16 September 2025

Article published online:
03 November 2025

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