Multidisciplinary Symposium — Lung Cancer

‘First and foremost we must, as a profession, become more ‘‘carcinoma-minded’’ in regard to the lungs’. No-one would disagree, but this statement was made by RC Brock, later Lord Brock, nearly 60 years ago in the British Medical Journal. Carcinoma of the bronchus still remains the most common cancer in men and the second most common cancer in women. In England there are approximately 32 000 deaths from lung cancer per annum. The incidence of lung cancer in males appears at last to be reducing but there is little real evidence of that happening in females. In some groups it is still rising and in Glasgow has even equalled that of breast cancer. In appropriately selected patients there is no doubt that surgical resection produces the best chance of long-term survival. Spencer Jones, a distinguished chest physician from East Kent wrote, ‘The value of surgery for lung cancer has been questioned . . . but without it death for each patient is inescapable . . . Relatives should be left in no doubt that the patient must see a thoracic surgeon if there is any possibility of a surgical resection’. Why? In his study group of patients, of those not treated surgically, 90% were dead in a year and 100% in 26 months. Of the 30 who underwent resection 13 were alive 5 years later. In a large series from the American Armed Forces Central Medical Registry, the overall 5-year survival rate for those having a definitive resection was 49%, in a smaller series from England it was 40%. These results are not confined to the young either, as Ishida et al. reported a 5-year survival of 48% in patients over 70 and 41% in those aged under 70. Despite these facts, the UK has one of the lowest resection rates for lung cancer. In 1998/9 there were only 3284 resections for lung cancer in the whole of the United Kingdom.