Carcinoma of the bronchus 60 years later.

T he subject of malignant disease of the lung, particularly bronchogenic carcinoma, appears to be a suitable one for such an occasion as this for many reasons. It is a condition of considerable importance owing to its increasing incidence; it clearly illustrates the advance in diagnosis and treatment in chest disease obtained during the last 20 years. It affords, in all its various aspects, opportunities to all sections of this association for study, and, lastly, it is a subject which has always been of considerable interest to me personally (excerpt from A Tudor Edwards). 1 Above the readers of today's Thorax will find the introduction to the first article ever published in this journal. The article was written by A Tudor Edwards and is based upon his presidential address to the association for the study of diseases of the chest on 27 July 1945. Despite the fact that this address was given 60 years ago and about 2 months after VE day celebrations signalling the end of World War II, it could just as easily have been given in the year 2006. For certain, lung cancer is a condition of considerable importance in the world today. It is the leading cause of preventable cancer death worldwide. Clearly, there have been advances in the diagnosis , staging, and treatment over the past 60 years. As asserted by Tudor Edwards 60 years ago, lung cancer lends itself to a multidisciplinary approach with respiratory physicians, thor-acic surgeons, oncologists, and radiotherapists working jointly to study the disease while providing comprehensive cancer care. Throughout the remainder of this article we will endeavour to provide an update in lung cancer while paying particular attention to how far we have come from then until now. Where possible we will use excerpts from the original article (in italics) to illustrate just how far we have come and how far we must go to eliminate this disease. EPIDEMIOLOGY The causes of the increasing incidence are necessarily difficult to determine, but many factors have been held responsible by different observers. Influenza, with its effects on bronchial mucosa of atypical regeneration, metaplasia, and cell-nest formation, has been widely suggested as a predisposing cause. On the other hand, Iceland, where carcinoma is, or rather was, unknown, has suffered from severe epidemics of influenza. Other factors such as smoking, exhaust gases from motor vehicles, and tar particles from roads have all been held …