Lung cancer: can staging improvement ensure a better survival?

Lung cancer is among the most common cancers in the world. Despite advances in defining the molecular mechanisms involved in lung oncogenesis and the remarkable efforts made to improve screening programs for secondary cancer prevention, patients' prognosis remains poor. Moreover, wide international inequalities remain apparent, even among developed countries. Here we analyze and discuss the findings of the extensive work by Walters S et al., recently published in "Thorax", which aimed to clarify whether differences in stage at diagnosis might explain these divergences. A better understanding of why survival differences between different states still exist will facilitate policy design to increase lung cancer overall survival itself and to bring it up to the highest international standards. It is the first international population-based study of lung cancer survival by stage at diagnosis and includes nearly 60,000 patients. By using a well detailed and appropriate statistical approach, authors conclude that improvement in outcomes is primarily related to a proper initial disease staging and that socioeconomic international and interregional inequalities might play a relevant role in this scenario. Our review takes in consideration both the methodological and scientific issues of the paper, focusing on the potential consequences in lung cancer management and on the need, in the post genomic era, of a molecular-based epidemiologic approach.