Definition of lung cancer

Lung cancer is characterized by the uncontrolled growth of abnormal cells in the trachea, bronchus or lung ( Cancer Res. UK 2022a  ). These tumours disrupt the ability of the lungs to supply oxygen to the body through the blood (ECIS 2021 ). It has the potential to spread to lymph nodes or other organs, including the brain. 

There are two main types of lung cancer, which require distinct treatments due to their different growth patterns ( WHO 2023  ):

• Non-small cell carcinoma (NSCLC) – refers to any type of epithelial lung cancer other than small cell carcinoma (SCLC). They are more common than SCLC and grow slowly, although they are usually less responsive to chemotherapy and radiation therapy than SCLC.
• SCLC – It is less common but it is often widely spread by the time of diagnosis, growing and spreading more quickly than NSCLC. 

The most common symptoms of lung cancer include a persistent cough, chest pain, shortness of breath, coughing up blood (hemoptysis), fatigue, unexplained weight loss, and recurrent lung infections ( WHO 2023  ). However, lung cancer may not exhibit symptoms in its early stages, or they may be dismissed as common respiratory issues, resulting in delayed diagnosis ( Cancer Res UK 2022  ).

Incidence of lung cancer in the European Union

In the European Union in 2022, lung cancer ranked as the second most commonly diagnosed cancer type in men and the third in women, with an estimated 203 000 new cases in men and 116 000 new cases in women (ECIS 2022a). Moreover, it is the leading cause of cancer death accounting for around 19.5% of all cancer deaths (ECIS 2022b). The age-standardized incidence rate for lung cancer in the EU in 2022 was estimated to be 94.5 per 100 000 in males and 44.1 per 100 000 in females. Table 1 shows the estimated number of new cases and age-standardised incidence rates for lung cancer by sex and per country of the European Union in 2022 (ECIS 2022a).

Table 1: Age-standardised incidence rate of lung cancer   

Factors related to lung cancer risk

There are multiple risk factors for lung cancer. The vast majority of lung cancers are caused by tobacco use ( IARC/WHO 2020  ). Other modifiable risk factors include air pollution, exposure to second-hand smoke, radon and workplace hazards like exposure to asbestos ( EEA 2022a ,  NCI (USA) 2023 ). Evidence for other potential risk factors, such as dietary factors and physical activity, remains limited since it is highly confounded (e.g. people who follow a healthy lifestyle are less likely to smoke) by cigarette smoking ( NCI (USA) 2023 ). Further details on the main modifiable risk factors for lung cancer are summarised in Table 2.

Non-modifiable risk factors include personal and family history of the disease, genetic syndromes, and germline (inherited) mutations ( IARC/WHO 2020  , ACS (USA) 2023  ). Moreover, a history of emphysema, chronic bronchitis, tuberculosis or pneumonia is associated with a higher risk of lung cancer. People with Chlamydia pneumoniae, a type of bacterium that can cause chest infections, also have a higher risk of lung cancer ( WCRF/AICR 2018  ).

Table 2:Modifiable risk factors related to lung cancer     

Disease and economic burden related to lung cancer

The age-standardised mortality rates due to lung cancer by sex and country in the EU in 2022 are presented in Table 3. According to the European Cancer Information System, nearly 252 600 deaths were attributed to lung cancer in EU countries in 2022, with the majority (164 400) occurring in men. Additionally, the Global Burden of Disease 2021 study has estimated that more than 5.8 million Disability Adjusted Life Years (DALYs) in the EU are due to lung cancer ( IHME 2024  ).

View visualisation: Disability-Adjusted Life Years due to lung cancer in males map and data table 

View visualisation: Disability-Adjusted Life Years due to lung cancer in females map and data table 

View visualisation: Age-standardised deaths due to lung cancer in males map and data table 

View visualisation: Age-standardised deaths due to lung cancer in females map and data table 

The latest data on the economic burden of major cancer sites dated from 2009 estimated that lung cancer had the greatest overall economic burden in the EU with €18.8 billion in costs, representing 15% of overall cancer costs. The healthcare expenses attributed to lung cancer were €4.23 billion (8% of all cancer-related healthcare costs), with inpatient care accounting for the majority of healthcare expenses associated with lung cancer (€2.87 billion, 68% of all costs). 

Lung cancer also had the highest productivity losses attributable to mortality with €9.92 billion (23% of productivity losses from all cancers) ( Luengo-Fernandez et al., 2013  ). The healthcare costs per citizen for lung cancer across EU countries in 2009 are shown in Table 4. 

Table 3: Age-standardised mortality rates and DALYs rate  

Table 4: Healthcare cost of lung cancer in the EU   

Policies related to the prevention of lung cancer

Numerous EU countries have implemented initiatives to combat cancer, with the main emphasis on mitigating cancer risk factors (primary prevention) and establishing screening programmes to detect cancer at earlier stages (secondary prevention).

Primary prevention of lung cancer (lung cancer risk factors)

Europe’s Beating Cancer Plan ( EC 2021a  ), a political commitment of the EU, prioritises cancer prevention by promoting healthy behaviours and mitigating their risk factors.

In terms of primary prevention of lung cancer, smoking cessation remains the most effective prevention measure. For example, according to the Organisation for Economic Co-operation and Development’s Strategic Public Health Planning (SPHeP) modelling work, almost 1.9 million new cancer cases could be prevented in the EU between 2023 and 2050 if tobacco reduction targets were met ( OECD/EC 2025   ). 

It is, however, also important to foster smoke-free environments, implement evidence-based tobacco control policies, mitigate occupational hazards, and reduce levels of environmental pollution to prevent lung cancer. Tobacco control policies   are listed in the dedicated pages of this Health Promotion and Disease Prevention Knowledge Gateway. 

The ‘Healthier Together’ EU-non-communicable diseases (NCDs) initiative supports Member States and stakeholders in preventing and managing NCDs, including chronic respiratory diseases, via collaborative work between the Member States (‘Joint Actions’) and stakeholder-led projects ( EC 2021b  ). 

Moreover, in December 2024 the Council adopted a recommendation to help reduce exposure to second-hand smoke and aerosols, which encourages EU to broaden the scope of their existing protection against second-hand smoke exposure to include key outdoor areas like playgrounds and restaurant terraces. The new measures will also apply to emerging tobacco and related products such as e-cigarettes and heated tobacco products (HTPs) ( EC 2024  ).

Secondary prevention of lung cancer (screening)

Secondary prevention strategies for lung cancer include screening methods designed to detect the disease during its early stages, prior to the onset of symptoms.

In December 2022, the Council of the EU released a revised recommendation on cancer screening as part of Europe’s Beating Cancer Plan, proposing to expand population-based screening to include cancer sites beyond breast, colorectal and cervical, based on further research, including lung cancer. 

The Council proposed that countries should explore the feasibility and effectiveness of screening with use of low-dose computed tomography, starting with populations at high risk (i.e., current and ex-smokers who have quit smoking within the previous 15 years). This action will be complemented by the development of EU guidelines and quality assurance schemes for lung cancer screening and care ( EC 2022  ).
 

References

Overview of the references to this brief