Why does Lung Cancer Awareness Month matter? An oncologist's view

November is Lung Cancer Awareness Month. For me, Lung Cancer Awareness Month should be about three things: getting more people screened, ending the shame people feel when they're diagnosed, and telling everyone that early lung cancer is now one of the real success stories in cancer care.

I'm a consultant clinical oncologist. I treat lung cancer every day. This is my opinion on why this month matters, and what I'd like people to take from it.

Who gets lung cancer?

I say that deliberately. Too many of my patients tell me they feel ashamed to say they have lung cancer. A lot of that comes from the first question people ask when they find out: "Did you smoke?"

I once had a patient cry in my clinic. Someone sitting next to her in the chemotherapy day unit had asked her that question when they found out she had lung cancer. She felt completely othered, as if the other person was claiming some moral high ground because they had never smoked and had a different kind of cancer. It made me really cross.

About 6,000 people in the UK who have never smoked die of lung cancer every year. On its own, that would make it the eighth most common cause of cancer death in the UK [4]. Lung cancer is not a disease that only happens to smokers.

Is lung cancer my fault if I smoked?

No. Smoking does make lung cancer more likely. But we all do things every day that affect our health. Plenty of people who have smoked all their lives never get lung cancer, and plenty of people who have never smoked do.

I think of it as the lung cancer lottery. Every day you're alive, you collect tickets. Smoking buys you more tickets. So does living in an area with high levels of radon, a natural gas that seeps up from the ground and is linked to around 1,100 lung cancer deaths a year in the UK [5]. So does breathing polluted air, which is classed as a cause of lung cancer [6]. More tickets means a higher chance, but it is still a lottery. Nobody deserves to win it.

If you have lung cancer and you smoked, you should not feel any shame. You need care, not judgement.

Why does Lung Cancer Awareness Month matter?

Because of stage. The stage of a lung cancer, how big it is and how far it has spread, is what drives the chance of cure. You can read more in my guide, What is lung cancer?

In England, almost 65 out of 100 people diagnosed with stage 1 lung cancer live for at least 5 years. For stage 4, it is around 5 out of 100 [3]. With stage 4, we can hope to get to the point where there is no evidence of disease on the scans, and some people live for years. But we rarely talk about cure. Sadly, for most people with stage 4 lung cancer, the cancer is the cause of their death.

So the most important thing we can do is find lung cancer earlier. And that means screening.

Does lung cancer screening really make a difference?

Yes, and the numbers are striking.

NHS England's lung screening programme found 5,037 cancers by the end of August 2024. 76% were stage 1 or 2 [1], and over 60% were stage 1 [2]. Before the programme, fewer than 30% of lung cancers were found at stage 1 or 2 [2]. People diagnosed at the earliest stage are nearly 20 times more likely to survive five years than those diagnosed late [1]. For stage 1 lung cancer found through screening, five-year survival is over 90% [2].

That is why I care so much about this month. The more people who go for screening, the more people will be eligible for treatment that aims to cure them.

Who should go for lung cancer screening in the UK?

If you live in the UK, are registered with a GP, are aged 55 to 74, and your GP record shows that you smoke or used to smoke, you should be invited for a lung health check. When you're invited, please go [7].

The NHS programme is still being rolled out, so not everywhere offers it yet. If your GP record doesn't show that you smoked, ask your surgery to update it [7]. The Cromwell Hospital also offers lung cancer screening.

Screening is not for people with symptoms. If you have a cough that won't go away, are coughing up blood or are losing weight without trying, see your GP now [7].

Is stage 1 lung cancer curable?

Yes, and this is where I want to go to town.

When I was a junior doctor in the early 2000s, I couldn't have imagined the results we now see in stage 1 lung cancer. Today there are two excellent treatments, and for many people there is a real choice between them.

Surgery. Usually keyhole or robotic surgery to remove the lobe of lung containing the cancer, along with the nearby lymph nodes. In a large trial of small stage 1 tumours, 91% of people were alive five years after lobectomy [8].

SABR. Stereotactic ablative radiotherapy, which I'll explain below. In people who were not fit for surgery, SABR controlled 98% of tumours at three years [9]. In people who were fit enough for surgery but had SABR instead, 87% were alive at five years [10]. At ten years, overall survival was 69% after SABR and 66% in a matched group who had surgery [11].

What is SABR?

SABR stands for stereotactic ablative radiotherapy. Instead of small daily doses over about six weeks, SABR gives a few very high, very precise doses, usually in 1 to 5 sessions. It is non-invasive: no operation, no anaesthetic, no hospital stay. You lie on the treatment couch, the machine moves around you, and you go home the same day.

The dose is shaped tightly around the tumour, so the healthy lung, heart and ribs around it get much less. The image of one of my real SABR plans shows how tightly the high dose wraps around a small tumour.

Side effects are usually mild: tiredness, a cough, and sometimes chest wall pain. Tumours near the centre of the chest need extra care in planning.

Is surgery or SABR better for stage 1 lung cancer?

Honestly, we don't know for sure, and I don't think anyone should pretend otherwise.

The proper way to find out would be a randomised trial, where a computer decides who has surgery and who has SABR. Many have tried:

• STARS and ROSEL both closed early because too few people joined. When their 58 patients were pooled, the results favoured SABR, but that is far too small to settle the question [12].
• ACOSOG Z4099 closed early with poor recruitment [13].
• SABRTooth, in the UK, showed that a full randomised trial was not feasible here [14].
• VALOR and STABLE-MATES are still running or have not yet reported [15, [16]](#ref16).

In my opinion, these trials are hard because everyone has strong feelings. Clinicians often have a firm view about which treatment a patient should have. And patients have strong feelings too. When some people find out they have cancer, they immediately want it physically cut out. Others would do anything they could to avoid an operation.

Neither is wrong. If you're not well enough for surgery, SABR is a really excellent alternative. If you are fit for both, you should hear about both.

That's why, unless one option is clearly better for that person, or they already know what they want, my patients with stage 1 lung cancer meet both me and a surgeon. The choice is theirs to make, with good information.

What would I like Lung Cancer Awareness Month to achieve?

Three things.

1. More people screened. If you're invited, go. Earlier stage means a much better chance of cure.
2. No more shame. Being alive and having lungs is enough to get lung cancer. Please stop asking people if they smoked.
3. Real choices for early lung cancer. Stage 1 lung cancer is one of the great success stories of modern cancer care. Anyone with it deserves to hear about both surgery and SABR.

There is still a long way to go with lung cancer, but the picture is changing. This month is our chance to keep it changing.

Frequently asked questions

When is Lung Cancer Awareness Month?

November. Lung Cancer Awareness Month runs every year from 1 to 30 November.

Can you get lung cancer if you have never smoked?

Yes. About 6,000 people in the UK who have never smoked die of lung cancer every year [4]. The biggest risk factors are being alive and having lungs.

Is lung cancer curable?

Often, if it is found early. Almost 65 out of 100 people diagnosed with stage 1 lung cancer in England live for at least 5 years, compared with around 5 out of 100 for stage 4 [3].

Who is eligible for lung cancer screening in the UK?

People aged 55 to 74 who smoke or used to smoke and are registered with a GP, in areas where the NHS programme is running [7]. If you're invited, go.

What is SABR for lung cancer?

Stereotactic ablative radiotherapy: a few very high, very precise doses of radiotherapy, usually in 1 to 5 outpatient sessions, with no operation or anaesthetic.

Is SABR as good as surgery for stage 1 lung cancer?

No randomised trial has settled it. In one study of people fit for surgery, 10-year survival was 69% after SABR and 66% in a matched surgical group [11]. In my opinion, people fit for both should hear about both.

References

1. NHS England. Thousands of cancers caught early through NHS lung checks. November 2024.
2. UK National Screening Committee blog. Timely detection of thousands of cancers underlines benefits of a national lung cancer screening programme. 11 November 2024.
3. Cancer Research UK. Survival for lung cancer. People diagnosed in England 2016 to 2020. Accessed November 2026.
4. Bhopal A, Peake MD, Gilligan D, Cosford P. Lung cancer in never-smokers: a hidden disease. J R Soc Med 2019. doi:10.1177/0141076819843654.
5. UK Health Security Agency. UKHSA and BGS publish updated radon map for Great Britain. 2 December 2022.
6. International Agency for Research on Cancer. Outdoor air pollution a leading environmental cause of cancer deaths. Press release 221, October 2013.
7. NHS. Lung cancer screening. Accessed November 2026.
8. Saji H, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L). Lancet 2022;399:1607–1617.
9. Timmerman R, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer (RTOG 0236). JAMA 2010;303:1070–1076.
10. Chang JY, et al. Stereotactic ablative radiotherapy for operable stage I non-small-cell lung cancer (revised STARS). Lancet Oncol 2021;22:1448–1457.
11. Chang JY, et al. STARS 10-year update. ASTRO Annual Meeting 2025, abstract 268. ASTRO news release.
12. Chang JY, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol 2015;16:630–637.
13. ACOSOG Z4099/RTOG 1021. ClinicalTrials.gov NCT01336894.
14. Franks KN, et al. SABRTooth feasibility study. Eur Respir J 2020;56:2000118.
15. VALOR. ClinicalTrials.gov NCT02984761.
16. STABLE-MATES. ClinicalTrials.gov NCT02468024.