Maintaining momentum: the history and future of lung cancer disparities in the United States

Lung cancer, once considered a clinical rarity, is now the leading cause of cancer-related mortality among both men and women in the United States (US) and remains the deadliest cancer worldwide. Early investigations focused on a broad range of environmental and occupational exposures as putative factors. However, the emergence of robust epidemiologic evidence in the mid-twentieth century established tobacco use, particularly cigarette smoking, as the dominant driver of lung cancer incidence. These discoveries fundamentally shaped US tobacco control policies, cancer prevention strategies, and subsequent scientific advances in thoracic oncology. Over the past three decades, innovations in screening, staging, molecular characterization, and treatment have transformed the landscape of lung cancer care and created unprecedented opportunities to improve outcomes for populations at greatest risk. Yet, the benefits in these advancements have not been equally realized. Persistent disparities in access to screening, prevention, timely diagnosis, and evidence-based care continue to disproportionately burden at-risk groups, including individuals with lower socioeconomic status and those in rural areas. Addressing these inequities requires multifaceted, cross-sector strategies that extend beyond the clinic to the social and structural determinants of health. This review aims to provide a brief history of lung cancer research, reflect on advancements in lung cancer treatment from 1990 - 2025, and highlight efforts toward continued progress in truly equitable lung cancer screening, treatment, care, and policy.