The recognition of the link between cigarette smoking and
lung cancer in the 1964 Surgeon General's Report initiated definitive and comprehensive research on the identification of
carcinogens in tobacco products and the relevant mechanisms of
carcinogenesis. The resultant comprehensive data clearly illustrate established pathways of
cancer induction involving
carcinogen exposure, metabolic activation,
DNA adduct formation, and consequent mutation of critical genes along with the exacerbating influences of
inflammation,
cocarcinogenesis, and
tumor promotion. This mechanistic understanding has provided a framework for the regulation of tobacco products and for the development of relevant tobacco
carcinogen and toxicant
biomarkers that can be applied in
cancer prevention. Simultaneously, the recognition of the link between smoking and
lung cancer paved the way for two additional critical approaches to
cancer prevention that are discussed here: detection of
lung cancer at an early, curable stage, and
chemoprevention of
lung cancer. Recent successes in more precisely identifying at-risk populations and in decreasing
lung cancer mortality with helical computed tomography screening are notable, and progress in
chemoprevention continues, although challenges with respect to bringing these approaches to the general population exist. Collectively, research performed since the 1964 Report demonstrates unequivocally that the majority of deaths from
lung cancer are preventable.