Lung cancer occupies a peculiar place in the public mind. It takes the lives of more people than any other cancer (page S2), yet, because the disease is so closely associated with the lifestyle choice of cigarette smoking, sympathy for its victims tends to be mixed with blame.

But neither lung cancer's inevitable end nor its attachment to cigarettes are accurate portrayals. There are embers of hope for new therapeutics. Some of the most promising developments come from therapies that turn the body's immune system against the disease (S10). On another front, drugs that target the genetics of particular tumours are emerging from the laboratory (S8). Screening technology can pick up tiny lung nodules when they are more easily treatable, although putting such screening into widespread use faces economic and institutional obstacles (S4 and S7).

Credit: Russell Cobb

The link between smoking and lung cancer has been firmly established for decades. And although most lung cancer can be attributed to direct inhalation of tobacco smoke, about one quarter of lung-cancer cases worldwide occur in people who have never smoked (S12) and who have arrived at their fate through some unlucky combination of genetics and environmental factors. Evidence is mounting that outdoor air pollution can cause lung cancer — findings that ought to spur action on reducing emissions, especially of particulates (S14). In Asia, lung cancer is alarmingly common in non-smoking women — apparently as a result of heavy use of indoor cooking stoves in unventilated homes (S16). In short, avoiding cigarettes, while still a wise health choice, is no guarantee against lung cancer.

This Outlook was produced with the support of Boehringer Ingelheim and Cancer Research UK. As always, Nature retains sole responsibility for all editorial content.