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North Jersey Media
Group
The Record
March 8, 2006
By Lindy Washburn
For a nation that envisions the
typical lung cancer victim as an old man with a lifelong
smoking habit, the death of Dana Reeve, a 44-year-old
non-smoker, was a harrowing reminder of how much we
still don't know about cancer.
Christopher Reeve's widow died at
Memorial Sloan-Kettering Cancer Center on Monday night,
just seven months after announcing that she'd been diagnosed.
She had cared for her husband, paralyzed in a 1995 riding
accident, until his death in October 2004, and led the
foundation they established for research into a cure
for spinal cord injuries. Their 13-year-old son is now
orphaned.
"Who could be more blameless
than Dana Reeve?" asked Susan Mantel, executive
director of Joan's Legacy, a non-profit foundation that
funds lung cancer research, focusing particularly on
the occurrence of the disease among non-smokers.
Reeve's death highlighted the puzzling
increase of lung cancer among non-smokers, the epidemic
of lung cancer among women, and the grim outlook for
those who receive a lung cancer diagnosis -- its five-year
survival rates are the lowest among the major cancers.
In a nation that often stigmatizes
lung cancer patients as having brought the disease on
themselves by smoking, Reeve was the poignant exception,
a young woman who had never smoked.
And yet one out of five women diagnosed
with lung cancer has never smoked, along with one in
10 men.
"There has been a very disturbing
increase in the number of non-smoking younger women
being diagnosed now with lung cancer," Laurie Fenton,
president of the Lung Cancer Alliance, noted earlier
this year.
While the death rate from lung cancer
among men has declined slightly, it is climbing among
women.
"What do we do to keep more
Dana Reeves alive?" Mantel asked. "That's
what this should be about today. I don't think anyone
deserves to die of lung cancer."
Researchers are exploring possible
explanations for the differences between men and women
in the incidence of lung cancer, especially non-smokers.
Does estrogen play a role? Are women's smaller lung
size and reduced ability to filter contaminants from
secondhand smoke or air pollution a factor?
But federal research funding for
lung cancer is a fraction of funding for breast cancer,
when measured by the number of deaths.
The National Cancer Institute reported
that it spent $1,740 on lung cancer research for each
person who died of that disease, compared with $13,649
on breast cancer research.
That may reflect the politics of
health-research spending. "Oftentimes these patients
aren't well enough to be advocates for themselves,"
said Dr. Mika Sovak, a thoracic oncologist at the Cancer
Institute of New Jersey. "And unfortunately, there's
a lot of shame associated with having the disease."
Advocates bemoan the fact that none
of the $246 billion to be paid to the states as tobacco
settlement money by cigarette manufacturers was set
aside for research into the disease.
Much more is spent on prevention
efforts, such as smoking cessation programs, to prevent
lung cancer from occurring in the first place. But that
leaves those who develop the disease with less hope
than victims of other types of cancer.
More than thirty years after President
Nixon declared a war on cancer, the five-year-survival
rate for newly diagnosed patients has hardly budged:
15 percent survive five years now, compared with 12
percent in 1971.
That compares with 63 percent surviving
colon cancer for five years, 88 percent surviving breast
cancer, and 99 percent surviving prostate cancer.
More women who never smoked will
die of lung cancer than of ovarian cancer or leukemia
this year. Nearly twice as many women will die of lung
cancer as of breast cancer.
And overall lung cancer deaths,
in men as well as women, will exceed those from breast,
ovarian, prostate and colon cancer combined.
"It's not a very positive story,"
said Dr. Harry Harper, chief of the division of thoracic
oncology at Hackensack University Medical Center.
"My lung cancer patients today
are kind of depressed about the whole thing, especially
if they're embarking on treatment. To have a high-profile
patient like that lost is disturbing."
Yet, his outlook is more optimistic
than shown by the statistics, he said.
A genetic mutation more commonly found in those who've
never smoked, as well as women, Asians, and those with
a certain type of lung cancer, has been identified as
a potential trigger for non-smokers to develop the disease.
This has led to the development of new drug therapies
that interfere with the action of those receptors and
have produced "sustained remissions" in some
lung cancer patients, he said.
One of the key factors in the high
death rates is the lack of early detection.
There is no equivalent of the widely used annual mammography
to detect breast cancer, or the Pap smear to detect
cervical cancer.
"By the time you see them,
it's too late," said Dr. Joseph Grizzanti, co-director
of The Center for Lung Cancer Prevention and Treatment
at The Valley Hospital.
A majority of patients have already
reached Stage 3 or 4 when they consult a doctor.
Grizzanti recommends yearly screening
CT scans for anyone who smokes more than 20 packs of
cigarettes a year. But the public-health value of such
a costly screening for a broader population -- one likely
to include patients like Dana Reeve -- is still being
evaluated.
E-mail: washburn@northjersey.com
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