The Wall Street Journal,
April 14, 2004; Page D1
By Amy Dockser Marcus
Lung cancer, a deadly disease
that once primarily afflicted men, has reached epidemic proportions
among women, according to a new study published today. Lung
cancer now kills more women each year than breast and ovarian
The findings, published in the Journal of the American Medical
Association, are likely to fuel a shift already under way
in the study and treatment of what's traditionally been considered
a male smoker's disease.
While the number of new lung cancer
cases diagnosed among men has decreased in recent years, diagnoses
among women climbed a surprising 60% between 1990 and 2003,
the study found. Two of the authors, Jyoti D. Patel and Mark
G. Kris, said that, for the first time, more than half of
the patients in their lung-cancer clinics are women.
It's not clear why lung cancer
may be striking women at a higher-than-expected rate. Some
researchers argue that women may metabolize carcinogens differently
than men, making them more susceptible to the disease. Others
suggest that women don't repair damage done to DNA as effectively
as men or that hormonal differences may play a role. Oncologists
say these factors may explain why the jump in lung-cancer
rates cannot be fully explained by women's smoking patterns
Lung cancer has surpassed breast
cancer as the leading cause of cancer in women by nearly 20,000
patients a year. Yet lung cancer still lacks the public constituency,
research clout and visible political profile of the breast-cancer
community. An estimated 68,500 women will die from lung cancer
this year. (The death toll among men is 88,400 but that has
slipped 1% from 2000.) But for every lung-cancer death, $1,200
is spent on research on the disease, while more than $11,000
per death is devoted to breast-cancer research, based on National
Cancer Institute data. Lung cancer has a five-year survival
rate of only 14%.
An estimated 85 to 90% of all lung cancer patients have smoked
at some point in their lives. What's startling is that many
of those diagnosed today already have kicked the habit, often
decades before, or were so-called "social smokers"
at some point in their lives and then quit. The other 10%
to 15%, about 20,000 new cases every year, have never smoked.
Among the people who have never smoked, women appear more
likely to get lung cancer than men, the JAMA study says.
Lung cancer victims have long been stigmatized because of
the disease's close connection with smoking, and so for people
who have never smoked, it is especially shocking when they
get sick. Richard N. Barg, whose partner, Nadine Manney, a
life-long nonsmoker and vegetarian, died last year at the
age of 45 from lung cancer, says that lung-cancer patients
"are treated like a modern day class of lepers, ostracized
for their supposed character defects and impulse control problems."
He says that Ms. Manney was constantly explaining to friends,
co-workers, and even doctors who treated her that she never
smoked. People with heart disease or diabetes, which are both
strongly linked to diet and obesity, are not blamed for their
illnesses, Mr. Barg notes.
Craig Norberg-Bohm of Arlington, Mass., whose wife, Vicki,
48, died of lung cancer last month, says he agreed to tell
the local newspaper obituary writer the cause of death only
if she would add that Ms. Norberg-Bohm had been a nonsmoker.
"People were not ready to offer their hearts until learning
she was not a smoker," he says. Some families, like that
of Wendy D. Wyrick, a 32-year-old from Lexington, Ky., who
never smoked and died in 2003 of lung cancer, are starting
to create foundations to help raise awareness and change the
stigma around the disease.
Many women often feel "betrayed by the system"
says Joan Schiller, who heads the lung-cancer program at the
University of Wisconsin in Madison. She also has set up the
group Women Against Lung Cancer to encourage research into
gender differences in the disease and its treatment and encourage
more women doctors to enter the field. "They know about
breast cancer, but they never heard of lung cancer or thought
they'd get it, and when they go to learn more, they find little
research, no support and little hope."
• More women will
die this year from lung cancer than breast cancer
and ovarian cancer combined.
• Women appear to be more susceptible to
genetic damage caused by smoking than men.
• Women who never smoked get lung cancer
more often than men who never smoked.
See a list of Web sites
with information on women and lung cancer.
The recent findings are fueling more research into how women
respond to lung-cancer treatments. Researchers are particularly
excited by evidence that women, especially those who have
never smoked, appear more likely to respond to new, targeted
cancer treatments such as AstraZeneca PLC's Iressa and Tarceva,
which is being developed by OSI Pharmaceuticals Inc., Genentech
Inc. and Roche Holding AG.
Women who have never smoked -- defined as
someone who has smoked fewer than 100 cigarettes in her lifetime
-- were once an overlooked group in lung cancer. Their prognosis
was considered no different than other lung-cancer patients
and, as a group, they were considered too rare to merit closer
study. But with emerging data suggesting that they fare better
in trials, doctors are starting to take a closer look.
These patients are a "major area of interest,"
says Roy Herbst, chief of thoracic medical oncology at the
M.D. Anderson Cancer Center in Houston. "If we understand
what is different about them, it could help us understand
the mechanism of lung cancer and lead to better therapies
The first major sign that never-smoking women
respond differently to treatment than men or former and current
smokers emerged last year. That's when researchers at Memorial
Sloan-Kettering Cancer Center in New York reported preliminary
results from a trial of Iressa. The drug was approved in 2003
in the U.S. for patients with advanced non-small cell lung
cancer, the most common form of the disease. The trial results
were published last month in the Journal of Clinical Oncology.
According to the study involving 139 patients,
tumors in 25% of the women shrank after they used the drug,
compared with only 8% of the men in the trial. The results
for people who never smoked were also significantly different.
Of the patients who never smoked, 36% responded to the drug,
while only 7.7% of the current or former smokers did. The
researchers hypothesized that because tumors in never-smokers
appear to be less genetically complex than those in former
and current smokers, they may arise through mutations in only
one or a small number of critical cellular pathways, making
it potentially easier to study what goes wrong. If these pathways
can then be identified, they may lead to the development of
Early results in a trial with Tarceva suggest
that people who never smoked do better with this treatment
as well. M.D. Anderson and Vanderbilt University Cancer Center
in Nashville are running a trial of Genentech's cancer drug
Avastin and Tarceva.
These changes are something Barbara Parisi,
54, has advocated for since being diagnosed nearly five years
ago with lung cancer. A runner and life-long nonsmoker, she
was shocked when a routine chest X-ray turned up the disease.
When she looked around for support groups near her Wall, N.J.,
home, she says she found smoking cessation ones but no groups
that were specifically for lung-cancer patients.
She got involved in patient advocacy and participated
in the first annual Thomas G. Labrecque Classic last year
-- a four-mile road race in New York that raises money for
lung-cancer research. It was established in memory of the
never-smoking former bank chairman who died of the disease.
"One reason lung cancer has lagged behind other cancers,"
she says, "is the fact that so few of us survive."
following Web sites have more information about women and
for Lung Cancer Advocacy, Support, Education
developing a special section targeted to women
on lung cancer, support groups
To Focus On Lung Cancer
Bristol-Myers Squibb, the site lists clinical
trials, treatment and prevention information
in the disease, special interest in lung cancer
in people who have never smoked
about medical treatment and support
research into gender differences in diagnosing
and treating lung cancer