Quick - what's the biggest cancer killer of women?
If you said, "breast cancer," you'd be in good company. But you'd be wrong.
Lung cancer kills more women in the United States than breast cancer and all other gynecologic cancers combined. The American Cancer Society says nearly 70,000 American women are expected to die of lung cancer this year, compared with about 40,000 who will succumb to breast cancer.
"Women don't have this on their radar screen," said Dr. Kathy Albain, professor of medicine at Loyola University Chicago, "and it's a travesty."
Lee Ann Gaal, 50, one of Albain's patients, learned the hard way. The longtime schoolteacher started having mammograms in her 30s. An aunt had died of breast cancer, making Gaal well aware of that danger. But even though her father had died of lung cancer, Gaal smoked at least a pack of cigarettes a day from age 13.
"I guess I thought lung cancer was just for men," she said.
(That was true in the past, because far more men smoked cigarettes. In recent decades, women have about caught up: 21 percent of U.S. women and 25 percent of men now smoke.)
About six years ago, Gaal noticed that her ankles were swollen. Her primary-care doctor sent her to an arthritis specialist, who poked and prodded and eventually pronounced, "I'm not positive, but I'm pretty sure you have lung cancer."
It was a bolt from the blue. Gaal turned out to have an 8-centimeter tumor on her lung that eventually spread to her brain. But after surgery, radiation and chemotherapy, she's alive to tell her story.
The majority of lung cancer patients are dead within two years of diagnosis, but Albain stressed that increasing numbers are beating those odds, thanks to improved treatments.
"I need to say `Thank you, Jesus' every day," Gaal said. "It's only by a miracle that I'm alive."
Her biggest regret is that she put her family through hell. "Women who smoke need to know they're risking their lives," Gaal said. "But what they do to their families is so much worse."
Gaal and Albain (who specializes in both breast and lung cancer) are trying to spread the word. Three years ago, Albain helped found Women Against Lung Cancer, which brings women oncologists and medical professionals together with leaders of women's advocacy groups.
This year she and other researchers are launching a large clinical trial that will attempt to establish why some people get lung cancer while others don't, and why some patients do better once they get it.
Being female may have something to do with it, Albain believes. Some studies (but not all) suggest that women who smoke are more susceptible to carcinogens in cigarettes. There also are many more women than men among lung cancer patients who have never smoked.
A reason why
Dr. Michael Thun, who heads epidemiological research for the American Cancer Society, said that could be simply because there are more older women than men in America who have never smoked.
Women also tend to get different types of lung cancer, to be younger when they get it and to have a close relative with the disease. In addition, lung cancer behaves differently in women than in men: Women are more likely than men to respond to certain types of treatment, and they live longer once diagnosed.
"Lung cancer appears to be a different disease in women," said Dr. Jyoti Patel, author of a paper in the Journal of the American Medical Association calling for gender-specific studies to address the differences.
Patel said that lung cancer is not a priority for agencies that fund medical research. HIV/AIDS research gets almost $30,000 per patient death, and breast cancer gets about $13,000, she said. But lung cancer gets only about $1,500 per patient death.
"There are no pink ribbons for lung cancer," Patel said. "So it's a double blow - you have a horrible illness, and no one seems to care."
Some of the angles Albain expects to examine are whether women metabolize certain carcinogens differently, whether their DNA is less efficient at repairing itself, whether they have more or different gene mutations that promote cancer ("oncogenes"), and how hormones affect their risk of getting lung cancer. Some studies have suggested that women who take oral contraceptives or hormone replacement therapy are more likely to get lung cancer.
"We know that smoking causes lung cancer," Albain said. "But only one in 10 smokers get the disease. Why is that?"
The answer probably lies in the complex interactions between smoking and other factors, both environmental and biological.
So Albain's study of 740 lung cancer patients will collect information on smoking, exposure to secondhand smoke and other environmental carcinogens in addition to tissue and blood samples.
"We need to find out if there's an environmental exposure profile that puts you at higher risk," she said.