Lung cancer: As deadly as ever?

It's been a year since ABC news anchor Peter Jennings died of lung cancer. And the disease remains as lethal as ever. In the past year alone, 170,000 Americans have received a diagnosis of lung cancer. Lung cancer deaths among women have increased almost 200% over the past 20 years, while those among men have actually decreased 5%.

In addition, women seem less concerned than men about developing lung cancer. "Men began to smoke about 20 to 30 years earlier than women," said Diane Stover, M.D., chief of the pulmonary service and head of general medicine at Memorial Sloan-Kettering Cancer Center in New York City. "So lung cancer is seen as a man's disease because the effects of smoking, such as lung cancer and chronic obstructive pulmonary disease [COPD], were first seen predominantly in men." Women focus primarily on breast and ovarian cancers, as well as other female-specific malignancies. And many more patients with breast cancer compared with lung cancer survive to advocate for research and better therapies.

Why women should be concerned

Although women smoke fewer cigarettes than men, they still develop lung cancer at the same rate men do, Stover said. In addition, nonsmokers who develop lung cancer are twice as likely to be women than men.

Stover noted that controversial molecular and genetic data exist that attempt to explain why women appear to be at increased risk for lung cancer compared with men. For example, women appear to retain the carcinogens in tobacco smoke in their bodies longer than men do. As women retain these carcinogens over an extended period, their DNA undergoes mutagenesis, she explained.

The latest research points to other differences between men and women in terms of lung cancer risk factors. The authors of a new study found that a significant proportion of women newly diagnosed with lung cancer had normal lung function in pulmonary function tests compared with newly diagnosed men. In addition, among those with lung cancer, significantly more men than women presented with COPD, an independent risk factor for lung cancer, even after controlling for age and smoking status.

"Our findings support previous data that women are inherently susceptible to lung cancer," said Raghu Loganathan, M.D., an attending physician in pulmonary and critical care at Lincoln Medical & Mental Health Center in Bronx, N.Y., and lead author of the study. He said future research should focus on epidemiological differences in men versus women with lung cancer. "Prevalence of COPD in women compared to men around the time of diagnosis of primary lung cancer" was published in the May issue of the journal Chest.

Current treatments

Unfortunately, the results of standard treatment for non-small-cell lung cancer (NSCLC) are poor, except for the most localized tumors. The National Cancer Institute (NCI) stated that chemotherapy can offer modest improvements in median survival to those with advanced disease, although their overall survival rate is low. According to the NCI, cisplatin, carboplatin, paclitaxel, docetaxel (Taxotere, Sanofi-Aventis), topotecan (Hycamtin, GlaxoSmithKline), irinotecan (Camptosar, Pfizer), vinorelbine, and gem-citabine (Gemzar, Eli Lilly) are among the agents that are active in the treatment of advanced NSCLC. Erlotinib (Tarceva, OSI Pharmaceuticals) is approved for use in those who have previously received platinum-based chemotherapy.