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By Meryl L. Bralower and Pasi A. Jänne  |  May 7, 2006 | The Boston Globe
JUST BECAUSE you never smoked, don’t think you won’t get lung cancer.

Lung cancer is the leading cancer killer of both men and women in the United States, accounting for 30 percent of all cancer deaths. It takes more lives than breast, ovarian, prostate, and colon cancer combined. Its link to smoking has made lung cancer an underdiagnosed and underfunded disease. With 15 percent of these 160,000 annual deaths attributed to nonsmokers, it is time for that to change.

The recent death of Dana Reeve has brought attention to the fact that there is an increase of lung cancer in nonsmokers, especially in women. Eighty percent of all nonsmoking lung cancer patients are women.

Up until now there has been an inextricable link between lung cancer and smoking in the minds of the public and for many doctors as well. There was an assumption that if you never smoked or smoked a minimal amount, you would be immune from lung cancer. This connection linking smoking and lung cancer created a stigma around the disease. The perception that patients with lung cancer brought it on themselves affects the degree of empathy they receive compared to other cancers. And most important, it affects both its early detection and its funding for research.

Today lung cancer needs to be on the radar screen for everyone, not just people who smoke. Doctors, especially primary care physicians, need to be more suspicious when nonsmokers exhibit symptoms that can include a persistent cough, shortness of breath, repeated attacks of pneumonia or bronchitis, wheezing or hoarseness, and an increased amount of sputum or sputum streaked with blood.

Unlike other common cancers, there is no diagnostic screening for lung cancer. Often the disease goes undetected because of the lack of symptoms until the disease is in its later stages. Other types of cancer that have diagnostic testing have greatly improved survival rates. Compare lung cancer with its survival rate of 15 percent for five years, to breast cancer at 87 percent, prostate cancer at 98 percent, and colon cancer at 62 percent.

The research dollars don’t reflect the prevalence of lung cancer, which kills twice as many women as breast cancer. In 2004, the American Cancer Society spent an estimated $130 million on research, with $29 million tabbed for breast cancer and only $12 million for lung cancer. In 2003, the federal government spent $14,045 per breast cancer death and $10,761 per prostate cancer death on research. In contrast, for each lung cancer death, only $1,632 went toward research.

There needs to be more funding devoted to lung cancer, its epidemiology, its prevention, and hopefully its cure. We need to know what factors in addition to smoking cause lung cancer so we can do more in terms of prevention.

There is promising new research into targeted therapies for lung cancer. By identifying each cancer’s unique gene pattern, the most effective therapies can be chosen for patients. Compelling examples include gefitinib and erlotinib, drugs targeted at specific growth-factor proteins found in many lung cancers. In a subset of lung cancer patients, more commonly in non-smokers, these drugs are particularly effective due to unique genetic alterations present in these tumors. By continuing to study genetic alterations in lung cancers, more effective therapies may be on the horizon for the vast majority of patients.

It is time to shine a spotlight on lung cancer. We have done that successfully with other prevalent cancers, and that has resulted in greater public awareness, earlier detection, increased research, and, most important, saved lives. First we have to educate the general population as well as the medical community so that there will be earlier detection. We need better diagnostic tools that will help with this process, and we need to find more effective treatments that increase survival rates.

Every three minutes someone is diagnosed with lung cancer. Men have a lifetime risk of 1 in 13, and women 1 in 17. We have to treat lung cancer as a disease that could happen to any of us, because it can, even if we never smoked.

Meryl L. Bralower, a consultant to new ventures with a social orientation, is a nonsmoker and a survivor of lung cancer. Dr. Pasi A. Jänne is a physician-scientist at the Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute and an assistant professor of medicine at Harvard Medical School.