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Diagnosis from left field

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http://www.orlandosentinel.com/features ... -lifestyle

Nonsmokers will be among the victims of the nation's No. 2 killer -- lung cancer.

Lisa Roberts | Sentinel Staff Writer

Posted March 14, 2006

Mention lung cancer, and the mind conjures the image of someone in a haze of smoke, puffing through a couple of packs of cigarettes a day. But Dana Reeve's death last week has drawn attention to an aspect of the disease that is often ignored: It can kill even a nonsmoker.

Dot Davis, a retired school administrator, knows well the shock of a lung-cancer diagnosis. In 2003, the 66-year-old Celebration woman, a nonsmoker, was told she had a tumor in her right lung. "It was so unexpected," she says. "And it's still very hard to believe it's me."

"The chance of a nonsmoker having lung cancer is very small, but it's real," says Dr. Kay Vydareny, a researcher at Emory University in Atlanta. According to the American Cancer Society, of the more than 174,000 people in the United States expected to be diagnosed with the disease this year, about 16,000 will be nonsmoking women. And as the nation's No. 2 killer, behind heart disease, lung cancer is expected to claim more than 162,000 lives in 2006.

Overall, the number of women with lung cancer swelled to epidemic proportions, with deaths increasing 600 percent from 1930 to 1997. Researchers attribute much of that increase to more women taking up smoking. Although the death rate from lung cancer has stabilized overall, some health-care professionals have noted an uptick in lung cancer in nonsmoking women.

Experts aren't sure how to explain the increase. Hormones and genetics -- even work environments such as smoky bars and restaurants -- could be factors.

Although tobacco smoke is the largest cause of lung cancer, exposure to things such as secondhand smoke, asbestos, air pollution, radon, coal products and gasoline also can cause cancer. The risks of secondhand smoke are well-documented. The American Cancer Society estimates nonsmoking spouses of smokers have a 30 percent greater chance of contracting lung cancer.

Davis, who has no family history of cancer, says she was never exposed to much secondhand smoke. She originally sought medical attention for a sore spot on her sternum. When treatment prescribed by her doctor didn't help, she requested a chest X-ray.

"It was just intuition," she says. "I don't know what I expected to find, but I never expected cancer."

Though her cancer was advanced when it was finally diagnosed, she had no other symptoms. That's not unusual, say health-care professionals, who say lung cancer often is a "silent" disease. Most people don't seek medical attention until they are symptomatic, says Dr. Gregory Pennock, a medical oncologist at M.D. Anderson Cancer Center in Orlando. They may cough up blood, or experience shortness of breath, weight loss, a chronic cough or repeated bouts of bronchitis or pneumonia. By that time, the disease usually has taken a firm hold, making it difficult to effectively treat or to perform surgery to remove tumors. In many cases, doctors must rely on chemotherapy and radiation treatments to shrink or contain the cancer, Pennock says.

Overall, the five-year survival rate for lung-cancer patients is just 15 percent. Unfortunately, there is no definitive screening test that can detect the cancer early, says Emory's Vydareny, who is studying chest X-rays and CT scans as possible tools. "We know both can pick up cancer. The key is whether we can pick up something early enough to reduce mortality."

Though new forms of radiation treatments are being tested and "targeted agents" -- drugs that attack cancer cells in a variety of ways -- have been developed, a lack of funding has hampered advancements in the field, experts say.

The disease "doesn't have a strong lobby of survivors, because it is so rapidly deadly," says Dr. Eva Szabo of the National Cancer Institute. And, says M.D. Anderson's Pennock, "There's a lot of stigma attached to the disease . . . 'If you smoke you did it to yourself.' "

Meanwhile, Davis returns to the cancer center every three weeks for preventive chemotherapy that is keeping her advanced cancer contained.

"Stage 4 is a very serious stage of cancer," she says. "But we don't dwell on the prognosis -- we dwell on living with cancer and doing what we can. Of course, I know what the statistics are, and I know they're not very favorable for my type of cancer. I just make the most of daily life."

First photo ran on page E1.

Lisa Roberts can be reached at 407-420-5598 or lroberts@orlandosentinel.com.

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