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Cancer survivor ignores the odds


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http://www.chicagodefender.com/page/loc ... cleID=8366

February 2, 2007

Cathy Bernas thought she might have pneumonia. A nagging cough had lingered long enough to prompt a visit to her doctor. She never smoked, nor had she spent much time in a second-hand smoke environment. But when initial tests led to more tests, she started to get scared.

It was the beginning of a nightmare. Bernas was diagnosed with stage IV lung cancer - the classification for the most advanced cases of this most lethal form of cancer in women. Her cancer had already spread throughout her body, including to her liver and lymph system. Surgery and radiation were no longer options. Chemotherapy, a toxic and debilitating treatment regimen, provided her only potential recourse. Her doctor told her to start considering hospice because, he advised, she surely would not live more than two years past her diagnosis.

That was two years ago last month, and Bernas has beaten the odds. She credits the chemo as instrumental to her survival, but one by one, each chemo treatment that has kept her tumors at bay has also stopped working on the cancer. And each time the tumors start to grow again, she switches to a new type of chemo with new side effects - ranging from violent nausea to complete hair loss.

Bernas' case is an example of how some doctors are learning to treat cancer like a chronic illness rather than a terminal one.

Dr. Ermilo Barrera, past president of the Illinois chapter of the American Cancer Society and an oncologist in the Evanston Northwestern Healthcare system, explains the constant tweaking of medications is necessary because of cancer's ability to mutate in response to medical intervention.

"When you give chemo to someone, it works on a certain chemical point of the cell to kill the cell," Dr. Barrera says. "But the cell develops defense mechanisms to get around that. Its genetics get altered to develop a side pathway around the original pathway that has been blocked. That's why when we treat cancers we treat with multiple drugs."

"My lung cancer is basically a medical condition I have to live with for as long as I can," Bernas says. "It's like diabetes or hypertension. I'll be on some sort of chemo schedule for the rest of my life. You just keep a positive attitude and you keep going on."

Lung cancer continues to have a devastating effect on the U.S. female population. This is contrary to the overall trend of more people surviving with cancer as demonstrated in the 2007 Facts and Figures statistical report of the American Cancer Society.

In Illinois, lung cancer incidences are expected to increase this year by a whopping 2,260 cases over 2006 figures, according to the American Cancer Society report. And although deaths from lung cancer in the state will drop by a small margin, much of that can be accounted for in men, whose survival rate from the disease has increased even as women develop and succumb to lung cancer in growing numbers.

Dr. Barrera cites smoking trends as the principal cause of the discrepancy.

"The reason is the lag time in developing lung cancer relative to smoking - it's not like you smoke a pack today and get lung cancer tomorrow," Dr. Barrera says. "The damage to the lungs takes place over many years. Women started smoking much later than men - the 1950s and 60s - so the expectation would be that you will see the downswing in women 10-15 years later than in men."

This conjecture is supported by statistics from the American Lung Association that show lung cancer diagnosis has increased 600 percent in women since 1955.

That's cold comfort for people like Bernas, who have been conscientious about not smoking but still ended up battling lung cancer. In fact, cases of lung cancers unrelated to smoking account for up to 20,000 of the 175,000 lung cancer diagnoses each year, according to Stacy Ignoffo of the American Lung Association of Metropolitan Chicago.

The causes of these non-tobacco related lung cancers remain somewhat unclear. The American Cancer Society reports that potential factors include exposure to radon, asbestos, radiation, or a history of tuberculosis, among other possibilities.

"A lot of it is environmental - exposure to city pollution and that kind of thing," Dr. Barrera says. But he cautioned that a potential genetic component to the disease remains elusive to medical professionals. "Because the environment (including smoking and second hand smoke) has such a huge impact, it really diminishes our ability to define whether there is some sort of genetic component."

Ominously, Illinois received failing grades from the American Lung Association on clean air issues, including tobacco prevention and education programs and youth access to tobacco products. But there is good news in the form of municipal regulations limiting smoking in public places for cities like Chicago and Springfield.

Still, the City of Chicago Department of Public Health Epidemiology Program Report released in 2004 indicates that there are 13 neighborhoods clustered on the south and west sides of Chicago that have at least a 33 percent higher death rate from lung cancer than the city as a whole. These neighborhoods include Fuller Park, South Deering, Woodlawn, and North Lawndale. Rogers Park is the only North Side neighborhood to share this distinction.

The five-year survival rate for lung cancer has crept up slowly from 12 percent to 15 percent over the last 20 years. This pales in comparison to the survival rates for other common cancers such as breast and prostate cancers, which have improved to 88 percent and 99 percent, respectively.

One important area of new research is the development of tests that detect lung cancer at an earlier stage. The American Cancer Society reports that early detection raises five-year survival rates from 15 percent all the way up to 49 percent. And a study published in the New England Journal of Medicine last year indicates that early detection followed by surgery within one month can raise survival rates all the way up to 92 percent.

"With lung cancer, it is usually found at a later stage because it is not normally detected until symptoms have appeared, which is usually a sign things have progressed," Ignoffo says.

But for Cathy Bernas, the hope is that in addition to earlier detection, treatment protocols for those already living with advanced lung cancer will continue to improve.

"It's just to give me hope," Bernas says. "At this point, I don't necessarily need to know what the new treatments are, I just like to have the hope that some sort of new treatments are on the horizon that I haven't tried yet."

Dr. Barrera cautions, "Research is not something that you're not going to know something one week and the next week you have a magic bullet. It takes years."

Bernas says she is willing to wait and see, "

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Rich,

Thanks for the article. You and Tony know exactly what she is talking about when she says, "I'll be on some sort of chemo schedule for the rest of my life. You just keep a positive attitude and you keep going on."

Ain't it the truth. God bless ALL of you survivors in this type of situation.

Welthy

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