Lung-cancer rate outpaces breast cancer in U.S. women

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Tawni Spargur felt blindsided when she was diagnosed six months ago with lung cancer.

The 46-year-old Spokane woman had been concerned enough about breast cancer to perform self examinations and to undergo recommended medical screenings to ensure early detection. With emphasis given to breast-cancer awareness in recent years, she never saw the threat of lung cancer coming.

“I was not paying attention to something I thought would never happen to me,” she says.

She hadn’t smoked for 10 years, and back when she did smoke, she thought of herself as a “social smoker” rather than a “full-time smoker.”

While breast cancer gets more publicity, more women have died from lung cancer than from breast cancer since 1987, the American Lung Association says. A Mayo Clinic report says that more than 70,000 women die of lung cancer in the U.S. each year, while breast cancer is the second leading cause of cancer death in U.S. women, with 40,000 deaths each year.

Statewide, cancer overtook heart disease as the leading cause of death in 2004, with 185 cancer deaths per 100,000 people, compared with 177.1 heart-disease deaths per 100,000 people, says the Washington state Department of Health’s latest available vital statistics report.

In 2004, lung cancer was the leading type of cancer death in Washington, with 52.3 deaths per 100,000 people, the Department of Health says. That’s just under the U.S. rate of nearly 54 lung cancer deaths per 100,000 people in 2004.

The lung-cancer rate in Spokane County, which had 254 lung cancer deaths in 2004, or 58.1 lung cancer deaths reported per 100,000 people, was higher than both the state and national rates.

While smoking is by far the biggest cause of the estimated 175,000 new lung-cancer cases diagnosed annually in the U.S., about 20 percent of women and 8 percent of men diagnosed with lung cancer are nonsmokers, says a Stanford University study published last month in the Journal of Clinical Oncology. The study calls for more research to determine if women are more susceptible than men to contract lung cancer from causes other than smoking, such as second-hand smoke, exposure to radon gas, and air pollution.

Spargur says she may never be certain if smoking caused her cancer, which developed long after she quit smoking. She says her lung cancer was found after she developed pneumonia and her treatment for that ailment was followed up with a series of chest X-rays.

When a spot on her upper right lung didn’t respond to treatment with antibiotics by the time she had her third X-ray, her doctor recommended that she undergo a computed tomography (CT) scan, which is a more sensitive series of X-rays. When that also was inconclusive, the doctor recommended a positron emission tomography (PET) scan, which involved injecting a radioactive dye that “lit up” the tumor, identifying it as cancer, she says.

Within 48 hours, she was in surgery, having the upper third of the lung removed.

At first, Spargur, a single mom with 11- and 16-year-old sons, says she was devastated by the lung-cancer diagnosis and thought her life was nearly over.

“My impression of breast cancer was that you live,” she says. “I thought, if you get lung cancer, you die.”

Her initial research into the disease didn’t provide much comfort.

The American Lung Association says the five-year survival rate for lung-cancer victims is 15.5 percent, compared with a survival rate of 89 percent for breast cancer. The lung-cancer survival rate improves to about 50 percent if the disease is diagnosed in its early stages, but less than a quarter of lung-cancer patients are diagnosed at an early stage.

Dr. Jay Wittenkeller, a medical oncologist with Rockwood Clinic PS’s Cancer Treatment Center here, says the odds of surviving lung cancer are improving.

In recent years, advancements in surgical procedures, radiation treatments, and chemotherapy have improved lung-cancer survival rates, Wittenkeller says, adding that new medications are showing promise in extending and improving patients’ quality of life.

Wittenkeller, who specializes in treatment of lung cancer, says he’s particularly encouraged by the use of chemotherapy following surgery.

Until about five years ago, no studies showed an advantage of following surgery with chemotherapy, he says. More recent studies show the likelihood of surviving for five years is higher for those who undergo chemotherapy after surgery than for those who don’t.

“Except for early Stage I, surgery and chemotherapy is the standard treatment, provided the patient has the ability to tolerate chemotherapy,” he says.

Cancer is identified as having four progressive stages, with stage I being the earliest stage, in which the cancer is small and contained within the organ where it started. Stage IV, in which the cancer typically has spread from one part of the body to another part, is the most advanced stage.

Wittenkeller says he sees two or three newly diagnosed lung cancer patients per week. More than half are in stages I to III. They are treated with a goal of remission, long-term survival, and eventual cure, Wittenkeller says.

Until recently, most lung cancer cases had progressed to stage III or IV before they were diagnosed. Stage IV is not known to be curable. Goals at that stage are to prolong the patient’s life and improve the quality of life, he says. Stage IV patients who beat cancer “are the exception rather than the rule,” he says.

Spargur considers herself lucky to have been diagnosed early, before she was showing any symptoms of the disease. If the tumor had reached the lining of her lung or her lymph nodes, and advanced to stage II, it would have required more aggressive treatment, including chemotherapy.

Were it not for her pneumonia, she wouldn’t have had the initial chest X-ray that led to further monitoring and eventual diagnosis.

“Early screening for lung cancer seems nonexistent, yet you have all these other regular exams,” she says, referring to screening for breast, cervical, and colorectal cancers. “No one ever asks for a lung X-ray.”

Spargur says her sisters were told that screening probably wasn’t necessary.

“Screening was accidental, but very effective for me,” says Spargur, who now is a volunteer advocate for the American Lung Association. “I feel I actually have a 90 percent chance to survive without the cancer returning in my lifetime.”

Wittenkeller says screening for lung cancer has been a controversial subject, partly because studies have shown the conventional chest X-ray isn’t effective in detecting the disease in its early stage.

“In the past, chest X-rays resulted in no increase in survival rates,” Wittenkeller says.

He says spiral CT scans are more sensitive than conventional chest X-rays, but even those are recommended only for people who have family histories or other risk factors for lung cancer.

“It’s still in the research phase,” he says. “We’re not at the point where widespread screening for lung cancer is approved as opposed to something like breast cancer.”

While breast cancer research gets more funding than lung cancer research, and breast cancer gets more media attention, Wittenkeller says it’s not just lack of funding and awareness that makes lung cancer more deadly than breast cancer. It’s also the biology of the tumor.

“Lung cancer is typically more aggressive and resistant to treatment,” he says.

Rockwood Clinic’s multidisciplinary tumor board, which is made up of specialists in oncology, radiology, surgery, and cancer research, meets weekly and collectively designs the best course of action for each patient.

“Any patient who comes here is included in the discussion when we do tumor boards,” Wittenkeller says. “For lung-cancer patients, they are often getting three opinions for the price of one.”

Lung cancer was once widely perceived to be a man’s disease, but a University of Michigan Health System report published in November says the incidence of lung cancer among women is catching up to that of men. Nationwide, about 40 percent of new lung-cancer cases today are in found in women, compared with 22 percent in the 1970s, the report says.

In 2004, there were 3,066 lung cancer deaths reported in Washington state. Of those, 46 percent were women, says the state Department of Health.

Wittenkeller says overall lung-cancer incidence runs parallel with, but 20 years behind, smoking rates.

That’s about how long smoking has been declining significantly among men, and lung-cancer rates in men have appeared to plateau only recently and may be on a downward trend.

Lung-cancer incidence among women, however may not have leveled off yet due to a spike in cigarette use among young women in recent years, Wittenkeller says.

“I would assume women don’t know they have a slightly higher risk than men, partly due to the perceptions of what lung cancer used to be,” he says.

Contact Mike McLean at (509) 344-1266 or via e-mail at mikem@spokanejournal.com.