National Women's Health Network

A Voice For Women, A Network for Change

By Tracey Stelzer Hyams, JD, MPH

If you were asked to name the cancer responsible for the most deaths in women, what would you respond?  If you are like two-thirds of Americans, you would say that breast cancer is the leading cause of cancer death in women, but in fact lung cancer is the proper reply.[1] 

Lung cancer takes the lives of more women each year than breast, ovarian, and uterine cancers — combined.[2]  In 2010 alone, approximately 70,500 women will die from the disease.[3] While the death rate from lung cancer has declined in men, the death rate in women has increased, particularly among young women who have never smoked.[4]  In fact, although lung cancer is widely viewed as caused by tobacco use, one in five women (and one in twelve men) who are diagnosed with the disease today have never smoked.[5] 

Despite lung cancer’s ranking as the leading cancer killer in both women and men, and its alarming rise in incidence among women, Federal funding for research on the disease lags far behind other cancers and many common diseases. For FY2009, combined Federal funding for the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and Department of Defense (DOD) was just $214,000,000 — $1,249 per lung cancer death. By contrast, the equivalent of $27,480 per death was allocated for breast cancer research (total: $833,000,00) and $14,336 for prostate cancer (total: $357,000,000) [6],[7]  Federal research funding per cancer death is, based on some estimates, approximately 21 times greater for breast cancer and 13 times greater for prostate cancer than for lung cancer research.  Between 2003 and 2007, the National Cancer Institute’s funding of lung cancer research actually decreased while its funding for breast cancer research increased.[8] 

The effects of this funding gap are undeniable when comparing five-year survival trends for cancer over the past 30 years.  From 1975 to 2003, the five-year survival rate for all cancers combined improved from 50 percent to 66 percent. During that period, the five-year breast cancer survival rate rose by 14 percent, to 89 percent; the five-year prostate cancer survival rate rose by 30 percent, to 99 percent; and the five-year ovarian cancer survival rate increased by 8 percent, to 45 percent. In that same time frame, the five-year survival rate for lung cancer increased just 3 percent, to 15 percent overall.[9]  Although women enjoy a slight survival advantage over men, the 85 percent likelihood of dying within five years of receiving a lung cancer diagnosis has hardly budged since the “War on Cancer” was declared in 1971. 

What could increased Federal funding for lung cancer accomplish?  Research on sex differences in lung cancer risk, etiology, progression, and treatment is vitally needed.  Mounting evidence suggests that genetic, hormonal, behavioral and environmental factors influence the different patterns of lung cancer in women and men. A better understanding of the role these factors play can advance preventive, diagnostic, and therapeutic practice and improve outcomes for those suffering from this disease.

Another priority is early detection. The benefits of effective new treatments for early stage disease, including targeted therapies (e.g., “smart drugs”) cannot be fully realized until lung cancer is found in patients before the disease has progressed.  Unlike breast and prostate cancer, which utilize mammography screening and prostate-specific antigen (PSA) tests respectively, there is no widely accepted screening protocol to detect lung cancer. Only 16 percent of lung cancer patients are diagnosed before their disease has metastasized, compared to over 60 percent of breast cancer patients and over 90 percent of prostate cancer cases.[10]

Research shows that computed tomography (CT) scans are effective in detecting lung cancer early, when the disease is most treatable and the likelihood of five-year survival is greatest.  Studies have not shown that screening with CT scans reduces mortality, however; as a result, the U.S. Preventive Services Task Force gave CT screening for lung cancer its “I” rating, finding insufficient evidence to recommend for or against screening people who have no symptoms of the disease.[11]  Interestingly, PSA screening to detect prostate cancer has the same “I” rating, because of the same absence of proof of life-saving benefit, yet is widely administered, covered by Medicare, and mandated as a private health insurance benefit in 33 states.[12],[13] It is difficult to understand this difference in enthusiasm for two not-yet-fully-proven screening techniques.  Possible explanations include the high cost of CT scans, and a blame-the-victim attitude towards people with lung cancer, although over 60 percent of patients have either never smoked or already stopped.[14],[15]

New diagnostic tools for lung cancer are in early stages of investigation, including biomarkers tests that examine urine, blood, sputum or tissue samples for abnormal levels of certain substances.[16] These may someday lead to widespread and inexpensive personalized risk assessment. These tests have several advantages over radiologic screening (including CT scans), such as enabling identification of individuals who are at high risk for lung cancer, and allowing careful monitoring and early treatment of pre-cancerous nodules. Biomarker tests also show promise for avoiding over-diagnosis by distinguishing which nodules are likely to become deadly cancers, which is key to eliminating costly and potentially harmful unnecessary treatment.

Passage of the Lung Cancer Mortality Reduction Act of 2009 (S.332, HR.2112) would represent an important step toward improving outcomes from the disease. The bill, which currently has 17 sponsors in the Senate and 47 in the House, would authorize a comprehensive, multi-agency research effort to cut lung cancer’s mortality in half by 2016.  The first year of the five-year bill would provide at least $75 million to the Secretaries of Health and Human Services, Defense, and Veterans Affairs to develop a comprehensive and coordinated research program aimed at accomplishing this goal. 

The barriers to making needed advances in lung cancer detection and treatment are as much political as scientific. Lung cancer advocacy has not gained traction as a movement demanding attention and research funding as successfully as other cancer lobbies have — possibly because there are so few long-term survivors to speak out. Although over 60 percent of lung cancer cases are diagnosed in patients who have either never smoked or already stopped smoking, the disease carries a stigma almost unheard of with other deadly illnesses, hindering the unconditional support and investment of resources afforded to patients with other serious conditions. Even clinicians are not immune from assigning unwarranted blame: one study found that physicians were less likely to send lung cancer patients with advanced disease to an oncologist than they were to refer breast cancer patients, and that breast cancer patients were more likely to be referred for further therapy, while lung cancer patients were referred only for symptom control.[17] 

One in every 16 women will develop lung cancer in her lifetime.5 (Reference is correct) The increasing incidence and mortality rates of lung cancer in women, particularly among younger women who have never smoked, are cause for alarm and should be a priority of the women’s health policy and public health communities. 

Tracey Hyams is the Director of Women’s Health Policy and Advocacy at the Connors Center for Women’s Health and Gender Biology, at Brigham and Women’s Hospital. This article is based in part on the forthcoming report “Out of the Shadows: Women and Lung Cancer” which will be published in May 2010.  The report will be available at www.brighamandwomens.org/womenspolicy.