Sunday, April 02, 2000
Lung cancer lags as priority
Funds disproportionate
BY TIM BONFIELD
The Cincinnati Enquirer
More Americans die of lung cancer than any other kind of cancer. So one might expect that the hunt to cure the disease also would attract the most research money, right?
Not even close.
This year, the National Cancer Institute (NCI) will spend more than $400 million on breast cancer and more than $240 million on AIDS research, which isn't even a type of cancer.
It will spend $150.3 million on lung cancer.
The American Cancer Society, a leading private source of research money, ranks lung cancer seventh on its money list — behind leukemia, lymphoma, breast, colorectal, prostate and ovarian cancers.
This even though lung cancer kills nearly four times as many people per year as breast cancer, about nine times more people than AIDS and 11 times more people than ovarian cancer.
None of this is good news to Mary Groh, a Maineville resident who has lung cancer. Nor for Greater Cincinnati in general, where lung cancer rates exceed state and national averages.
“Wow. If (lung cancer) is the leading killer, it should be receiving the same amount of money as those others, at least,” Mrs. Groh said.
While lung cancer patients say they are surprised by the research funding figures, doctors who study and treat the disease say they've been frus trated by weak funding for years. They say research priorities are being driven more by politics than actual public health needs.
As a result, less money for lung cancer means slower progress toward developing effective screening tests and better treatments. That means smokers, ex-smokers and others at increased risk of getting lung cancer will continue to face much lower odds of survival than many other common forms of cancer.
“If everybody stopped smoking tomorrow, there would still be millions of peo ple at increased risk of developing lung cancer for the next 10 to 20 years,” said Dr. Marshall Anderson, director of University of Cincinnati's department of environmental health. “But lung cancer doesn't get as much funding because there's no political advocacy for it.”
Not only is lung cancer among the most common types of cancer in America, victims face far worse odds of survival than other leading forms.
For breast cancer, the overall five-year survival rate is 85 percent. That figure includes a 97 percent chance of survival for those who get treated for localized tumors and a 22 percent chance of survival if tumors have spread to other parts of the body.
The high overall survival rate indicates that mammography, a widely used screening test for breast cancer, really makes a difference. The medical system is catching the vast majority of women with breast cancer in the earliest stages of disease, which allows surgery, chemotherapy and radiation to work.
Not so for lung cancer.
The overall five-year survival rate for lung cancer is 14 percent. That figure includes a 50 percent survival rate for early-stage disease and a 2 percent survival rate for those with advanced disease at the time of first diagnosis.
The survival data indicate that state-of-the-art care for breast cancer is generally better than for lung cancer, but breast cancer continues to get more research money.
So why doesn't lung cancer get the lion's share of cancer research dollars?
One reason is a blame-the-victim attitude that stems from the widespread public perception that most lung cancer cases are caused by smoking.
“There's a bias against people with lung cancer,” said Dr. John Winkelmann, director of hematology and oncology at UC. “People see it as a self-inflicted disease.”
The thinking goes: if people choose to smoke, why should publc agencies like the NCI spend millions seeking a cure?
But when policy-makers insist that the “cure” for lung cancer is to avoid smoking, they come close to writing off the people who already have the disease, Dr. Winkelmann said. That includes people who never smoked or did the “right” thing by quitting years ago.
That includes people like Mrs. Groh.
Like an estimated 40 million ex-smokers in America, Mrs. Groh listened to the health police. She quit smoking 16 years ago.
When the 60-year-old Maineville resident started smoking nearly 40 years ago, there weren't any surgeon general warnings about the deadly risks of cigarettes.
“I was in college. Everybody was smoking,” she said. “You don't think about these things when you're young.”
By 1984, however, the warnings were clear enough. So, Mrs. Groh finally quit. But last summer, to her complete surprise, she got lung cancer anyway.
“It was a total shock. I was basically in very good health. I was walking two miles a day,” Mrs. Groh said. “But I had this cough that kept coming back.”
In one sense, Mrs. Groh is among the luckier lung cancer patients. Doctors spotted the disease early enough to perform surgery, which gives her the highest odds of long-term survival.
“Let me tell you, the treatment is not very nice,” Mrs. Groh said. “They cut my back open. They cut some of my ribs and they took out two-thirds of my lung. Then I had radiation. Then I had chemotherapy.”
Linda Haas, a 58-year-old West Chester resident who was diagnosed with lung cancer about a year ago, also said she was surprised to learn that other cancers get more research money than lung cancer.
“Who makes these decisions?” she said.
The American Cancer Society spends more money on six other types of cancer than it does for lung cancer.
“Part of the reason for (not focusing heavily on lung cancer) is that we know the cause: smoking. Our focus has been to put more effort into prevention,” said Dawn Willis, scientific program director for ACS.
But preventing lung cancer by giving up smoking isn't so simple. Many smokers try and fail to quit. Although some states claim success at reducing youth smoking, in Ohio and many other states, teen smoking rates are going up.
How hard is it to quit? Despite her disease, two rounds of chemotherapy and her doctor's advice, Mrs. Haas still smokes.
“I've smoked since I was 15 years old. I've known for a long time that it was bad for me. But it's a hard habit to break,” Mrs. Haas said.
Another reason for the lack of lung cancer spending is that researchers themselves aren't pushing hard for the money.
“What we spend depends on the kinds of applications we get,” Ms. Willis said. “We don't set aside specific amounts of money for specific types of cancer. We depend on the researchers out there on the front lines, who know what's possible to do, to come up with ideas.”
Funding agencies can and do influence research efforts. From time to time, the cancer society sets aside 10 percent of its research budget to encourage work in under-studied areas.
Last year, it sought proposals for cancers that affect the poor and under-served, which indirectly includes lung cancer. A few years ago, it called for more study of the psycho-social aspects of cancer.
However, the cancer society has never used the 10 percent program to focus directly on lung cancer, Ms. Willis said.
At the National Cancer Institute, AIDS research gets more money than lung cancer.
AIDS killed 17,171 Americans in 1998, a fraction of the deaths caused by lung cancer. On top of that, death rates from AIDS have dropped sharply in recent years with the use of the multidrug “cocktails.”
AIDS does have a cancer connection, said NCI spokeswoman Caroline McNeil. As the HIV virus that causes AIDS wipes out the immune system, victims are more likely to develop certain kinds of cancer, such as Kaposi's sarcoma.
While Kaposi's sarcoma may be a relatively rare form of cancer, the effort is worthwhile because understanding the connections between viruses, the immune system and cancer has opened lines of research that could benefit many types of disease, Ms. McNeil said.
Meanwhile, the devastation AIDS has brought to Africa creates a sense of urgency that overshadows the American statistics, she said. By its very nature, a sexually transmitted disease appears to be a bigger public health threat than one caused by smoking.
Even though the money doesn't match the impact of the disease, lung cancer research is going on.
UC researchers are leading a multicenter effort to comb through data from thousands of lung cancer patients to search for families with high rates of lung cancer. The goal is to find genetic links that may help explain why some smokers get lung cancer but others don't, Dr. Anderson said.
The most immediate needs, however, are to develop more effective ways to help people quit smoking and to develop a good early detection test for lung cancer.
“There's no mystery about why the death rate from lung cancer is so high. It's because the early detection rate is so low,” Dr. Anderson said.
Unlike mammograms for breast cancer, PSA tests for prostate cancer, and pap smears for cervical cancer, there is no widespread screening test for lung cancer. At least, not yet.
Multi-slice helical CT scanners — often called “fast” CT scanners — are good enough to get high-resolution pictures of the lung even as a patient breathes. The technology allows doctors to detect lung trouble long before it could be spotted with a standard chest X-ray.
“Helical CT has a lot of promise,” Dr. Anderson said.
The machines exist. Greater Cincinnati has at least three in use already.
The problem with using them for mass screening is mostly about cost. At current rates, a full chest CT scan can cost about $400, far more than the $65 fee many hospitals charge to do a mammogram.
Will private insurers pick up the tab? Will taxpayers? What about the money from the tobacco settlements with the states?
In Japan, smokers can buy into a private organization that covers twice-a-year lung cancer testing. Recently, members have started getting CT scans instead of traditional chest X-rays.
Maybe something like that could work in America, Dr. Anderson said.
“A major effort on screening for lung cancer could have an effect like mammograms had for breast cancer,” he said.
Reds may already have won - at gate
Team comes first in Lindner era
Clinging to a glimmer of hope
Legislators told: Fix farm laws
Lung cancer lags as priority
Ohio likely battlefield for presidential race
Public schools show off their results
PBS encourages kids to read Between the Lions
98 degrees helps make the band
He's a high priest of technology
Queen City's moments to shine reflected in book
Accused robber now under indictment
Builder wants Dayton to get a bigger share
Cards, letters ease Bob Braun's retirement
City tries again to get homes water
Covington principals reassigned
Covington schools head praised for initiatives
Festival organizers meet to avoid another Mardi Gras
Four communities get $50,000 grants
GET TO IT
Joseph Kowalewski, scientist, college dean, dies at 100
Lawsuit last straw for winless team
Lobbyists' side jobs prompting questions
Love of game built diamond
Mason backs tax abatement deck,20,1 Mitsubishi may expand
Pianist makes familiar tunes fresh
Protest criticizes health system
'Smallest chapel' was almost lost
Memories of the local report from Bombeck
Aiken for some help
Commandments bill facing fight
Thou shalt not expect miracle from Assembly
A life from which to take inspiration
![[photo]](/editions/2000/04/02/CANCER120x160.jpg)