Deadliest Cancer Getting Smaller Chunk of Research Dollars

Lung cancer spending should focus more on detection and treatment, advocates say

It has been reported through careful observation that-

• Lung cancer is the most deadly form of cancer in the United States, killing about 157,300 people every year -- more than colon, breast and prostate cancer combined, according to the U.S. National Institutes of Health.
• It is also the nation's second leading cause of death, second only to heart disease.

And yet lung cancer attracts fewer federal research dollars per death than the other leading forms of cancer demise. Doctors have yet to find a reliable method for screening for lung cancer. And new treatments for lung cancer roll out at a snail's pace compared with therapies for other cancers.

So why does the top cancer killer attract so little attention?

Largely because people are perceived to have done this to themselves, garnering little public sympathy, said Kay Cofrancesco, director of advocacy relations for the Lung Cancer Alliance, a national nonprofit group dedicated to lung cancer support and advocacy.

About 90 percent of men and 80 percent of women who die from lung cancer are current or former smokers, according to NIH.

"In demonizing the tobacco companies, we've then demonized the smoker," Cofrancesco said. "So there is that blame-the-victim mentality when it comes to lung cancer patients."

Yet some advances are being made. Clinical trials are being conducted on one potential screening tool for lung cancer, she said. Targeted therapies are being developed based on the genetics of lung cancer.

But clearly more can be done, experts say. Survival rates for lung cancer are dismal compared with other cancers, largely because lung cancer is most often not detected until it has metastasized.

"Some lung cancers have a tendency to spread widely throughout the body," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. "By the time they have symptoms, the cancer has spread."

Because smoking is so closely linked to lung cancer, most money aimed at prevention has gone into programs to promote smoking cessation, Cofrancesco said.

These programs have not made a lot of headway. Between 1998 and 2008, the percentage of U.S. residents who currently smoked declined just 3.5 percent, from 24.1 to 20.6 percent, according to the U.S. Centers for Disease Control and Prevention. Even as some people quit, perhaps encouraged by strict smoke-free laws and public anti-smoking campaigns, others take up the habit.

Quitting smoking does provide numerous health benefits -- improved lung function and decreased blood pressure among them -- but former smokers will always have an elevated risk for developing lung cancer. Three of every five new lung cancer cases are reported in former smokers, whereas one of five cases comes from current smokers, according to the Lung Cancer Alliance.

"When you quit smoking, unfortunately, your lungs never go back to normal," Cofrancesco said. "You're still at elevated risk for lung cancer and other diseases as well. What's so alarming is there are 45 million current smokers and about 46 million former smokers."

The alliance has begun to lobby lawmakers and politicians to route more research dollars toward detection and treatment of the disease and away from the near-total emphasis on prevention that has been the approach to date, she said.

There's a lot of ground to be made up. Breast cancer research received $28,660 in federal funding for every breast cancer death in 2010, according to the Lung Cancer Alliance, and prostate cancer research received $13,700 per death. Lung cancer research received not quite $1,400 per death.

Research so far has made little headway in terms of detection of lung cancer, though better detection methods have been found for breast, colon and other forms of cancer. Studies have ruled out chest X-rays as a way to screen for lung cancer, Lichtenfeld said.

However, clinical trials are underway to determine whether regular PET scans could serve as a means of early lung cancer detection, Cofrancesco said. Doctors also are researching blood and sputum tests.

The Lung Cancer Alliance suggests that current and former smokers talk with their doctors about the possibility of a PET scan to rule out lung cancer, though such scans have not been adopted as a screening method.

"We recommend you talk with your physician about the risks and benefits of receiving a CT scan to screen for lung cancer," Cofrancesco said. "What can help today is that CT scan, when done right."

The leading forms of treatment for lung cancer currently are surgery, radiation therapy and chemotherapy, but researchers are making headway in developing targeted therapies that interfere with cancer's ability to grow and spread. "There's no question they've made a difference for a minority of people with lung cancer, but we've still got a ways to go," Lichtenfeld said.

Along with better targeted therapies, doctors are researching ways to figure out which medications would work best for which patients. "We are discovering genetic markers that can be used to determine whether a person would respond well to targeted therapy," he said.

At this time, though, doctors believe that a combination of improved detection and continued emphasis on smoking cessation is the best way to prevent lung cancer deaths.

"Unfortunately, lung cancer is a complex disease," Lichtenfeld said. "I don't expect we're going to have a breakthrough in treatment."