Q: Are there significant biological differences in how lung cancer manifests itself in men and women? Or in how it is treated in women compared to men?
A: We know that: 1) women are younger at the time of diagnosis of lung cancer than men; 2) the proportion of adenocarcinoma and bronchoalveolar carcinoma is higher in women than in men; and 3) women are less likely to have a smoking history.
Lung cancer presents in a similar way in men and women. A typical presentation for lung cancer would be the development of a chronic cough that does not go away with antibiotic treatment and rest. Sometimes symptoms of lung cancer include coughing up blood, chest pain and weight loss. Women tend to seek less medical treatment than men, so lung cancer may present at a more advanced stage in females than in males.
Lung cancer treatment is the same for men and women. Early stage disease is treated with surgery, while intermediate stage disease is treated with a combination of chemotherapy, radiation and surgery. Advanced lung cancers are usually treated with chemotherapy alone.
There are ongoing clinical trials in San Diego hospitals, including the UC San Diego Moores Cancer Center, to study better ways to treat and cure lung cancer. These studies provide patients with a way to potentially benefit from state-of-the-art drugs and technologies, and to help the fight against lung cancer. Within the last several years, for example, a major advance in the field of lung cancer treatment has been the identification of specific genetic mutations associated with lung cancers. These “molecular fingerprints” make each patient’s tumor unique. Drugs that target mutations in EGFR, ALK, and EML4-ALK are being used now to treat patients with lung cancer with good success. The discovery of these mutations and the design of drugs to combat tumors harboring these mutations is the result of clinical trials funded both by the National Institutes of Health and private agencies.
Q: Lung cancer is the leading cause of cancer death in the nation. It kills nearly twice as many women as breast cancer every year and three times as many men as prostate cancer. Yet, lung cancer receives measurably less research funding than either prostate or breast ($221 million in categorical funding from the National Institutes of Health in 2011 compared to $284 million for prostate and $715 million for breast). Why do you think that is?
A: Lung cancer has been tremendously underfunded compared to other types of cancer. This is because lung cancer has traditionally been considered a “smoker’s disease.” In other words, the patient is blamed for getting the disease.
With the awareness that lung cancer is increasing in women nonsmokers, it is imperative that funding is made available to study the biology of lung cancer and to design effective cures. The fact that lung cancer remains the number one cause of cancer death in both men and women in the United States speaks for itself.
During my lifetime, I have witnessed the dramatic decrease in deaths from many forms of cancer, particularly breast cancer. This has been due, in part, to grass-roots efforts of individuals who have been affected by breast cancer, either directly or by knowing someone with the disease. Awareness and advocacy leads to raising money for research, sharing a common goal to cure cancer, and a common voice to stimulate the National Institutes of Health to allocate funding for particular forms of lung cancer. As a physician and surgeon who treats patients with lung cancer, I strongly believe that more funding for prevention and research is needed to combat this deadly disease.
Finally, gender-based differences in lung cancer make it imperative that both men and women are included in clinical trials and that gender stratification is used. Better elucidation of female-male differences will suggest new avenues of research to benefit both men and women at risk for lung cancer.