Celebrities, new study put spotlight on lung cancer

Washington -- Just as more attention has focused on lung cancer after the death of ABC anchorman Peter Jennings and the diagnosis of actor Christopher Reeve's widow, the National Cancer Institute has released a new research plan to fight the disease.

The plan, released on Aug. 12, hopes to reduce lung cancer rates by 2015. It focuses on:

• Improving smoking cessation rates via new therapies for nicotine addiction and the exploration of the genetics of nicotine addiction and the gene/environment interactions of nicotine dependence.
• Further early detection via proteomic and gene expression technologies and by using tissues from lung cancer cases diagnosed in a separate cancer trial to identify biomarkers.
• Drug development and responses to therapy that will include studying early and pre-cancer microenvironments and focusing on the effects of inflammation, infection and injury on the development of lung cancer.

Several trials are also under way to determine the viability of CT screenings for lung cancer, although the enterprise is controversial.

Studies have shown that although screening can reveal cancer at its earliest and most treatable stage, many benign conditions also are discovered that can prompt unnecessary and costly surgery.

A National Cancer Institute-affiliated cancer center at the University of Nebraska in Omaha, is embarking this fall on a five-year, statewide effort to examine CT scans' screening potential. Current and former smokers who meet the study's qualifications will be given free, annual CT scans.

The Nebraska Early Detection and Informatic Technology study is modeled on an effort under way at Cornell University in New York. That study, international in scope, involves CT scans of more that 30,000 current or former smokers. The researchers there have found that 80% of the lung cancers they've found have been in the earliest stages.

"If our effort succeeds, we could help shape lung cancer screening programs in other states and give new hope to people at risk for lung cancer," said Ken Cowan, MD, PhD, director of the Eppley Cancer Center at the University of Nebraska Medical Center.

A celebrity spotlight

Meanwhile, antismoking advocates are advising physicians to seize the moment and counsel their patients about the need to quit smoking and to clear the air of secondhand smoke.

News coverage of the Jennings and Reeve cases prompted a flood of calls to smoking cessation programs, the American Cancer Society said, and many smokers, or those who have experienced secondhand smoke, are likely to turn to physicians as well.

"These high-profile cases have made millions of Americans keenly aware of lung cancer's continuing toll," noted Stephen F. Sener, MD, national volunteer president of the American Cancer Society.

Each year, 160,000 people in the United States die from lung cancer, making it the No. 1 cause of cancer deaths in the country. The primary cause of lung cancer is tobacco smoke.

"Everyone who comes in wants to know if their chest x-ray shows any sign of lung cancer," said Heather Krumnacher, a nurse practitioner who runs the University of North Carolina at Chapel Hill's smoking cessation clinic. "Even if they are 25 years old and have never smoked, they want to make sure their chest x-ray is normal."

The main message for physicians to deliver to patients is, 'Quit as early as possible,' " said AMA Trustee Ron Davis, MD. The benefits of quitting can occur very quickly, especially for heart disease, he noted, although cancer risk decreases more slowly.

Jennings had quit smoking 20 years before his Aug. 7 death at age 67. He allowed that he had resumed smoking after the Sept. 11, 2001, terrorist strikes, though he had quit once again.

"People who have smoked, regardless of how long its been since they quit, still have a greater risk of lung cancer than someone who has never smoked," said Sharon I.S. Rounds, MD, immediate past president of the American Thoracic Society and professor of medicine at Brown University in Providence, R.I.

Dana Reeve, though, is among the 15% of women diagnosed with lung cancer who have never smoked. Her age of 44 places her well below the average age at diagnosis, which is 70.

Although rates of the disease have been declining among men for many years, women's rates, until very recently, had increased. The Society for Women's Health Research, a Washington, D.C.-based advocacy group, released a poll in June showing that breast cancer is still the disease that women fear the most despite the fact that lung cancer is more lethal.

In addition, "Nonsmoking women are more likely than nonsmoking men to develop lung cancer," said Sherry Marts, PhD, vice president of scientific affairs for the society. Past studies have shown that genetics could play a role in that difference, such as the greater presence in women of the gastrin-releasing peptide receptor, a genetic element known to play a role in the promotion of lung cancer.