When It Comes to Lung Cancer, Gender Plays a Role
Nov. 14, 2005 — -- For 52-year-old Corrine Lamb, a smoking habit that peaked at two packs a day ended several years ago, when one of her numerous attempts to quit finally succeeded. But she received a painful reminder of her past behavior just a few weeks ago, when doctors informed her she had advanced lung cancer.
Lamb is one of 80,000 women who will be diagnosed this year with lung cancer, according to the American Cancer Society. For her, it's still too early to fully come to terms with the disease.
"I think once the biopsy was done and then you're told, there's no good way to tell someone," Lamb said. "It's still very hard for me, you know, to believe that this is happening."
The diagnosis came about almost by accident for Lamb, who did not have any obvious symptoms and had visited the doctor for what she thought was an allergic reaction. A chest X-ray and several tests later, she learned the shocking news.
"I think the hardest part is not so much receiving the information that you have this disease, it's telling your family and friends," Lamb said. "That's the most difficult part."
As smoking rates among women increased over the years, so did their lung cancer rates. The death rates among women attributed to lung cancer jumped 600 percent since 1950. With these increases, researchers have been noticing a difference in the way lung cancer affects women and men -- from diagnosis through treatment.
Women are more likely to get a certain type of lung cancer -- adenocarcinoma -- than men. They are most likely to get the disease at an earlier age and are more likely to have had less tobacco exposure before its onset. Women also respond better to some targeted treatments and generally live longer with the disease.
Dr. Kathy Albain, a top lung cancer expert with the Loyola University Health System who is treating Corrine Lamb, is one of the leaders of a new national study looking at these gender differences in lung cancer.
"It may be that as a gender, as a sex, women have overall different biology to their lung cancers than do men," Albain said. "So that's what we're working toward is understanding these biologies."
Albain and other researchers in the Southwest Oncology Group -- with funding from the National Cancer Institute -- hope their work can solve some of the gender puzzle.
They want to know why women metabolize carcinogens differently, why women's bodies are less able than men's to repair DNA damage that occurs with cancer, and why lung cancer may be helped along by certain hormones, particularly estrogen.
"It can stimulate cells in the lung that are perhaps destined to become lung cancer and haven't quite made that final commitment," Albain said. "The estrogen can come along and make those cells grow and develop into lung cancer."
Another trend researchers are examining is gender differences among those lung cancer patients who have never smoked.
Twenty percent of female lung cancer patients never smoked, while among men the number is only 10 percent. Exposure to substances like radon and other environmental toxins are believed to play a role, and researchers want to learn more about how gender factors into the equation.
Karen Parles would like to know the answer, too. A 46-year-old wife and mother of two, Parles never smoked tobacco and was diagnosed with advanced lung cancer in 1998. She had gone to the doctor with a persistent cough and was put on antibiotics when doctors thought it was pneumonia. Weeks later, a follow up X-ray and CT scan found cancer throughout one lung.
"I've never smoked and I've never been exposed to secondhand smoke," Parles said. "None of my doctors know why I have it. And I really don't spend much time thinking about it. I just got lung cancer."
Parles was initially told she had only six to nine months to live. Trying to buy herself some time, she had experimental surgery to remove the lung and some of her chest wall. That, along with aggressive treatments and chemotherapy two out of every three weeks left Parles outliving her doctors' predictions.
After her surgery, Parles was "cancer-free" for a period of four-and-a-half years. But late in 2002, doctors found the cancer had returned -- and this time had also spread to her bones and her liver. Today, Parles maintains a positive attitude but acknowledges that the prognosis is not reassuring.
"We know with my recurrence, I'm going to die of lung cancer," Parles says. "But right now, I can say there are treatments available. I am responding to treatment. I'm not going to die tomorrow. I've got lots of things to do, reasons to live and so you take each day as it comes."
Parles launched a Web site, www.lungcanceronline.org, to help other people with the disease access information. She finds great support in her husband and two teenage children, who she says were first on her mind as a mother getting a terminal illness.
"All you do is think of your children," Parles said. "To think you weren't going to see them grow up or they weren't going to have a mother is just devastating."
Dr. Mark Kris of the Memorial Sloan-Kettering Cancer Center says that as more is learned about the gender differences in lung cancer, better and more targeted treatments will benefit both women and men.
"If you saw that lung cancer was caused by a certain mutation which is more common in women, then you could target a drug against that mutation to a woman more directly than you would to a man," Kris says.
For Corrine Lamb, talking about her personal struggle with lung cancer publicly is one way she hopes to find some good in her diagnosis. She hopes she might be able to help others avoid the same fate she has met.
"If smoking caused this," Lamb says, "Then if I could just reach one person, I don't care. I'd like them to quit, but if they don't quit, I'd at least like them to be aware and cut down, so eventually they'll quit."
For more information on the national lung cancer study mentioned above, contact the coordinating center -- the Southwest Oncology Group -- at (210) 677-8808 and refer to study #S0424. Researchers hope to enroll 720 men and women nationwide with stages I, II and III non-small cell lung cancer, both smokers and non-smokers, up to four months after diagnosis.
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