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EDITORIAL: Cancer on the run 

The American Cancer Society recently reported some good news: Cancer is still on the run.

Although men and women continue to get the disease in large numbers, the big change is found in cancer deaths. For men, death rates from cancer fell 21 percent between 1990 and 2006. Death rates for women fell 12.3 percent in that time. In all, some 767,000 deaths from cancer were avoided.

Now the sobering news: an estimated 569,490 people in the U.S. will die from cancer this year. . . .

There's at least one cause-and-effect that's plain as day and completely controlled by the individual. As smoking in the U.S. has plunged, so has the rate of lung cancer. Not smoking substantially reduces the chances that you will succumb to one of the greatest threats to public health. The national campaign against smoking has been a resounding success. Thousands of people walking around are living proof.

There are troubling signs, though, that we've hit a roadblock on this. About one in every five U.S. high school students smoke cigarettes, and that number has been stubbornly consistent, according to the Centers for Disease Control and Prevention.

Kids aren't getting the message that smoking can kill you. Anyone who has visited an outdoor mall recently can't help but notice how many teens light up. It's painful to watch. Less obvious, but on the rise, is the use of other tobacco products such as snuff, roll-your-own tobacco, small cigars and even hookahs. They're aggressively marketed. . . .

Almost half the states, though, have yet to ban smoking in food and drink establishments, and a few states still allow it in private workplaces and public spaces. Want to guess where cancer rates tend to be stubbornly high?

Lung cancer still accounts for more deaths than any other kind of cancer. The numbers are going in the right direction -- cancer is indeed on the run. But let's make sure the kids know the story.

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Study ties abnormal cells in blood to lung cancer 

A novel approach detects genetically abnormal cells in the blood of non-small cell lung cancer patients that match abnormalities found in tumor cells and increase in number with the severity of the disease, a research team led by scientists at The University of Texas MD Anderson Cancer Center report in the journal Clinical Cancer Research.

Lung cancer patients in the study also had many times the number of these circulating abnormal cells than study volunteers in a closely matched control group.

"We suspect additional research will show that these circulating abnormal cells are circulating non-small cell lung cancer cells," said study corresponding author Ruth Katz, M.D., professor in MD Anderson's Department of Pathology. "Blood tests for these circulating tumor cells could be used to diagnose lung cancer earlier, monitor response to therapy and detect residual disease in patients after treatment."

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Easing the Pain of Lung Cancer 

Several readers had questions for the Consults blog about the complications of lung cancer. Dr. Derek Raghavan of the Cleveland Clinic responds.

When Lung Cancer Spreads to the Bones

Q.

After surgical removal of three lobes for primary adenocarcinoma tumors since 2000, I recently underwent radiation therapy for metastasis of lung cancer to the spine . . .

When Lung Cancer Causes Bleeding in the Chest

Q.

What causes lung cancer patients to bleed into their chest?

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Stereotactic Body Radiation Therapy for Lung Cancer a Key Topic for Elekta Presenters at Annual ASTRO Conference 

The American Society for Radiation Oncology (ASTRO) has accepted four abstracts from users of Elekta Stereotactic Body Radiation Therapy (SBRT) technology on the use of SBRT to treat non-small cell lung cancer (NSCLC). The clinicians will present their findings during presentations at ASTRO's 52nd Annual Meeting (October 31 - November 4) at the San Diego Convention Center.

NSCLC, the most common form of lung cancer, arises from a number of causes, including active smoking, passive smoking (secondhand smoke), asbestos and radon exposure. Lung cancer is the leading cause of cancer death in men and women. Each year, primary carcinoma of the lungs affects 93,000 men and 80,000 women in the United States and 86 percent die within five years of diagnosis. The incidence of lung cancer peaks between the ages 55 and 65.(1)

"The research in which our Lung Cancer Consortium is engaged is completely consistent with ASTRO's theme this year: Gathering Evidence; Proving Value," says Joel Goldwein, M.D., Senior Vice President and Director of Medical Affairs for Elekta. "The researchers have made a number of very important discoveries, some of which I believe will be likely to change how SBRT is administered to this challenging group of patients. It doesn't get much more valuable than that."

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• Not Starting Means Never Having to Quit  

My husband's fate was sealed at age 11, when he smoked his first cigarette. As he put it, "I got hooked that very day." Although he tried repeatedly to quit, he rarely abstained from nicotine longer than a tortured week or two.

Finally, with the help of a hypnotist and nicotine gum, at age 61 he quit for good. But 50 years of smoking took its toll. Emphysema limited his stamina for a decade, and lung cancer killed him 15 years after he smoked his last cigarette.

That's the bad news. The good news is that he repeatedly told our sons, "Learn from my mistake -- if you never start, you'll never have to quit," and they never started. . . .

Still, the improved understanding of nicotine addiction, including evidence of a genetic influence, has offered new avenues for prevention and treatment. First and foremost, of course, is to keep youngsters from starting. . . .

Dr. Benowitz expects that New York's new $4.35-a-pack cigarette tax (by far the highest in the nation) will deter adolescent smoking by raising the full price to about $10. But more can be done through taxation, especially if tax dollars are directed toward tobacco control.

In The New England Journal of Medicine this month, Dr. Steven A. Schroeder and Kenneth E. Warner note that European tobacco taxes tend to be much higher; in Norway, for example, they exceed $11 a pack. The writers suggested extending smoke-free zones to vehicles in which children ride, apartments and condominiums, and public parks and beaches, as well as more public financing of cessation programs.

Nicotine's Hook

Nicotine provides a quick fix. . . .

Dr. Benowitz noted that women who smoke are more strongly influenced than men by "conditioned cues" and negative emotions. Women also metabolize nicotine more quickly, which can make them more dependent on nicotine and explain in part why it is more difficult for women to quit.

"If we understand the reasons different people smoke, we can provide specific behavioral skills to deal with them instead of smoking," he said. "Smoking cessation has to be individualized."

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My husband's fate was sealed at age 11, when he smoked his first cigarette.
NY Times "Personal Health" columnist Jane Brody gets personal about the effects of smoking on the smoker -- and his family.

Expert sees end to lung cancer epidemic  

An award-winning public health advocate says lung cancer will most likely become an uncommon disease in Australia by 2050.

Professor Simon Chapman says a ban on advertising, indoor smoking and health warnings on cigarette packets have contributed to a decline in the disease.

. . .

Professor Chapman says we could be seeing the beginning of the end of the lung cancer epidemic, thanks to government policy. . . .

He says although people are clearly still addicted to cigarettes, it is a far cry from the 1970s when people were smoking in offices.

"There was tobacco advertising everywhere, to be a smoker was to be a very different personality than you are today if you're a smoker," he said.

"I don't think too many smokers [today] enjoy being smokers."

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Annual Review of Advances in Lung Cancer Clinical Research: A Report for the Year 2009 

The use of positron emission tomography compared with conventional staging increases the detection of extrathoracic metastases and reduces the number futile thoracotomies in patients being evaluated for surgical resection. Long-term follow-up of one of the two adjuvant chemotherapy trials revealed a continued overall survival (OS) benefit to adjuvant chemotherapy. In locally advanced non-small cell lung cancer, a phase III trial of chemoradiotherapy alone and with surgical resection revealed no statistically significant difference in OS between the treatment arms. In advanced stage non-small cell lung cancer, a phase III trial compared gefitinib with carboplatin and paclitaxel in a clinically enriched patient population for epidermal growth factor receptor (EGFR) tyrosine kinase (TK) mutations; among patients with an EGFR TK mutation, patients in gefitinib arm compared with carboplatin and paclitaxel arm experienced a statistically significant superior response rate and progression-free survival, and among patients without EGFR TK mutation patients in the gefitinib arm compared with carboplatin and paclitaxel experienced a statistically significant inferior response rate and progression-free survival. A phase III trial of platinum-based therapy with and without cetuximab in the first-line setting revealed improved OS in the cetuximab arm. A phase III trial of maintenance pemetrexed compared with placebo in patients who had not progressed after initial platinum-based therapy revealed an improvement in OS of patients in the pemetrexed arm with nonsquamous histology. In limited-stage small cell lung cancer, a phase III trial compared standard and high-dose prophylactic cranial irradiation and revealed no significant difference in the rate of brain metastases between the two treatment arms.

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New method of tissue banking makes gene analysis more practical for lung cancer 

Analyzing the genes expressed by cancer cells allows for a better understanding of that patient's specific disease and in turn, a more personalized approach to treatment. But obtaining the RNA from a tumor in the lungs in order to conduct the genetic analysis is a challenging prospect. Currently, lung cancer researchers are limited to using RNA extracted from early-stage tumors removed during surgery. The small quantities of tissue extracted during routine diagnostic biopsies have not been useful to researchers, due to their small size and the variety of ways they have been processed.

Since oftentimes surgery is not an option in advanced lung cancer, genetic analysis of the tumor is critical, there is a need to obtain good quality RNA samples from tumor tissue taken via biopsy, no matter how the biopsy procedure is conducted.

In a study in the July edition of the Journal of Thoracic Oncology, Malcolm H. Lawson describes a process to successfully obtain and to store high quality RNA from lung tumor biopsies. Lawson and fellow researchers at the Cancer Research UK Cambridge Research Institute and Papworth Hospital, both in the United Kingdom, received consent from patients to take extra biopsies for research purposes during the diagnostic procedure. Biopsies were obtained using the three most frequently used techniques -- endobronchial biopsy forceps, transbronchial needle aspirate - or CT-guided needle biopsy. Acceptable RNA for gene expression analysis was extracted from 72 percent of lung cancer biopsies.

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Many Lung Cancer Patients Stopped Smoking Years Before Diagnosis 

Much of what people think they know about smoking and lung cancer might be wrong, according to findings presented here at the 11th International Lung Cancer Conference.

For example, many if not most patients with a history of smoking quit decades before. In a retrospective study of 626 people with lung cancer treated at a tertiary-care facility in Southern California, 482 (77%) had a history of smoking. Of those, only 71 patients (14.7%) were still smoking at the time of their diagnosis. Of the remaining 411 patients, 245 (60%) had not smoked for a mean of 18 years, 8 of whom had quit 51 to 60 years earlier. The other 166 (40%) had stopped smoking within 10 years of their diagnosis.

"Sixty percent of our cohort developed lung cancer despite doing the right thing by stopping smoking over 1 decade ago," according to the researchers.

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The cancer blame game 

The blame that society puts on lung cancer patients could seriously impede attention and research funding on the disease, a local expert says.

"It gets 3 per cent of the total research funding for all cancers, and yet it is the No. 1 killer," says Dr. James Gowing, a Flamborough doctor and cochair of the Cancer Advocacy Coalition of Canada (CACC).

A 16-country survey released last week by the Global Lung Cancer Coalition and the CACC suggests one in five Canadians feels less sympathy for lung cancer patients because the disease is linked to smoking.

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AUDIO: Expert sees end to lung cancer epidemic  

An award-winning public health advocate says lung cancer will most likely become an uncommon disease in Australia by 2050.

Professor Simon Chapman says a ban on advertising, indoor smoking and health warnings on cigarette packets have contributed to a decline in the disease.

Professor Chapman has published 16 books and hundreds of articles in peer reviewed journals.

He used to smoke himself but is now best known as an anti-smoking activist.

Professor Chapman says we could be seeing the beginning of the end of the lung cancer epidemic, thanks to government policy.

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Cutting Your Lung Cancer Risk  

Sara D. Davis for The New York Times Taylor Bell's lung cancer was diagnosed in 2007 when she was 22; she is among those featured in Patient Voices: Lung Cancer.

If you stop smoking, does your increased cancer risk eventually return to zero? Can eating carrots protect against lung cancer? Should a recovering cancer patient test for radon, and are there other risks to be aware of in the home? Is there an estrogen-lung cancer link? These are among the questions readers recently posed by readers of the Consults blog. Dr. Derek Raghavan, director of the Taussig Cancer Institute at the Cleveland Clinic, responds.

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Lung cancer group in Watford celebrates first birthday 

A lifeline for lung cancer patients has celebrated its first birthday.

Up to 30 people visit the Lung Cancer Support Group each month, where they are able to meet other sufferers and speak to specialist Macmillan nurses, at the Seventh Day Adventist Church, in St Albans Road, Garston.

The group also provides a chance for carers and relatives to meet other people in the same position.

At its monthly meeting last week, visitors celebrated the special anniversary with cake and relaxation therapy.

Alistair Lawrie, 66, a former Watford policeman, was diagnosed with lung cancer five-and-a-half years ago.

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Just a Cough, or Lung Cancer?  

Dr. Raghavan responds:

I think that people increasingly need to take an active involvement in their own health care and participate actively in the decision process. First, I do want to emphasize that most people who present with cough, or features suggesting a chest infection or pneumonia, actually do end up with the diagnosis of infection or pneumonia being correct. So the question is: when should we start to be suspicious about possible lung cancer?

In general terms, doctors become increasingly suspicious when a chest infection doesn't resolve relatively quickly with correct treatment -- antibiotics, respiratory therapy, etc. If a chest infection doesn't resolve within one to two weeks, I usually get a chest X-ray (or sometimes a CT scan of the chest) unless there is another obvious explanation, such as a lab test showing that the first choice of antibiotics didn't fit well with the antibiotic responsiveness profile.

If there is a family history of lung cancer, that will increase my level of vigilance.

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Study Finds People Living With Lung Cancer Are too Often Stigmatized Because of Link to Smoking 

Today, Lung Cancer Alliance (LCA) highlighted a study, carried out by Ipsos MORI on behalf of The Global Lung Cancer Coalition (GLCC). The study finds lung cancer patients are likely to suffer significant stigma due to the disease's link to smoking.

Over 16,000 people in 16 countries were asked questions about their attitudes surrounding lung cancer. The study found some evidence that sympathy levels were influenced by the smoking rates of each country. Generally people in countries with lower smoking rates had a greater tendency to admit that they felt less sympathetic to people with lung cancer compared with other types of cancer. . . .

"This study reinforces what the lung cancer community has felt for decades -- public perception of this disease is overwhelmingly negative," said Laurie Fenton Ambrose, LCA President & CEO. "We must do more to overcome this pervasive stigma and focus attention where it should be -- on research for early detection and treatment for lung cancer. Lung cancer patients deserve the same compassion and support given to those impacted by other diseases."

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