Lung Cancer

Lung cancer is hard to detect and difficult to treat. About 178,000 new cases will be diagnosed in 1997, and there will be an estimated 160,000 deaths. Lung cancer is the largest single cause of cancer deaths in the United States. It is responsible for one of every four cancer deaths in this country. Five-year survival rates have remained stubbornly low 12 percent in 1973, 13 percent in 1992, and 14 percent today.

One promising development in lung cancer is the drop in the number of new cases diagnosed each year in men. With sharp declines in male smoking, the number of new cases each year has fallen steadily since 1984. Lung cancer deaths among men dropped nearly 7 percent between 1991 and 1995. Among women, however, the number of new cases is still going up each year. With the rising number of women who smoke, lung cancer surpassed breast cancer in 1987 as the leading cause of cancer deaths among women. In women, the death rate increased 6.4 percent between 1991 and 1995.

Advances Risk. Smoking education and cessation programs have helped cut tobacco use, the major cause of lung cancer. About 37 percent of adults in the United States smoked cigarettes in 1971, compared with about 25 percent in 1994.

Combined Therapies. Combining chemotherapy with radiation therapy has shrunk tumors and added months to survival time in some patients. A study of selected patients with locally advanced non-small-cell lung cancer has shown that, compared with radiation therapy alone, chemotherapy and radiation therapy together have nearly tripled the number of people still alive five years after diagnosis. This diagnosis accounts for one-third of all lung cancers, so the gain in survival affects thousands of people.

Novel Drugs. New chemotherapy drugs, such as vinorelbine (Navelbine), paclitaxel (Taxol), docetaxel (Taxotere), gemcitabine, and topotecan, have produced some tumor shrinkage in early studies, although most of these drugs are still under investigation. Paclitaxel combined with vinorelbine, now approved by the Food and Drug Administration (FDA), has improved survival rates.

Quality of Life. Researchers are testing a way to deliver radiation treatment directly to tumors through a tube in the lung. Known as endobronchial brachytherapy, this method avoids some of the common side effects of standard radiation therapy, such as damage to the esophagus, skin, and other tissues. Drugs thatmake chemotherapy more tolerable also contributed to improved quality of life.

Opportunities Smoking. Education strategies now aim at cutting tobacco use further and stopping the rise in smoking among young people and women.

Diet. Researchers are working to find substances in fruits and vegetables that might lower the risk of lung cancer in former smokers.

Early Detection. Early detection remains a major challenge. Most lung cancers are still caught at a late stage, when treatment can accomplish little. One early detection method now under study involves genetic and molecular changes in cells, such as microsatellite alterations (changes in DNA), that may serve as early markers of lung cancer.

Genetics. Studies of the mutated (altered) p53 gene and others found to play a role in lung cancer may lead to new ways of diagnosing and treating the disease.

Combined Therapies. Many studies are seeking the best combinations and timing of chemotherapy, surgery, and radiation for different types and stages of lung cancer.

Radiation Therapy. New ways to deliver radiation therapy promise to increase response rates and improve quality of life for lung cancer patients.

Additional Reading Cancer of the Lung: Research Report. National Cancer Institute, NIH Publication No. 93-526, 1993.

Feld, R. "Chemotherapy as Adjuvant Therapy for Completely Resected Non-Small-Cell Lung Cancer: Have We Made Progress?" Journal of Clinical Oncology, 1996;14(4):1045-1047. Statistics are from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database (January 1997) and from the American Cancer Society's Cancer Facts and Figures1997, which contains estimates based on SEER data.

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