Advocacy groups unite to make lung cancer in women a top priority

Women's health and lung cancer advocacy groups, led by the Society for Women's Health Research, vowed today to make lung cancer education and advocacy, especially among women, a top priority for their organizations in 2006 and beyond.

The roundtable meeting took place at the National Press Club, where health experts and advocacy leaders discussed sex-based research advances in lung cancer and the challenges in elevating public dialogue about the deadly disease. Lung cancer is the number one cancer killer of women and women are approximately 1.5 times more likely to develop lung cancer than men.

"A growing number of women, including non-smokers, are diagnosed with lung cancer each year," said Phyllis Greenberger, president and CEO of the Society for Women's Health Research. "We need to improve women's awareness of this disease and we need more research to understand the impact of sex and gender on the development and treatment of lung cancer. The federal government can play an important role in this process by increasing funding for research and education targeted at the underserved population of women."

Lung cancer claims the lives of more American women and men than the three most common cancers combined -- colon, breast, and prostate -- yet it receives a disproportionately low amount of media attention and government research funding. Approximately 350,000 people in the United States have lung cancer, and an estimated 173,000 were diagnosed in 2005. Non-small cell lung cancer is the most common form of lung cancer, accounting for approximately 87 percent of cases. While lung cancer incidence and mortality have been declining among men, there has been an alarming four-fold increase in lung cancer in women over the last 30 years.

Female smokers appear to be two to three times as susceptible to lung cancer as male smokers. Biological differences between the sexes may partially explain why women are more vulnerable to the cancer-causing effects of tobacco and other lung carcinogens. For example, the cells and DNA in women's lungs may be more easily damaged by tobacco smoke.

At the meeting, advocacy group representatives listened to presentations by top cancer researchers detailing the rising risks of lung cancer among women as well as inroads that have been made in sex-based research. Roundtable discussion prompted the groups to make lung cancer awareness in women a top national health priority, including a drive to urge the government to increase funding for sex-based lung cancer research.

Among the advocacy groups joining the Society for Women's Health Research to talk about ways to increase awareness of sex differences in lung cancer risk and treatment approaches were the American Society for Clinical Oncology, CancerCare, Intercultural Cancer Council, Joan's Legacy, Lung Cancer Alliance, LUNGevity, National Women's Health Resource Center, Women Against Lung Cancer, and the Women's Health Policy and Advocacy Program at Brigham and Women's Hospital.

Individuals participating in the Roundtable committed to working together around the following lung cancer advocacy needs:

• Greater attention by the public, policy makers, and researchers in order to reduce lung cancer risks and rates of occurrence, improve diagnosis, and expand treatment options through research -- particularly for women of all cultures, races, ethnicities, and socioeconomic strata.
• Significant increases in public and private funding to support sex- and gender-based research and education.
• Health care provider education to reduce nihilism, pessimism, and stigma in the treatment of lung cancer patients.

A major goal is to significantly increase survivorship and reduce death from lung cancer by 2015.

Sex-Based Differences in Lung Cancer

Between 85 and 90 percent of men and women diagnosed with lung cancer are current or former tobacco users. Since tobacco smoke is the leading risk factor for developing lung cancer, it is important to understand how the various components of tobacco smoke, including nicotine and many carcinogens, are metabolized or chemically modified in the body in ways that contributed to lung cancer development.

The reproductive hormone estrogen may increase women's susceptibility to developing lung cancer, but its exact role in this process is currently unknown. Estrogen binds to estrogen receptors in many tissues of the body, including lung tissue, which results in production of proteins involved in normal tissue growth. It has been postulated that the estrogenic environment in women and the differential expression of various forms of estrogen receptors in the lung tissue of women and men may contribute to sex differences in lung cancer susceptibility. Through the actions of these various forms of the estrogen receptor, estrogen may influence lung tumor growth in women by causing the synthesis of tumor-promoting proteins.

Also, estrogen may act directly on the DNA in lung cells to disrupt its normal function, resulting in uncontrolled growth of lung tissue. Some studies indicate that women who take menopausal hormone therapy have an increased risk for lung cancer.

"There is some exciting, emerging evidence of the role of estrogen in measuring the risk of and treating lung cancer," said Joan H. Schiller, M.D., University of Wisconsin Comprehensive Cancer Center, and a presenter at the Advocacy Roundtable. "We are optimistic that this breakthrough science will translate into targeted lung cancer treatments for women and we can give this patient group the medical attention they need." In addition to researching and treating lung cancer, Schiller is president of the board of directors for the advocacy group Women Against Lung Cancer.

Schiller is currently researching a novel approach to targeting lung cancer in women that relies on a chemotherapy agent that exploits the presence of estrogen in women and its effect on the metabolism of proteins in the cancer cell. Schiller is one of a team of investigators directing the international trial to evaluate the efficacy of a novel chemotherapy agent that appears to be more effective in the presence of estrogen-regulated proteins.

Research suggests that estrogen may facilitate lung cancer growth and metastasis, making the disease more aggressive in pre-menopausal women. However, the same estrogen-induced proteins that promote lung cancer may also facilitate delivery of a highly active therapeutic agent to tumor tissue, thus converting a negative risk factor -- higher estrogen levels -- into one that may benefit the patient.