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Lung Cancer is Different in Women Than Men; New Treatments are on the Horizon

In fall 2004, Catherine Bernas, 41, of Warrenville, Ill., saw her physician for a bad cough that would not go away. She never smoked in her life, and, in fact, she always went out of her way to avoid second-hand smoke, so she was shocked to hear she had stage IV lung cancer. It is the most advanced stage of lung cancer – the stage at which the cancer cannot be removed by surgery and has already spread beyond the lungs.

She was numb for days after hearing the news, but gained a sense of peace from her strong faith in God. Since then, she has been through surgery to drain her lungs, many doses of chemotherapy and numerous scans to monitor her progress, but she is feeling well and remains the linchpin in the busy lives of her husband and four children ages 5, 9, 12 and 14.

Ms. Bernas epitomizes the progress that has been made in lung cancer treatment, according to Kathy Albain, MD, her physician at Loyola University Health System (LUHS). “We’ve made major advances in prolonging life and even curing some patients with lung cancer,” said Dr. Albain, who is director of the thoracic oncology program at Loyola’s Cardinal Bernardin Cancer Center. “In the past 20 years, we have doubled the cure rates for stage II lung cancer and nearly tripled the cure rates for stage III,” she added. “For patients with stage IV disease, extending life beyond two years is not uncommon, whereas in the past, all patients diagnosed as stage IV died within one year,” Dr. Albain stated.

The pulmonologist who made Ms. Bernas’ original diagnosis at her local hospital gave her little hope. However, she found a “realistic but hopeful” attitude with Dr. Albain at LUHS. She also appreciated that, at LUHS, a team of specialists – thoracic surgeon, medical oncologist, radiation oncologist and others – consulted together about her case and gave her feedback in one day. “I felt I got personal care from the very beginning,” said Ms. Bernas.

Lung cancer is less common in nonsmokers, but this group does account for a sizeable percentage of cases. Approximately 10 percent of men and 20 percent of women diagnosed with lung cancer are nonsmokers, and lung cancer patients have other differences that appear to be related to the patient’s sex.

Dr. Albain is the national co-chairperson of a multi-center study sponsored by the National Cancer Institute to determine why lung cancer is different in women versus men. The study will attempt to explain why female smokers get lung cancer at earlier ages and often at lower doses of smoking, why women are more likely to be diagnosed with certain types of lung cancer, and why women live longer after lung cancer diagnoses. It also will attempt to uncover why nonsmoking men and women get lung cancer.

A greater understanding about the differences in lung cancer between genders will lead to more targeted treatments. For example, when one specific drug was tested in men and women with lung cancer, it was found to be more effective in women. “The drug needs a certain enzyme to make it active, and this enzyme is revved up by estrogen,” Dr. Albain explained. She is the principal investigator of a nationwide clinical trial of the drug, which aims to prove that the interaction with estrogen – a female sex hormone – is what makes it more effective in women. It is the first-ever lung cancer trial that exclusively studies women.

Every new development in lung cancer research is good news for Ms. Bernas, who greets each day with a positive attitude. In addition to biking, walking, shuttling her kids to their team sports, and volunteering at their school, in her spare moments she updates her Web site about her family and disease. She wrote in April: “Who would have thought a year and a half after being diagnosed I would still be feeling so good?”

For more information about lung cancer treatment and research at LUHS, call (888) LUHS-888.