Case 1 from the South Florida lung cancer files: Coconut Creek female, 44, pack-a-day smoker for 20 years. Small tumor found early, removed with surgery in August. Prognosis good.
Case 2: Pompano Beach female, 58, heavy smoker since teens. Advanced tumors found in lung and brain. Died in about 18 months.
Case 3: Boca Raton female, 76, two-pack-a-week smoker for 30 years, quit 20 years ago. Small tumor found early, removed with surgery in December. Prognosis good.
Three cases, many trends that inspire fear _ and hope.
First, a study this year confirms suspicions that women smokers are twice as likely to get cancer as men smokers, probably due to genetics and hormones. Puffing the same amount as a man, a woman tends to get cancer quicker. Even smoking just a little, they're more likely to succumb.
This at a time when smoking and lung cancer is falling in men but still rising in women.
Also, despite all the attention paid to breast and colorectal cancer, lung tumors remain the nation's biggest single cancer killer by far with poor survival rates.
But good news is emerging, too. The well-known CT scan (a quick X-ray scan of the body in the duration of one held breath) is proving to be very good at finding lung tumors when they are still small and curable, although the jury is still out on whether it will prolong life.
New surgical methods and chemotherapy with milder side effects are starting to boost the odds for lung cancer patients. They now have a 35 to 40 percent chance of surviving one year, up from 20 to 25 percent five years ago.
For the future, geneticists are trying to mobilize the body's immune system to stomp out tumor cells when they first appear.
"The severe pessimism is starting to disappear," says Dr. Kasi Sridhar, a lung cancer researcher and specialist at the University of Miami. "The pendulum has swung back to treating patients with lung cancer instead of just accepting they are going to die."
Consider Betty Lazzeri (case 1).
A teacher's aide with a son of 21 and a daughter of 17, she had smoked maybe a pack a day of Salem menthols for most of two decades, a moderate amount by tobacco standards.
"I had this cough that lasted for weeks. It was a hard cough. I had a sore throat sometimes, too. After a while, I started coughing up blood," Lazzeri says. "Then it was a lot more blood."
An X-ray last summer showed something but was inconclusive. Lazzeri tried to keep the C-word out of her mind. Biopsies and finally a CT scan pretty much confirmed it.
"I didn't really want to know too much, you know what I mean?" she says. "I didn't think it would be cancer. I was only 44."
But they had spotted the tumor while still only 0.5 cm, the size of a pencil eraser. It had not spread to the lymph nodes.
Lazzeri agreed to a relatively new surgical method. Doctors removed one-sixth of her lung through a 3-inch incision rather than the standard front-to-back cut that pierces the chest and back muscles.
Instead of being in the hospital one to two weeks in great pain, she was home in four days and back at school in two weeks. Her surgeon says she is at low risk for a relapse.
"We caught it early in her case," says Dr. Dimitri Pyrros of Margate, Fla. "She was lucky all the way around."
Lucky is not a word that comes up often in lung cancer.
More than 170,000 new cases arose last year (13,000 in Florida), almost 90 percent attributed to smoking. Lung cancer killed about 160,000 people (12,000 in Florida).
Three-fourths of cancer patients will survive at least five years if the tumor is caught at the earliest stage, almost half if it's caught before growing beyond its local area.
But only one in seven are detected that early. Most lung cancers attack more aggressively and faster than other cancers. And unlike others, symptoms often do not appear until the lung tumor is large and sometimes not even until it has spread to other parts of the body.
By then, the news is usually grim. Overall, only 14 percent of lung patients make it for five years, down at the bottom of the survival list along with liver, esophageal and pancreatic cancers, the National Cancer Institute says.
By comparison, the five-year survival rate for breast cancer is 85 percent, prostate cancer 93 percent and skin cancer 88 percent.
Terry Stowell lasted about 18 months.
"The last year of her life was terrible," says Ginny Ballard, who worked with Stowell as surgical nurses at North Broward Medical Center in Pompano Beach. "She wasted away."
Stowell (case 2) had smoked heavily her whole life. She knew the risks. She joked with her friends that she would never die of lung cancer, she would die of a brain tumor. Sure enough, by the time she was diagnosed, her cancer had spread to her brain.
"She probably got nagged too much and just wasn't going to stop. The habit was too strong for her, I guess," Ballard says. "With this health-conscious society where everyone is jogging and running and working out, it seems odd that the number of lung cancers would be going up."
The continual anti-smoking messages of the past three decades finally are showing up in the numbers, but only in men. Their lung cancer rates peaked in 1988, and by 1998 had dropped by 19 percent. Their death rate fell by 11 percent.
Among women, however, smoking rates keep climbing, although they are still one-third lower than among men. Today, 22 million women, plus 1.5 million teenage girls, smoke, along with about 25 million males.
"It's a national tragedy," says Dr. Christine Berg, chief of lung and upper digestive cancer research at the NCI. "It's going to take a longer period of time, but we can hope that eventually we're going to go in the right direction."
Women play a dangerous game when they smoke because they are more susceptible to the carcinogens in it, research shows.
A January study finally answered why. Researchers tied the increased cancer risk for female smokers to a gene that is more active in women, and found that the hormone estrogen appears to accelerate tumors in the lung, just as it does in the breast.
Most women don't know of their increased risk.
"It's really sad when I go out for lunch here at the university cafeteria and here are all these young girls smoking," says Jill Siegfried, a lung specialist at the University of Pittsburgh who worked on the study.
Edith (case 3), a Boca Raton retiree of 77 who asked that her last name not be used, wonders if she fits that bill. She had smoked only two packs a week before quitting 20 years ago, but she developed a small tumor last year. A routine chest X-ray and CT scan found it very early."I was stunned," she says. "I thought you have to be a heavy smoker. I never had any symptoms. No breathing problems, no coughing, no blood."
Betty Lazzeri heeded her wake-up call. Within days of her diagnosis, she and her sister-in-law quit cold turkey.
"I want to see my kids get married, you know?" Lazzeri says.
She smoked her last cigarette July 9, 1999 at a doughnut shop on Federal Highway in Pompano Beach. The two stopped for a cup of coffee on the way to a hypnosis session. Neither smoked since.
"When you see that someone who is part of your everyday life gets threatened, that could have easily been me," sister-in-law Barbara Lazzeri says. "It was a good motivator, to say the least."
Betty says she can resist: "I don't think a day goes by when I don't think about it. I know if I ever had another cigarette, I would start right back in again. I won't give in."
Clearly, quitting tobacco benefits.
An active smoker is about 16 times more likely to get lung cancer than a nonsmoker. Those who quit before age 50 see their cancer risk fall to only about twice normal after 15 years. Even people who quit at ages 60 to 64 are 10 percent less likely to die during the next 15 years than are smokers.
That doesn't even count the reduced risk of heart attack, emphysema and other cancers linked to smoking, the NCI's Berg says.
Despite all the quitting, lung cancer will remain the leading cause of cancer death for a decade or more.
"Even if everybody quit smoking today, there would still be (91) million ex-smokers," Berg says. "Better screening with the CT will help. If it works, it will make a dent by catching it early. But preventing cancer is like planting a tree. It will take 25 years for the tree to grow."
The CT scan holds strong promise.
The key study came out in July 1999. It said the familiar CT found three times more tiny lung tumors and pre-cancerous nodules than the usual chest X-ray.
Hospitals leaped to promote their CT scanners, at about $300 each, as an early-detection method for smokers.
"This is the best news nobody knows about," says Pyrros, the surgeon. "Patients need to know there is a better chance of finding it early."
But doubt remains. Many lung spots detected by the CT turn out to be harmless nodules or scars found in 20 to 40 percent of smokers. To learn that, however, some patients will undergo needless tests and biopsies with small but real risk of injury or death.
The NCI plans a large-scale study to see if CT really works for early diagnosis. Until then, Berg says, it only should be used to diagnose people at high risk of lung cancer or to pin down the severity of a known tumor.
"I let my patients decide if they have one. They are the ones at risk," says Sridhar, the Miami lung specialist.
(c) 2000, Sun-Sentinel, South Florida.
