The cancer that the NCI forgot

BTW, Gwohann has never smoked.

Excerpt from http://lifesciencesfoundation.org/printer_magazine-bonnie_addario.html

Bonnie embarked on advanced studies in the biology, epidemiology, and politics of lung cancer. In conversation with other patients, she learned that the ‘standard of care’ is late-stage diagnosis, a dearth of treatment options, and poorly-coordinated medical services. She also learned that research on lung cancer is relatively neglected.

In 1971, President Richard Nixon declared war on cancer. He signed the National Cancer Act into law, funneled a storm surge of federal dollars toward cancer research, and empowered the National Cancer Institute [NCI] to administer the funds. The legislation became a source of hope for cancer patients and their families, but lung cancer became the disease that NCI forgot.

In the United States, lung cancer claims a life every three minutes. It takes twenty people per hour, 450 people per day. The disease kills more people than breast, prostate, colon, liver, skin, and kidney cancer combined, but funding for research on lung cancer lags behind all the rest. A mere 5% of the NCI’s research support budget is allotted to lung cancer projects.

In 2001, the NCI’s Lung Cancer Progress Review Group, a panel of thirty expert clinicians, scientists, industry representatives, and patient advocates, reported that funding for studies of lung cancer was “far below the levels that characterize other common malignancies and far out of proportion to its massive public health impact.” The lopsided distribution has not been rectified.

A comparison with breast cancer funding is telling. In 2008, lung cancer killed 161,840 Americans. NCI expenditures for lung cancer research amounted to $1,529 per lung cancer death. Breast cancer took 40,480 lives in 2008, but the NCI spent significantly more per breast cancer death: $14,145. Addario’s view of the situation is simple: “Funding should be distributed equitably.”

A review of priorities in lung cancer research uncovers further issues. Sixty-two percent of NCI funds are earmarked for studies on prevention, causes, survivorship, and outcomes. Only 38% are dedicated to early detection, diagnosis, and treatment. Addario questions the wisdom of the apportionment. Many lung cancer patients receive stage IV diagnoses: “You have lung cancer. We’ll put you on Carboplatin and Taxol. Your hair will fall out. You’ll get sick and throw up. Then you’ll die.” Seventy-five percent of lung cancer patients die within eight to ten months of diagnosis. 

 

Addario believes that NCI’s emphasis on prevention has to do with the fact that lung cancer is stigmatized as a “smoker’s disease.” Patients diagnosed with lung cancer are regularly asked if they smoked – it’s frequently the first thing they hear when someone learns of their condition. The question is an attempt to make sense of the world, to reduce the complexity of experience and discern order, but it’s simultaneously an attempt to assign blame. If lung cancer is the result of an individual’s decision to smoke, does it deserve as much attention as other common killers – breast cancer, prostate cancer, or colon cancer?

Bonnie wants to set the record straight: “The world still assumes, apparently, that only smokers get lung cancer. That’s not true.” Some individuals are genetically predisposed to the disease, and environmental factors – atmospheric pollutants such as radon or the fine particulate matter found in smog, for example – contribute to the formation of lung tumors. Eighty percent of those diagnosed with lung cancer quit smoking decades earlier or never smoked at all.

Addario objects to NCI’s funding priorities because studies of causation, prevention, and outcomes will not improve deficiencies in diagnosis and treatment – areas of pressing need that are not similarly deemphasized in, for example, breast cancer research. “The breast cancer movement has done a fabulous job,” Addario says. “The five-year survival rate for breast cancer is now above 90%. We want to achieve the same kind of results for lung cancer.” The five-year survival rate for lung cancer is 15.5%, and the figure hasn’t changed in 40 years. “That’s unacceptable,” Bonnie declares. “It can’t take another 40 years to make a difference. This needs to change!”

End of excerpt

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Finally, NCI's spending on lung cancer research has increased, but it is still not enough.  

Cancer Type	2010 Spending (in millions)	2011 Spending (in millions)	2012 Spending (in millions)
Lung	$281.9	$296.8	$314.6
Prostate	300.5	288.3	265.1
Breast	631.2	625.1	602.7
Colorectal	270.4	265.1	256.3
Bladder	22.6	20.6	23.4
Melanoma	102.3	115.6	121.2
Non-Hodgkin Lymphoma	122.4	126.4	119.5
Kidney	44.6	46.2	49.0
Thyroid	15.6	16.2	16.5
Endometrial (Uterine)	14.2	15.9	19.1

-- Jacqueline