A screening that would save lives
/The Boston Globe
April 6, 2008 Beverly Beckham
She is angry, but who can blame her? Her sister - "my beloved sister" - died of lung cancer, writes a reader named Barbara.
Her sister was diagnosed in April 2004 with lung cancer. She thought she had a cold. She died two years later.
Whatever the cause - radon? cigarettes? asbestos? pesticides? pollution? - nobody knows.
What is known is that her sister might not have died if her cancer had been detected sooner. A test exists, a simple test, that could save lives, advocates insist, and that test is not being given.
Mammograms, colonoscopies, screenings for prostate cancer - these are routine. But a simple low-cost, low-level CAT scan that detects lung cancer in its earliest stages is not.
This, says Barbara, is what makes her angry.
And this is what state Senator Susan Fargo, a Democrat from Lincoln, is working to change. Last November she filed legislation to establish the nation's first Lung Cancer Early Detection and Treatment Research Fund, using money from existing cigarette taxes to pay for screening for high-risk people and to research the incidence of this disease.
Here's what's startling about this initiative: It would be the first ever.
How can this be? Lung cancer, according to the National Cancer Institute, is the leading cause of cancer deaths in the United States. It will kill more people this year than breast, prostate, colon, liver, kidney, and skin cancers combined. It will kill nearly twice as many women as breast cancer and three times as many men as prostate cancer.
But if found early, lung cancer can be treated. The five-year survival rate is only 15 percent (compared with 88.5, 99.9, and 64.1 percent for breast, prostate, and colon cancers) because 70 percent of lung cancers are not found until the cancer has spread, according to the Lung Cancer Alliance. And they're not found because even people who are most at risk - smokers and ex-smokers, veterans, African-American men - are not screened.
Startling, too, is that Massachusetts uses just 1.8 percent of all the revenue it gets from cigarette taxes and tobacco settlements to reduce tobacco use.
And not a single penny for lung cancer detection or research, according to the Campaign for Tobacco-Free Kids.
Massachusetts is not alone. Lung cancer research is underfunded nationwide. In fiscal year 2006, the Centers for Disease Control budgeted $204 million for breast and cervical cancer research, $14 million for prostate cancer research, and $14.6 million for colon cancer research.
And, the Lung Cancer Alliance says, nothing for lung cancer research.
Those who get lung cancer are often blamed for their illness. "Did they smoke?" people ask. And the answer?
Sometimes, yes. Sometimes no.
"You cannot discuss lung cancer without discussing discrimination," Joanne O'Connor, cochairwoman of the Massachusetts Lung Cancer Alliance, explained in her testimony supporting Senate Bill 2454. "Unlike other diseases, lung cancer and its victims have the added burden of stigma and shame. ... If you smoked, you brought it on yourself.
"My sister Kathy felt the shame," testified O'Connor. She wanted friends and family to be told she had breast cancer, the acceptable women's cancer. Kathy was diagnosed with Stage 4 lung cancer in January 2006 and died six months later.
Cigarettes cause lung cancer. We know this. But what most people don't know is that 60 percent of lung cancers are being diagnosed in former smokers, many who quit decades ago, and in people who have never smoked at all.
National Cancer Institute statistics are clear. Black men have a 37 percent higher rate of lung cancer than white men, though they smoke less. Veterans, who have been exposed to toxins and who, until 1976, got cigarettes free as part of their K-rations, have a significantly higher rate of lung cancer than nonveterans. And women under 50, who've never smoked at all, are now being diagnosed with this disease.
The National Cancer Institute also cites studies showing that when lung cancer is found early, there is a 92 percent 10-year survival rate.
Compare this with late detection and just a 15 percent survival rate, and it's clear that screening saves live.
Fargo's bill, if it survives the legislative process and becomes law, will be the first in the nation. It's modest. It focuses on people who are high risk.
But it's a noble start, a small step in the right direction. Equally important, it says to people with lung cancer: You count.
