Winning the war against cancer will not become a reality until lung cancer is defeated.
—Apar Kishor Ganti, MD, MS, FACP
Lung cancer is the most common cause of cancer-related death in the world. In the United States alone, an estimated 228,190 new cases of lung cancer and 159,480 deaths from lung cancer will occur in 2013. These are alarming statistics when compared to the next four common causes of cancer-related deaths (colon, breast, pancreas, and prostate), which are estimated to account for 159,040 deaths combined.1
Since the declaration of the “War on Cancer” in 1971, the contrast between the changes in survival for lung cancer and the other cancers are even more disturbing. A comparison of the 5-year survival rates in 1975 and now reveals an improvement in prostate cancer from 69% to 99.8%, in breast cancer from 75% to 89%, in colorectal cancer from 51% to 67%, and in bladder cancer from 74% to 80%. In contrast, the survival rate in lung cancer has moved from 13% to a mere 16%.
Paucity of Funding
A major reason for this lack of improvement is the paucity of funding for lung cancer research. Progress in the treatment of most malignancies has resulted from rigorous scientific research. Funding agencies have for the most part ignored lung cancer.
Data from the National Cancer Institute (NCI), Department of Defense (DoD), and Centers for Disease Control and Prevention (CDC) reveal that the amount of money spent per death from cancer for the fiscal year 2012 was $17,835 for breast cancer, compared to $1,378 for lung cancer. This represents a greater than 10-fold increased spending per breast cancer death compared to each lung cancer death. A look at the total funding for these malignancies is just as alarming. Between 2008 and 2010, the NCI spent $1,803.3 million on breast cancer research compared to $776.4 million on lung cancer research.2
This disparity is not unique to the United States. In the United Kingdom, in 2012, breast cancer research received £40.8 million; leukemia, £31.6 million; colon cancer, £24.5 million; prostate cancer, £20.9 million; and lung cancer, the cause of the highest number of cancer-related deaths, a paltry £14.8 million in research funding. When funding per death from cancer is evaluated, breast cancer received approximately £3,500, whereas lung cancer received just over £400 per death.3 Many individuals will spend more annually on round-trip airfares than either the United States or the United Kingdom spends on research per lung cancer death.
Reasons for Disparities
The reasons for these disparities are unclear. Some may argue that the goal of these federal agencies is to fund the most advanced research, irrespective of what type of cancer is being studied. Here, lung cancer is at a significant disadvantage compared to breast cancer. Since breast cancer has enjoyed a higher level of funding for a long period of time, it has attracted more researchers and has enjoyed more success, thereby raising the quality of research as well.
Another argument is that since the molecular pathways are similar for many cancers, results from the study of a pathway in one cancer would be applicable to another malignancy as well. But as recent studies have shown, what is true for the role of the EGFR-targeting antibody cetuximab (Erbitux) in colon cancer is not necessarily true in lung cancer. Thus, tumor-specific research is warranted.
Lung cancer has long been seen as a cigarette-smoking–related illness, and the stigma of smoking has contributed to the public perception of patients with lung cancer—the impression is that because these individuals smoked, they brought this upon themselves. A recent 1,700-person study by Dr. Joan Schiller at the University of Texas Southwestern Medical Center in Dallas found that both explicit and implicit attitudes were significantly more negative toward lung cancer than breast cancer.4
As a society, are we justified in vilifying this large group of individuals? Less than half a century ago, society endorsed these same habits that are so vehemently criticized today. While smoking cessation is of paramount importance, the majority of lung cancers occur in individuals who have quit smoking. When these individuals ask for help to combat this deadly disease, we must not turn our backs on them. Finding ways to combat this disease will also save money currently spent on taking care of the complications of lung cancer and its treatment.
Rising Incidence in Nonsmokers
The incidence of lung cancer in nonsmokers is increasing worldwide. Understanding of the genetics of lung cancer has led to identification of the same driver mutations in some lung cancers diagnosed in former smokers as seen in never-smokers. Presumably these individuals would have developed lung cancer even if they had never smoked. Approximately 15% of patients in the United States with lung cancer are in this category.
Lung cancer accounts for almost 23,000 deaths annually among nonsmokers in the United States. If this were categorized as a separate disease, lung cancer in nonsmokers would be the sixth leading cause of cancer-related deaths following lung cancer in smokers, colon, breast, pancreas, and prostate cancer. Clearly, the argument that patients with lung cancer brought it on themselves and therefore do not deserve sympathy is simiilar to comparing them to obese patients with cancer and does not hold much credibility.
Another reason for lack of funding may be the paucity of long-term survivors who can raise lung cancer awareness in the society and also be passionate advocates for increased funding support. Breast cancer survivors have raised billions of dollars through fundraisers, awareness campaigns, races, and galas. They have convinced large companies to contribute a percentage of sales toward breast cancer research. This increased funding for research has led to dramatic improvements in results for patients with breast cancer, and it stands to reason that the same could be true for lung cancer. Winning the war against cancer will not become a reality until lung cancer is defeated. ■
Dr. Ganti is Associate Professor in the Department of Medicine, VA Nebraska Western Iowa Health Care System, and in the Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha.
Disclosure: Dr. Ganti reported no potential conflicts of interest.
1. American Cancer Society: Cancer Facts & Figures 2013. Available at www.cancer.org. Accessed August 13, 2013.
2. NCI Office of Budget and Finance: 2012 Fact Book. Available at obf.cancer.gov. Accessed August 13, 2013.
3. National Cancer Research Institute: CaRD 2012. Available at www.ncri.org.uk/default.asp?s=1&p=3&ss=6.
4. Schiller JH, Bowden CJ, Mills J, et al: Explicit and implicit attitudes toward lung cancer, relative to breast cancer. 2013 ASCO Annual Meeting. Abstract 8017. Presented June 3, 2013.