Living with Lung Cancer

Web Extra! Meet Dr. Reginald Munden, UAB's new radiology chair and lung cancer expert!

The statistics on lung cancer paint a bleak picture.

Lung cancer is the number one cancer killer in the United States—and in Alabama.

It causes 30 percent of all cancer deaths.

It is the leading cancer killer among Caucasians, African-Americans, Asians and Hispanic males.

This year, lung cancer will kill more people than breast cancer, prostate cancer, colon cancer, liver cancer, kidney cancer and melanoma—combined.

It will kill nearly three times as many men as prostate cancer and twice as many women as breast cancer.

But there is hope. The five-year survival rate for lung cancer has now increased to 15 percent. While that number is substantially lower than other cancers, the increase is the first real impact on the disease in 30 years, says Robert Cerfolio, M.D., UAB Comprehensive Cancer Center scientist and UAB chief of thoracic surgery. “Thanks to improved screening methods, we are also diagnosing the disease in its earlier stages, which increases the chances of survival significantly,” he says. “If it is caught early, we can design a stage-specific treatment plan that is much more effective for the patient.”

Improved treatment methods have also made a significant impact on lung cancer patients. Minimally invasive surgical techniques have led to shorter hospital stays, less postoperative pain and decreased rehabilitation time. In addition, less toxic, more targeted chemotherapy and radiation treatments have helped improve outcomes.

Lung cancer patients at the UAB Cancer Center benefit from a multidisciplinary team approach to treating the disease. Nearly all lung cancer surgeries are performed by Dr. Cerfolio, who is recognized as one of the busiest thoracic surgeons in the world. Cancer Center senior scientist Francisco Robert, M.D., treats most lung cancer patients in the center's Hematology-Oncology Clinic, while center scientist Sharon Spencer, M.D., sees patients in radiation oncology. “UAB is truly leading the way with this multidisciplinary model for treatment,” says Dr. Cerfolio. “The whole world is starting to shift toward this type of coordinated-care approach.”

But one question remains: With all the advances in cancer research and treatment, why is the survival rate for lung cancer still so low?

The answer to that question is shaped by several factors. A crucial one is that lung cancer often is not diagnosed until it has reached its later stages, Dr. Cerfolio says. More than 50 percent of new lung cancer cases are diagnosed at stages IIIB or IV, and only 5 percent of those patients will live for five years. “While screening methods have improved, lung cancer has no symptoms,” Dr. Cerfolio says. “Many patients don't know they have it until it's too late. It's a silent killer.”

Lung cancer also suffers from being one of the least funded cancers in terms of federal research dollars. Over five years between 1999 and 2004, the Department of Defense provided $33 million for lung cancer research; in comparison, it funded $1.6 billion for breast cancer research from 1992 to 2004 and $565 million for prostate cancer research between 1997 and 2004. According to Dr. Cerfolio, the disparity in research dollars is reflected in survival rates. “If you take 100 women with breast cancer, 85 percent are alive after five years,” he says. “For prostate cancer, that number is 93 percent. Colon cancer is 60 percent. But for lung cancer survival, it is 13 to 15 percent.” In fact, lung cancer survival rates are nearly as low today as they were in 1971 when President Richard Nixon first declared war on cancer. At that time, lung cancer was the leading cause of cancer deaths in the United States—a distinction it still holds.

The good news is that lung cancer is preventable in most cases. Ninety percent of men and 80 percent of women who are diagnosed are smokers. Former smokers account for 50 percent of new lung cancer cases, while current smokers make up 35 to 40 percent of new cases. Only 10 to 15 percent of new cases are people who have never smoked.

Those facts create a significant challenge for the physicians and researchers fighting the disease, however. “Lung cancer is a disease that is largely preventable through education,” Dr. Cerfolio says. “It receives less attention because many see it as a ‘self-induced’ disease. Regardless of whether or not that's true, we have to educate people if we're going to make a difference. If you're a smoker, stop immediately. If you're a former smoker, get screened. If you've never smoked, don't ever start.”