The WHAM Report: Investing just $40 million new dollars in lung cancer research related to women has dramatic impact on U.S. economy – even assuming the most minor health improvements

Reports and Proceedings

BURNESS

Greenwich, CT (November 1, 2022)—Doubling the funding for research focused on women and lung cancer will have enormous economic impacts for families and the nation, according to a new report released today by Women’s Health Access Matters (WHAM), which commissioned The RAND Corporation to create this study on lung cancer in women. According to rigorous modeling based on a number of conservative estimates, even health improvements of 0.1 percent in mortality and quality of life will yield a return on investment of $1,200 for every additional dollar spent. Today’s findings mirror three previous studies from WHAM, which were executed by The RAND Corporation and show similar findings with respect to the power of investment for women’s health research associated with Alzheimer’s disease, heart disease and rheumatoid arthritis.

 

For lung cancer, this is particularly critical because in the U.S., lung cancer is the number one cause of cancer death in women. More women die of lung cancer (estimated approximately 61,000 in 2022, according to CA: A Cancer Journal for Clinicians) than of breast, ovarian and cervical cancers combined. And non-smoking women are more than two times as likely to get lung cancer as their male counterparts, yet the sex disparities of the disease have yet to be thoroughly examined, and only 15 percent of lung cancer research is focused on women.

 

Lung cancer research receives the least amount of funding of the major cancers affecting women. The new report is a first-of-its-kind microsimulation model that examines socioeconomic impacts of investments in women’s health research in the U.S. – revealing critical gaps in the nation’s current research portfolio and the potential gain to the economy through greater funding.

 

The new research examines the return on investment if the research funding for women and lung cancer were doubled. Assuming that the additional research generates health improvements of only 0.1 percent or less in terms of age incidence, mortality and quality of life, the nation can reliably anticipate the following payoff:

• For the U.S. population aged 25 and older, more than 22,700 years can be saved across 30 years of extended life, with substantial gains in health-related quality of life.
• Approximately 2,500 more labor years (valued at $45 million in labor productivity) result from increased work time and longer life.

 

Overall, doubling the investment would have an expected ROI of more than 1,200 percent.

 

“These findings are stunning,” said WHAM Founder and CEO Carolee Lee. “Women are sick and dying from a disease that disproportionately affects them, yet research doesn’t acknowledge this fact. And the pain of disease is not just a medical problem by any means. This new data could not be more clear about the economic pain we all pay when women leave the workforce early to manage their own health or serve as caregivers for their loved ones. Women’s health is an economic issue that impacts everyone, and we can’t afford to ignore it.”

 

“This research shows that very small investments in women’s health can generate outsized returns, in part because women’s health research is still very much under-funded,” said Lori Frank, senior author of the study. “Our modeling suggests that even small investments in women’s lung cancer research could result in significant gains in health outcomes, health-related quality of life and workforce productivity. But it also points to the importance of addressing diseases that hit women harder; equity in medical research leads to meaningful benefits.”

 

“This report brings important new data to the case that we have been making for years: that lung cancer impacts women differently – both physically and societally – and these disparities must be addressed,” said Laurie Fenton Ambrose, President and CEO of GO2 for Lung Cancer and supporter of the report. “The WHAM findings not only underscore the need for legislation that expands resources to better understand the science of lung cancer in women, but also show how investing in research could result in economic benefits for women living with the disease.”

 

The WHAM Report can be a tool to help decisionmakers plan for future research strategies, help funders decide how to allocate their portfolios, and address the business case for payers and business leaders to invest in women’s health.

 

The report authors recommend expanding the research agenda to address multiple aspects of sex and gender in lung cancer using the limited evidence base, including:

• The unknown interactions of sex and gender with lung cancer etiology, risk factors and disease progression to inform treatment and prevention research.
• Understudied interactions of gender and race with lung cancer risk, health care and disease progression; in particular, examining obstacles to access to and use of diagnostic technology, including for personalized medicine.
• Differences by sex and gender in lifestyle impacts on disease.
• Differences in disease course and outcomes by sex and gender, based on different patterns of the use of formal and informal caregiving.

 

“Women are more than half of the population and workforce, control 60 percent of personal wealth, and are responsible for 85 percent of consumer spending and 80 percent of healthcare decisions,” said Lee. “Yet even while diseases impact them disproportionately and differently, pulling many from the workforce too soon, investment in women’s health research lags. This is such an easy win for our country.”

 

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WHAM (Women’s Health Access Matters, whamnow.org)
Women’s health is an economic issue we can’t afford to ignore. WHAM works to increase awareness of and funding for women’s health research by accelerating scientific discovery in women’s health in four primary disease verticals – autoimmune disease, brain health, cancer, and heart health. The WHAM Report quantifies the economic opportunity for investing in women’s health, looking across diseases that impact women differently and differentially, including coronary artery disease, rheumatoid arthritis, and Alzheimer’s disease. Learn more at www.thewhamreport.org.

 

The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. Learn more at www.rand.org.

 

GO2 for Lung Cancer is leading the charge to confront lung cancer – and we're taking it on relentlessly from every front, every day. Founded by patients and survivors, we’re the go-to for one-on-one assistance, supportive connections, treatment information, and finding the best care in our local communities. We’re the place to go to learn about the latest research and special initiatives that increase survivorship – especially for our most vulnerable and underserved. We’re the source for improving health policies and leading public awareness to shift this disease from one of stigma to one of hope. Learn more at www.go2.org.

WAIT, WHAT?!

Eating fruits, vegetables and whole grains may increase chance of early onset lung cancer

Pesticide residue may play a role in increased rates of lung cancer in non-smokers under age 50

University of Southern California - Health Sciences

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Jorge Nieva, MD, is a medical oncologist and lung cancer specialist with Keck Medicine of USC and lead investigator of the study.

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Credit: Ricardo Carrasco III

LOS ANGELES — A diet rich in fruit, vegetables and whole grains is generally recommended for better health and to lower the risk of cancer and other diseases.  

However, new research from USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC, presented at the annual meeting of the American Association for Cancer Research suggests that this type of diet may put non-smoking Americans under the age of 50 at greater risk of developing lung cancer.  

“Our research shows that younger non-smokers who eat a higher quantity of healthy foods than the general population are more likely to develop lung cancer,” said Jorge Nieva, MD, a medical oncologist and lung cancer specialist with USC Norris and lead investigator of the study. “These counter-intuitive findings raise important questions about an unknown environmental risk factor for lung cancer related to otherwise beneficial food that needs to be addressed.”  

Nieva and his fellow researchers speculate that this risk factor may be the pesticides used to keep crops pest-free. Commercially produced (non-organic) fruits, vegetables and whole grains are more likely to be associated with a higher residue of pesticides than dairy, meat and many processed foods, according to Nieva. He also notes that agricultural workers exposed to pesticides typically have higher rates of lung cancer, which adds credence to the theory.  

The study also showed that young women who don’t smoke have a higher incidence of lung cancer than men, and that women tended to also have a diet higher in produce and whole grains than men.  

A New Epidemic of Lung Cancer 

Lung cancer has typically been a disease that affects older adults (the average age of lung cancer onset is 71), men more than women, and smokers. 

Smoking rates have fallen since the mid-1980s, which has led to fewer lung cancer cases across the United States, except for one unique group — non-smokers age 50 and younger, especially women, who are now more likely to get lung cancer than men.  

To investigate this trend, researchers launched the Epidemiology of Young Lung Cancer Project, which surveyed 187 patients who were diagnosed with lung cancer by age 50. Patients provided details on demographics, diet, smoking history and lung cancer diagnosis.  

Most patients had never smoked and had a form of lung cancer biologically different from lung cancer caused by smoking. A 2021 study from the Epidemiology of Young Lung Cancer Project, the Genomics of Young Lung Cancer Project, found that the subtypes of lung cancer seen in people under 40 were distinct from lung cancer in older adults.  

Researchers used the Healthy Eating Index (HEI), a ranking of the overall quality of Americans’ diet on a scale of 1-100, to compare patients’ diets with the broader United States population. Young non-smoking lung cancer patients had an average HEI score of 65 out of 100, compared to the national average of 57. Among participants in the study, women had higher HEI scores than men. 

On average, the young lung cancer patients ate more daily servings of fruit, vegetables and whole grains than the general population. For example, participants averaged 4.3 servings of dark green vegetable and legumes and 3.9 servings of whole grains per day, while the average U.S. adult eats 3.6 servings of dark green vegetables and legumes and 2.6 servings of whole grains per day. 

More Research Needed 

The link between pesticides and lung cancer in young people, especially women, needs more research, said Nieva. 

In the study, researchers did not test specific foods for pesticides. Instead, they used published data on average pesticide levels for food categories such as fruits, vegetables and grains to estimate exposure. The next step, said Nieva, is to confirm the link by directly measuring pesticide levels in blood or urine samples from patients. This could also help reveal whether or not some pesticides increase lung cancer risk more than others. 

“This work represents a critical step toward identifying modifiable environmental factors that may contribute to lung cancer in young adults," said Nieva. “Our hope is that these insights can guide both public health recommendations and future investigation into lung cancer prevention.”  

The research is supported by the Addario Lung Cancer Medical Institute, a nonprofit focused on advancing lung cancer research and care, as well as AstraZeneca, the Beth Longwell Foundation, Genentech, GO2 for Lung Cancer and Upstage Lung Cancer.  

Researchers also received funding from the National Institutes of Health, grant number R25CA225513 and the National Cancer Institute, grant number P30CA014089. 

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For more information about Keck Medicine of USC, please visit news.KeckMedicine.org. 

Disclosure: Dr. Nieva has received consulting payments from AstraZeneca and Genentech. 

Death rates from lung cancer will fall overall in the EU and UK in 2023, but rise among women in France, Italy and Spain

Peer-Reviewed Publication

EUROPEAN SOCIETY FOR MEDICAL ONCOLOGY

A total of 1,261,990 people will die from cancer in 2023 in the EU (EU-27). A further 172,314 people will die from the disease in the UK, according to new research published in the leading cancer journal Annals of Oncology [1] today (Monday).

 

Researchers led by Carlo La Vecchia (MD), a professor at the University of Milan (Italy), estimate there will be a 6.5% fall in cancer death rates in men and a 3.7% fall in women between 2018 and 2023.

 

They predict that death rates from the ten most common cancers will continue to fall in most European countries in 2023, although the numbers of people dying will go up due to aging populations. A greater proportion of elderly people in the population means there is a greater number at the age where they are more likely to develop and die from cancer.

 

Compared to a peak in cancer death rates in 1988, the researchers calculate that nearly 5.9 million deaths will have been avoided in the 35 years between 1989 and 2023 in the EU-27. In the UK, 1.24 million deaths will have been avoided.

 

Prof. La Vecchia said: “If the current trajectory of declining cancer death rates continues, then it is possible there could be a further 35% reduction by 2035. More smokers quitting contribute to these favourable trends. In addition, greater efforts need to be made to control the growing epidemic in overweight, obesity and diabetes, alcohol consumption and infections, together with improvements in screening, early diagnosis and treatments.

 

“The advances in tobacco control are reflected in the favourable lung cancer trends but more could be done in this respect, particularly among women, as lung cancer death rates continue to rise among them. No deaths from lung cancer have been avoided in women, both in the EU-27 and the UK, during the period between 1989 and 2023.

 

“Pancreatic cancer is also a cause for concern, as death rates from this disease will not fall among men and will rise by 3.4% in women in the EU and 3.2% in women in the UK. Smoking can explain between about a quarter to a third of these deaths, and women, particularly in the middle and older age groups, did not give up smoking as early as men.”

 

The researchers analysed cancer death rates in the EU 27 Member States [2] as a whole and separately in the UK. They also looked at the five most populous EU countries (France, Germany, Italy, Poland and Spain) and, individually, for stomach, intestines, pancreas, lung, breast, uterus (including cervix), ovary, prostate, bladder and leukaemias for men and women [3]. Prof La Vecchia and his colleagues collected data on deaths from the World Health Organization and Eurostat databases from 1970 to 2018 for most of the EU-27 and the UK. This is the thirteenth consecutive year the researchers have published these predictions.

 

In the EU-27 countries the researchers predict that will be an age standardised rate (ASR) [4] of 123.8 deaths per 100,000 men by the end of 2023. In women, the age standardised death rate will be 79.3 per 100,000. In the UK, the death rates will be 106.5 and 83.5 per 100,000 for men and women, respectively.

 

Cancer death rates will fall for all cancers in men in the EU-27 and the UK. They will also fall for women in the UK. Among EU women, death rates will rise by 3.4% to nearly six per 100,000 for pancreatic cancer, and to just over 1% to 13.6 per 100,00 for lung cancer. Although there will be a 13.8% drop in lung cancer death rates among women in the UK, the death rate of 16.2 per 100,000 is still higher than among EU women because more UK women started smoking earlier than those in the EU. Lung cancer now kills more women in the UK than breast cancer, which has a death rate of 13.5 per 100,000.

 

When the researchers looked specifically at lung cancer death rates in five EU countries as well as the UK, they found that, although death rates are predicted to fall in men for all six countries, for women they will rise by nearly 14% in France, 5.6% in Italy and 5% in Spain. Among women in different age groups, the researchers found a decrease in predicted death rates from lung cancer among those aged 25 to 64, but an increase in those aged 65 to over 75 years, and consequently an increase overall.

 

“This is because women now aged 45 to 65, born in the 1960s and 1970s, have smoked less and stopped earlier than those born in the 1950s, who were in their twenties in the 1970s when smoking among young women was most prevalent,” said Prof. Eva Negri from the University of Bologna (Italy), co-leader of the research.

 

Colorectal (bowel) cancer will be the third biggest killer for women in both the EU and the UK: eight and ten per 100,000, respectively. Prostate cancer will be the third biggest killer for men: 9.5 and 11.2 per 100,000 in the EU and UK, respectively.

 

The researchers say that organised screening programmes using low dose computed tomography (CT scans) could reduce deaths from lung cancer by up to 20%. However, there are no such organised programmes in Europe, and it is too early to evaluate the impact of screening in the UK, following the Lung Cancer Screening trial.

 

The researchers highlight the role that overweight and obesity plays in cancers such as post-menopausal breast, endometrial (womb) cancer, stomach and colorectal cancer. Although death rates from stomach cancer are falling overall, mainly because of improved methods of food preservation, healthier diets and a decline in Helicobacter pylori infection, approximately a third of stomach cancers now occur in the cardia, the entrance to the stomach, and are associated with overweight and obesity and, hence, reflux, which is a risk factor for the development of cancer at this site. For colorectal cancer, death rates are falling in the EU but the decline has slowed in the UK.

 

“This is concerning as increases in both incidence and mortality from colorectal cancer in young women have been recorded in the UK. This can be partly explained by the prevalence of overweight and obesity, and alcohol and tobacco consumption,” said Prof. Negri.

 

The researchers caution that their estimates do not take account of the COVID pandemic, which occurred after the dates when data were available on cancer deaths. “The COVID-19 pandemic may have an effect on cancer mortality in 2023 as a result of delayed visits and procedures, influencing both secondary prevention and treatment, and disease management for cancer,” they write.

 

(ends)

Notes:

[1] “European cancer mortality predictions for the year 2023 with focus on lung cancer”, by M. Malvezzi et al. Annals of Oncology, doi: 10.1016/j.annonc.2023.01.010

[2] At the time of this analysis, the EU had 27 member states, with the UK leaving in 2020. Cyprus was excluded from the analysis due to excessive missing data.

[3] The paper contains individual tables of cancer death rates for each of the six countries.

[4] Age-standardised rates per 100,000 of the population reflect the annual probability of dying adjusted to reflect the age distribution of a population.

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JOURNAL

Annals of Oncology

DOI

10.1016/j.annonc.2023.01.010 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

European cancer mortality predictions for the year 2023 with focus on lung cancer

ARTICLE PUBLICATION DATE

6-Mar-2023

LA REVUE GAUCHE - Left Comment: Search results for LUNG CANCER 

LA REVUE GAUCHE - Left Comment: Search results for LUNG CANCER WOMEN 

 

Lung cancer does not decrease in line with reduced smoking

UMEA UNIVERSITY

 

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BENGT JÄRVHOLM, PROFESSOR AT DEPARTMENT OF PUBLIC HEALTH AND CLINICAL MEDICINE, UMEÅ UNIVERSITY, SWEDEN

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CREDIT: MATTIAS PETTERSSON

Despite the fact that the number of people who smoke has decreased very sharply in Sweden, the number of cases of lung cancer in the population is not decreasing as much as expected. Among women lung cancer has in fact increased. This is shown in a new study at Umeå University, Sweden. The study means that the view of how long smoking affects health may change.

“Smoking is undoubtedly the most important risk factor for lung cancer. It is therefore surprising that the decline in smoking is not yet more visible in the statistics. More research is needed to find out why this is the case,” says Bengt Järvholm, professor at the Department of Public Health and Clinical Medicine at Umeå University.

The number of people who smoke has been declining in Sweden for many years. Today, one of twenty Swedes, about five percent, among men and women state that they smoke daily. In the 1960s, about one in two Swedish men between the ages of 18 and 69 smoked. Women generally started smoking later in history than men. In a large study in 1963, only slightly more than one in ten women, 11 per cent, aged 50–69 smoked, while 46 per cent of men were smokers. Among women, it was mainly younger people who smoked in the 1960s.

According to previous research, the risk of developing lung cancer decreases sharply and quickly after quitting smoking. According to a British study, the number of people who had lung cancer before the age of 75 fell from 16 percent to three percent among those who quit smoking before the age of 50.

The Umeå researchers have compared the change in smoking habits in Sweden from the 1950s with the incidence of lung cancer between 1970 and 2021 in men and women aged 40–84 years. They studied how the risk varied among men and women in different age groups. Previous studies have shown that squamous cell cancer is the form of lung cancer that has the strongest association with smoking.

The results showed that the risk of being affected varied greatly depending on the type of lung cancer, age and gender. Based on previous studies, it would have been expected that the risk of cancer would have decreased among the elderly as well. However, lung cancer was as common in 1970 as in 2021 among men aged 75–79 years. The number of squamous cell cancer had fallen sharply, while in 2021 it had instead increased six-fold for the other common form of cancer, adenocarcinoma. The risk of squamous cell cancer had increased among women in the age group 75-79 years to the same level as among men. For adenocarcinoma, the risk was similar for women and men, despite the fact that there were large differences in smoking habits among women and men in the 1970s.

The study does not provide an answer as to why the development of lung cancer does not correspond well with expectations. For that, other types of studies are required. However, there are several possible explanations. One explanation may be that people may underreport their smoking, i.e. that the reduction in smoking may be smaller in reality. Another possible explanation may be that previous assumptions have been exaggerated about how quickly the risk of being affected decreases when you quit smoking. Nor can it be ruled out that other environmental or lifestyle factors may play a role; Even those who have never smoked can get lung cancer, although it is less common. The fact that the trend is so much worse for women than for men is due to the fact that Swedish women generally started smoking later in history than men.

“The results should certainly not be interpreted as it is useless to quit smoking. On the contrary, the study emphasizes the importance of quitting early, preferably never starting, as it may be the case that the risk of lung cancer is elevated for longer than we previously thought,” says Bengt Järvholm.

The study shows that if the risk of developing lung cancer in 2021 was as high as the risk in 1970 in men and women aged 40–84, approximately 2,250 men would have suffered from lung cancer in 2021 instead of 1695 cases, i.e. a decrease of 555 cases. Among women, there would have been 544 cases instead of the current 2,181 cases, i.e. there has been an increase of 1,637 cases of lung cancer.

The study is based on data from the National Board of Health and Welfare's cancer registry, which was compared with statistics on tobacco smoking from surveys and from the sale of cigarettes.

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JOURNAL

European Journal of Public Health

DOI

10.1093/eurpub/ckae050 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Changing smoking habits and the occurrence of lung cancer in Sweden—a population analysis

AIR POLLUTION ENVIRONMENTAL TOXINS

‘But I never smoked’: A growing share of lung cancer cases is turning up in an unexpected population


By SHARON BEGLEY @sxbegle

JANUARY 26, 2021

Mandi Pike near her home in Edmond, Okla. Pike, a never-smoker, was diagnosed with lung cancer in November 2019.NICK OXFORD FOR STAT


Sharon Begley died of complications of lung cancer on Jan. 16, just five days after completing this article. She was a never-smoker.

Breast cancer wouldn’t have surprised her; being among the 1 in 8 women who develop it over their lifetime isn’t statistically improbable. Neither would have colorectal cancer; knowing the risk, Mandi Pike “definitely” planned to have colonoscopies as she grew older.

But when a PET scan in November 2019 revealed that Pike, a 33-year-old oil trader, wife, and mother of two in Edmond, Okla., had lung cancer — she had been coughing and was initially misdiagnosed with pneumonia — her first
reaction was, “but I never smoked,” she said. “It all seemed so surreal.”

Join the club. Cigarette smoking is still the single greatest cause of lung cancer, which is why screening recommendations apply only to current and former smokers and why 84% of U.S. women and 90% of U.S. men with a new diagnosis of lung cancer have ever smoked, according to a study published in December in JAMA Oncology. Still, 12% of U.S. lung cancer patients are never-smokers.

Scientists disagree on whether the absolute number of such patients is increasing, but the proportion who are never-smokers clearly is. Doctors and public health experts have been slow to recognize this trend, however, and now there is growing pressure to understand how never-smokers’ disease differs from that of smokers, and to review whether screening guidelines need revision.

“Since the early 2000s, we have seen what I think is truly an epidemiological shift in lung cancer,” said surgeon Andrew Kaufman of Mount Sinai Hospital in New York, whose program for never-smokers has treated some 3,800 patients in 10 years. “If lung cancer in never-smokers were a separate entity, it would be in the top 10 cancers in the U.S.” for both incidence and mortality.

A 2017 study of 12,103 lung cancer patients in three representative U.S. hospitals found that never-smokers were 8% of the total from 1990 to 1995 but 14.9% from 2011 to 2013. The authors ruled out statistical anomalies and concluded that “the actual incidence of lung cancer in never smokers is increasing.” Another study that same year, of 2,170 patients in the U.K., found an even larger increase: The proportion of lung cancer patients who were never-smokers rose from 13% in 2008 to 28% in 2014.

“It is well-documented that approximately 20% of lung cancer cases that occur in women in the U.S. and 9% of cases in men, are diagnosed in never-smokers,” Kaufman said.

To a great extent, this is a function of straightforward math, said epidemiologist Ahmedin Jemal of the American Cancer Society. Fewer people smoke today than in previous decades — 15% in 2015, 25% in 1995, 30% in 1985, 42% in 1965. Simply because there are fewer smokers in the population, out of every 100 lung cancer patients, fewer will therefore be smokers. And that means more of them will be never-smokers.

There are also hints that the absolute incidence of lung cancer in never-smokers has been rising, said oncologist John Heymach of MD Anderson Cancer Center. Some data say it has, but other data say no. The stumbling block is that old datasets often don’t indicate a lung cancer patient’s smoking status, Heymach said, making it impossible to calculate what percent of never-smokers in past decades developed lung cancer.

Jemal, however, cautions that it is not the case that a never-smoker has a greater chance of developing lung cancer today than never-smokers did in the past.

Current cancer screening guidelines recommend a CT scan for anyone 50 to 80 years old who has smoked at least 20 pack years (the equivalent of one pack a day for 20 years, or two packs a day for 10 years, and so on) and who is still smoking or quit less than 15 years ago. Screening is not recommended for never-smokers because the costs of doing so are deemed greater than the benefits, Jemal said; thousands of never-smokers would have to be screened in any given year to find one lung cancer.

Still, low-dose CT can catch lung cancer in a significant number of never-smokers. A 2019 study in South Korea diagnosed lung cancer in 0.45% of never-smokers, compared to 0.86% of smokers. The researchers urged policymakers to “consider the value of using low-dose CT screening in the never-smoker population.”

“It used to be that the high-risk group” for whom CT screening is recommended “was the vast majority of lung cancer patients,” Heymach said. “But now that so many lung cancer cases are in nonsmokers, there is absolutely a need to reevaluate the screening criteria.”

Related:
Lung cancer deaths are declining faster than new cases. Advances in treatment are making the difference

Researchers are trying to improve screening by reducing the incidence of false positives — when CT finds lung nodules “or an old scar that you got 20 years ago,” he said. Those don’t pose a threat but have to be biopsied to ascertain that. Screening never-smokers would also be more efficient than it is today “if we could identify who, among nonsmokers, are at higher risk,” he said.

Cancer doctors already know part of the answer: women. Worldwide, 15% of male lung cancer patients are never-smokers. But fully half of female lung cancer patients never smoked. And women never-smokers are twice as likely to develop lung cancer as men who never put a cigarette to their lips.

Beyond sex, “nothing stands out as a single large risk factor that, if we only got rid of it, we would solve the problem” of lung cancer in never-smokers, said Josephine Feliciano, an oncologist at Johns Hopkins University School of Medicine. “But air pollution, radon, family history of lung cancer, [and] genetic predispositions” all play a role. Chronic lung infections and lung diseases such as chronic obstructive pulmonary disorder (COPD) also seem to increase risk.

None of those, with the possible exception of genetics and indoor pollution (cooking fires in some low-income countries), affect women more than men. So what’s going on?

At least one biotech believes that biological differences between lung cancer in never-smokers and smokers merits a new drug, and one that might be especially effective in women. “A different disease needs a different drug,” said co-founder and CEO Panna Sharma of Lantern Pharma. In fact Lantern, which is developing a drug for lung cancer in female never-smokers, believes that disease is so different it recently tried to convince the U.S. Food and Drug Administration to designate it an orphan disease, said Sharma.

Called LP-300, the Lantern drug increased overall survival from 13 months to more than 27, compared to chemotherapy alone, in female nonsmokers, in a small trial. It “targets molecular pathways that are more common in female nonsmokers than in any other group,” said Sharma, targeting the mutations EGFR, ALK, MET, and ROS1 (common in never-smokers) directly and boosting the efficacy of other drugs that attack them, such as erlotinib and crizotinib. Lantern plans a larger trial this year.

Smokers’ tumors tend to have more mutations overall, thanks to mutagen-packed cigarette smoke attacking their lungs, but scientists have developed more drugs for never-smokers’ lung tumors than for smokers’. For instance, EGFR and ALK mutations are more common in never-smokers. (Mandi Pike had the EGFR mutation, which was relatively fortunate: A drug targets it, and she has been cancer-free since November.)

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The targeted drugs bollix up each mutation’s cancer-causing effects. KRAS mutations are more common in smokers’ lung tumors, and there are no KRAS drugs. (A KRAS drug for lung cancer is imminent, though, said thoracic oncologist Ben Creelan of Moffitt Cancer Center in Tampa, Fla.)

According to national guidelines, lung cancer in never-smokers should be treated the same as in smokers, said Creelan. “But I think we should reconsider this,” he said.

Because never-smokers have fewer tumor mutations, it’s harder to find them. So he said clinicians should be more aggressive about looking for actionable mutations in these patients. “I keep looking for a mutation until I find something important,” he said, adding that doctors might need better biopsy material or to use a different sequencing method in never-smokers.

In a cruel twist, the breakthrough drugs that take the brakes off immune cells, which then attack the tumor, are less effective in never-smokers’ lung cancer than in smokers’. The reason seems to be that smokers’ tumors have more mutations, said Mount Sinai’s Kaufman; the mutations often cause the tumor cells to have molecules on their surface that the immune system perceives as foreign and revs up to attack. Never-smokers’ tumors have few, if any, of those “come and get me” molecules. Immune cells therefore ignore them.

“In smokers, conversely, with more mutations, there is more for the immune system to recognize as bizarre and foreign, and so to provoke” an attack, Creelan said.

In contrast, never-smokers’ tumors are more likely to respond to targeted drugs, and as a result to be in remission for a long time or even cured. That’s because with fewer mutations, never-smokers’ tumors are more likely to have an “oncogene addiction,” Heymach explained: They are propelled by only one mutation. The plethora of mutations in smokers’ tumors means that there is usually a back-up cancer driver if a targeted drug eliminates cells with only one. “When a tumor has more and more mutations, blocking one is less likely to have an impact,” Heymach said. “But in nonsmokers, it can.”

Heymach called for more funding to study lung cancer in never-smokers. It “is an area that’s underserved and deserves more investment,” Heymach said. “It should be commensurate with the public health threat it represents.”



About the Author


Sharon Begley
Senior Writer, Science and Discovery (1956-2021)
Sharon covered science and discovery.

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LA REVUE GAUCHE - Left Comment: Search results for LUNG CANCER (plawiuk.blog)spot.com

Make Up Your Mind

Sunlight healthy in small quantities

In what has turned out to be a delicate balancing act, the group is advising that while too much time in the sun raises the risk of skin cancer, avoiding it entirely can lead to a deficiency in vitamin D -- and that may elevate the risk of other types of cancers and diseases.

Cancer research is another form of social hysteria fueled by speculation, and lack of empirical data, by the medical pharmaceutical establishment.

Like the myth of Second Hand Smoke and the myth that associates Lung Cancer with smoking.

Cancer is a direct result of the industrial revolution, it is the 'social disease' of capitalism. Of course a little bit of sushine never hurt anyone. Even if the Ozone layer is being depleted. Another result of industrial development.

We ban sunshine and cigarettes because it's easier than banning capitalism.

What does this tell you when the environmental causes of cancer have NOT been studied by the medical pharmecutical establishment till now.

The University of Pittsburgh has created a center—considered the first of its kind anywhere—that will identify environmental causes of cancer. The center’s first director is more than ready to do battle against the disease. In fact, battles are her specialty.

Cancer Crusade

Now as director of the new Center for Environmental Oncology, a collaborative venture between the Graduate School of Public Health and the University of Pittsburgh Cancer Institute, Davis will be fighting to find environmental causes of cancer. The center is the only one of its kind within a cancer institute, says Bernard Goldstein, professor and retiring GSPH dean.

The first project is a collaboration between the center and the University’s Center for Minority Health that will investigate why more young Black women have breast cancer than their White counterparts. They will examine whether beauty products for African American women contribute to increased occurrences of breast cancer. Environment isn’t limited to forests, rivers, lakes, fields, and sky. It is what we eat, what we use, and what we wear. Beauty products that target African American women often contain estrogen. This affects women in a few ways. For instance, these products might induce early menstruation, and researchers believe that women who menstruate earlier are more likely to get breast cancer. And it’s commonly believed that higher levels of estrogen contribute to increased risks of breast cancer. If African American women are using products that increase the level of estrogen in their bodies, they may be at higher risk.

Bad Air a 'Genetic Risk'

Hamilton scientists' findings show genetic damage from the tiny chemically coated particles of soot regularly spewed out by both industry smokestacks and vehicle exhaust pipes. Soot particles mutate genes in male mice, scientists find. Genetic mutations passed along to offspring via sperm.

Rare lung cancer is leaving sorrowful legacy among working class

Mesothelioma, caused by asbestos, may one day strike rescuers and survivors of World Trade Center attacks

Lung Cancer in a Steel City: A Personal Historical Perspective

In my 1972-74 studies, the male death rate from lung cancer in the most heavily polluted residential zone was 65/100,000, which was 2.83 times higher than the national average of 23/100,000 (2), compared with a 2.42 times higher rate reported in a 1988 study of the same zone involving a correction for age which reduced the ratio to 1.99, along with an additional correction for smoking which further decreased the ratio to 1.40 (5). In terms of my own experience, I suspect that the correction(s) for smoking might be excessive, because the lung cancer victims which I studied had not smoked as many cigarettes as did their "white collar" colleagues. Nevertheless, the main point to remember is that even a suspected over-correction of the raw data revealed a significant difference in lung cancer deaths between the heavily polluted zone and other areas, even when based on "guestimates" calculated 14 years later.

Age and smoking-adjusted lung cancer incidence in a Utah county with a steel mill.

In a recent study of urban air pollution, a Utah county with a steel mill was compared with a county without a steel mill. The result was that 38% of respiratory cancer deaths could be attributed to the air pollution emanating from the mill.


Lung cancer among steelworkers in Ontario.
In internal comparisons within the steel companies, increased lung cancer risk was observed among foundry, coke oven, and pouring pit workers. Retrospective hygiene assessment suggested that the increased risk of lung cancer among steel pourers might be related to the use of tar-based mold coating agents or to exposure to mineral fibers.

Male Breast Cancer
Men who work in steel mills, blast furnaces, rolling mills, or other environments of intense heat have a slightly increased incidence of breast cancer ...


Pollution Poses High Cancer Risk

Residents in Indiana’s heavily industrialized areas - particularly Lake County and Indianapolis - face an elevated risk of developing cancer from breathing air pollution, according to a new federal analysis.

The study released by the U.S. Environmental Protection Agency is the agency’s most ambitious look to date at cancer risks from breathing chemicals.

In its National Air Toxics Assessment, the EPA studied 133 chemicals emitted in 1999 by businesses and traffic. It outlines lifetime cancer risks in states, counties and census tracts.

Find blog posts, photos, events and more off-site about:
Sunshine, Sun, sunbathing, tanning, tan, cancer, capitalism, industrial-pllution, smoking, lung-cancer, breast-cancer, hamilton, steel-mills, asbestos,

A calculator that predicts risk of lung cancer underperforms in diverse populations

Research finds that a commonly used risk-prediction model for lung cancer does not accurately identify high-risk Black patients who could benefit from early screening

THOMAS JEFFERSON UNIVERSITY

Research News

 

PHILADELPHIA - Lung cancer is the third most common cancer in the U.S. and the leading cause of cancer death, with about 80% of the total 154,000 deaths recorded each year caused by cigarette smoking. Black men are more likely to develop and die from lung cancer than persons of any other racial or ethnic group, pointing to severe racial disparities. For example, research has shown that Black patients are less likely to receive early diagnosis and life-saving treatments like surgery. Now researchers at Jefferson have found that a commonly used risk prediction model does not accurately identify high-risk Black patients who could gain life-saving benefit from early screening, and paves the way for improving screenings and guidelines. The research was published in JAMA Network Open on April 6.

"Black individuals develop lung cancer at younger ages and with less intense smoking histories compared to white individuals," explains Julia Barta, MD, Assistant Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at Thomas Jefferson University, and researcher at the Jane and Leonard Korman Respiratory Institute. "Updated guidelines now recommend screening eligible patients beginning at age 50, but could still potentially exclude higher-risk Black patients. We are interested in finding methods that could help identify at-risk patients who are under-screened."

Screening for lung cancer is an annual CT scan to detect the presence of lung cancer in otherwise healthy people with a high risk of lung cancer. Current guidelines do not require a risk score for screening eligibility, but some researchers think that risk models could improve care. Risk prediction models are mathematical equations that take into account risk factors like smoking history and age to produce a risk score, which indicates the risk for developing lung cancer. Existing risk prediction models are derived from screening data that only include 5% or fewer African American individuals.

"What makes our study unique is that our screening cohort included more than 40% Black individuals," says senior author Dr. Barta, a member of Sidney Kimmel Cancer Center - Jefferson Health. "To our knowledge, our study is the first to examine lung cancer risk in a diverse screening program and aims to strengthen the argument for more inclusive guidelines for screening eligibility."

The most well-validated model used in screening research is the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial modified logistic regression model (PLCOm2012). "It uses 10-12 risk factors that include age, race, smoking history, as well as some socioeconomic factors like education to calculate a risk score," says Christine Shusted, MPH, first author of the study and research data analyst for Jefferson's Lung Cancer Screening Program through the Korman Respiratory Institute at Thomas Jefferson University. "The higher the score, the higher the risk of developing lung cancer. We wanted to see how well this model identifies patients with the highest risk of lung cancer in this diverse patient population."

The researchers conducted a cross-sectional, retrospective study in 1,276 Black and white patients (mean age, 64.25 years; 42.7% Black; 59.3% women) who enrolled in the Jefferson Lung Cancer Screening Program between January 2018 and September 2020. From this screening cohort, lung cancer was detected in 32 patients, 44% of whom were Black - these patients formed the cancer cohort. The researchers then calculated risk scores using the PLCOm2012 model. In the screening cohort, more Black patients than white patients were in high-risk groups, indicating that Black patients in this cohort had a higher risk of developing lung cancer.

As anticipated, white patients with screen-detected lung cancer generally had high lung cancer risk scores. "Among Black patients, we would have expected to see a similar trend," explains Dr. Barta. "However, we saw that despite having a lung cancer diagnosis through screening, Black patients were actually defined as lower risk. This indicates that the model is not accurately predicting risk of lung cancer in Black patients."

"These findings allowed us to identify weaknesses in this model for risk calculation for lung cancer," explains Shusted. "It indicates that we need to not only expand criteria for lung cancer screening so that more diverse populations are included, but that these prediction models need to include factors, like environmental contributors, access to health care, and other social determinants of health."

The researchers hope to continue building on these findings, with the ultimate goal of defining comprehensive risk factors and improving lung cancer screening uptake and adherence especially among vulnerable populations.

"This work is an important step to reducing disparities in the screening and early detection of lung cancer, and making sure we can trust our models to predict those individuals at the highest risk," says Dr. Barta.

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This work was supported in part by the Bristol Myers-Squibb Foundation's Specialty Care for Vulnerable Populations initiative. Dr. Barta reported receiving grants from the Genentech Health Equity Innovations Fund and the Prevent Cancer Foundation outside the submitted work. The authors report no other conflicts of interest.

Article Reference: Christine Shusted, Nathaniel Evans, Hee-Soon Juon, Gregory Kane, Julie Barta, "Association of Race With Lung Cancer Risk Among Adults Undergoing Lung Cancer Screening," JAMA Network Open, DOI: 10.1001/jamanetworkopen.2021.4509, 2021