Women and lung cancer

Laura Newvine took her first drag from a cigarette when she was 15 years old.

She likely slipped it out of her mother’s pack when she wasn’t looking. She also went to her friends who smoked and asked them for cigarettes until she could afford to buy her own.

She smoked every day after that.

As years passed, she thought she had gotten away with any health problems associated with smoking. She was wrong, and instead had become part of a statistical trend of women getting lung cancer at a faster rate than men. The 51-year-old Newvine also is a reflection of a trend that has doctors trying to encourage people to talk to their physicians about their chances of getting cancer.

It was in 2009 that Newvine's breathing became labored.

“The main thing was, I was spitting up blood,” she said. “But I still didn’t connect the two: the blood and possible cancer. I just thought it was a bad cold.”

Her first doctor misdiagnosed her cancer and so did a local hospital emergency room, thinking she had pneumonia, she said.

Eventually, she said, a doctor at the Forest Family Health Clinic examined her and ordered more X-rays.

“She called me that same day and said she wanted us to come back. That’s when she told me I needed to pack a bag and go to the hospital, I had small-cell carcinoma,” Newvine said.

Small cell carcinoma is an aggressive and common form of lung cancer, especially among smokers. The survival rates are generally not good. When the cancer is detected early, the survival rate is nearly 50 percent but drops to as little as six months when its caught late and has spread into other organs, according to the American Cancer Society.

The rate of new lung cancer patients over the past 40 years has dropped 32 percent among men but has risen 94 percent among women, according to the American Lung Association. Yet, fewer than 50 percent of women most likely to contract the disease have spoken to their doctors about lung cancer.

In the United States, lung cancer is the leading cancer killer in both men and women. In 1987, it surpassed breast cancer to become the leading cause of cancer deaths in women.

In 2013, the latest data available from the U.S. Centers for Disease Control and Prevention, about 70,500 women died of lung cancer that year, compared to about 40,800 who died of breast cancer. Yet more than 80 percent of women cited breast cancer as their main cancer concern.

An estimated 158,080 Americans are expected to die from lung cancer in 2016, accounting for approximately 27 percent of all cancer deaths, according to the American Lung Association.

***

While oncologists do not know why there is a general increase for new lung cancer cases among women, doctors like Dr. Ravi Sandrapaty thinks it is because there was an increase among women smokers decades ago.

“The effect of smoking doesn’t manifest immediately,” Sandrapaty said. “So when people decrease smoking, you don’t immediately see a drop (in lung cancer cases).”

Not only is there a delayed manifestation of the disease, but estrogen also appears to interact with lung cancer and perhaps the toxic chemicals associated with small cell carcinoma.

Sandrapaty is a board-certified radiation oncologist affiliated with 21st Century Oncology in Ocala. The healthcare company has offices in 17 states. At his clinic, doctors use sophisticated machines that can better expose cancerous areas to radiation from multiple directions and in ways so as not to damage surrounding organs. With less damage to healthy tissue, he said, oncologists can now expose cancer areas to much more radiation to ensure remaining cancer cells are killed.

The radiation is most effective when the lung cancer cells divide and the DNA is most exposed and vulnerable, Sandrapaty said. But the problem is that some of the cancer cells break away from the main tumor and escape radiation. That is where chemotherapy drugs come in. They can find and fight the cancer cells where they might be hiding. But the downside is that many of those cancer drugs don’t work as fast as radiation.

That’s why it’s important to find the cancer early, Sandrapaty said.

There also is new screening for lung cancer, which oncologists say will detect many more early cases.

And, Medicare is now paying for low-dose computed tomography tests (typically referred to as CT scans) for people ages 55-77 who have smoked at least one pack of cigarettes per day for 30 years, are still smoking, or have stopped smoking in the past 15 years

The CT scans, if utilized by patients, are expected to curb lung cancer deaths by 20 percent.

Most lung cancers can be avoided altogether, Sandrapaty said.

***

Smoking, the main cause of small-cell and non-small cell lung cancer, is the cause behind 80 percent of lung cancer deaths in women, according to the American Lung Association. It is 90 percent in men. Even so, the rate of women getting lung cancer has been outpacing the rate of men getting the disease.

Dr. Rama Balaraman, an oncologist at Florida Cancer Affiliates in Ocala, said factors include that women are living longer than men, and adults whose parents smoked are more likely to get lung cancer than people who were not around smoking parents.

Despite the spike, she said, cancer treatment is far more advanced now, especially with anti-nausea drugs that help people tolerate chemotherapy drugs better.

“And we’ve had an evolution of new drugs,” she added.

Cancers associated with smoking and the toxins inhaled by the smoker void a healthy cell’s natural checkpoint to divide in a normal fashion. The drugs stop the cancer cells in new ways from dividing, often attaching to the cancer cells exterior receptors to stop the process, she said.

The problem is that lung tumors that were formed because of smoking often have several mutations, caused by the ingredients in cigarettes, that cause them to divide uncontrollably, she said.

She said that in addition to using chemotherapy drugs and specialized targeting drugs, oncologists now also use drugs to stop and kill new blood vessel growth, starving the cancer. They also give patients drugs to stimulate their own immune system, making it better at identifying and attacking tumors and abnormal growths.

“When it works it’s great, but it doesn’t always work,” Balaraman said.

The cancer cells evolved very well at dividing and “cloaking” themselves so drugs and the immune system can’t always recognize a bad cell. Unfortunately, “it’s an evolution gone wrong,” she said.

The point is to treat the lung cancer with a combination of drugs and other treatments before the it can mutate to resist or spread to other parts of the body and hide. That’s especially true with lung cancer because most lung cancers mutate very aggressively, she said.

***

Newvine, a seamstress, had a 14-year-old daughter and a 24-year-old son when she was diagnosed with cancer in 2010 . Her husband is a self-employed handyman.

Sandrapaty and her other doctors explained to her how they would treat her cancer with radiation and chemotherapy. They did not perform surgery.

“I was listening, but I was I wasn’t grasping it. I was hysterical. I thought I was going to die,” she said. “But it wasn’t so much the thought of dying as it was the thought of leaving.” 

Doctors treated Newvine for about five months. Sandrapaty routinely telephoned her to see how she was feeling and if anti-nausea medicines were working. She said she could not have gotten better care.

The cancer is in remission and she gets checked every six months. Meanwhile, she wants other women who smoked to consider testing so if they have cancer it can get caught early.

As for smoking and what she now knows now, Newvine said it was a terrible mistake.

“If I knew then what I know now,” she said, “I never would have picked up that cigarette.”

— Reach Fred Hiers at fred.hiers@starbanner.com and 352-397-5914.