Kathy Albain

Director, Thoracic Oncology and Breast Cancer Research

Cardinal Bernardin Cancer Center

Loyola University Health System

Deaths from lung cancer among women have risen 150 percent in the last 20 years, and the disease now kills about 70,000 women annually in the U.S., more than breast and ovarian cancer combined. To counter this trend Kathy Albain, an oncologist and cancer researcher affiliated with the Loyola University Health System in Maywood, helped found the professional organization Women Against Lung Cancer. Lung cancer, she says, may be different for women than men.

Harold Henderson: I’ve gotten used to the idea that cancer is not one disease but many. Now do I need to learn that lung cancer is too?

Kathy Albain: Probably each type of cancer is many different diseases, defined by individual molecular genetic profiles we are just beginning to understand. Regarding whether lung cancer is truly one disease in men and a different one in women, we don’t know for sure. There are two parts to the question. First, is there a difference in susceptibility to lung cancer by sex? Second, once lung cancer is diagnosed, does it respond differently to treatment? There are very interesting data coming out on both issues. As a medical oncologist, I do research on the second one.

In general, for the first question, it appears that females on average get lung cancer at a younger age and perhaps with less tobacco exposure than males. This is consistent with basic science in other areas, where we find that women metabolize various compounds differently than men do. Women tend to develop more of the subtype of lung cancer called adenocarcinoma. And when you look at lifelong nonsmokers who develop lung cancer there are twice as many women as men.

There are three main reasons why men and women may develop lung cancer differently, and they probably all interact. There are behavioral aspects–we know women smoke different cigarettes and may have different genes making them susceptible to addiction. There are biological differences–women may metabolize carcinogens differently or have less DNA repair capacity. Hormones most likely also play a role.

HH: What makes you somewhat tentative about the question then?

KA: The problem is that most of these data come from small studies that don’t always agree with each other regarding male-female differences in susceptibility to lung cancer. There have been no prospective studies conducted on this issue.

HH: Why not?

KA: For the level of importance lung cancer has on cancer survival in this country, the effort and money devoted to it–for advocacy, publication, and research–are woefully small. For example, I recently saw figures attributed to the National Institutes of Health on research dollars allocated per patient death: AIDS receives approximately $30,000, breast cancer $13,000, and lung cancer $1,500. This is a travesty for the number one cancer killer in both men and women.

But I think the tide is beginning to turn. Just recently the National Cancer Institute has funded a grant to the Southwest Oncology Group, a cooperative research group of 283 institutions. We’ll be studying this question in lung cancer tumor tissue and healthy tissue from men and women, smokers and nonsmokers.

HH: What about the other issue, about lung cancer acting differently in the two sexes once it’s diagnosed?

KA: Well, we’re on a bit more solid ground here. We have multiple clinical studies showing that after treatment women survive longer than men, even though women may experience more side effects from the therapy itself. What needs much more research is the why.

HH: So, will lung cancer come to be seen as two different diseases?

KA: In the future it may be more than that. For example, we know smoking causes lung cancer, but only one smoker in ten gets the disease. Part of the reason may be differences in how people’s bodies deal with the carcinogens in tobacco smoke. These biochemical differences come from common variations in our DNA called SNPs, or single nucleotide polymorphisms.

HH: Different DNA, different responses to the toxic exposure?

KA: Different degrees of activity or efficiency in the metabolism of the toxin. For example, there’s an enzyme called NAT2 that detoxifies the aromatic amines in tobacco smoke and in dyes. NAT2 has some common inherited variations that result in slower detoxification. The slow NAT2 genotype, which is present in about 60 percent of Caucasians, is associated with an increased risk of bladder cancer among dye workers. Other common SNPs affect how well we can repair DNA already damaged by carcinogens. Our new study will address many of the specific SNPs pertaining to lung cancer risk in men and in women.

HH: So we’re back to whether lung cancer is truly different by sex.

KA: So far there’s no cancer where we say “You’re a man, so we’ll treat you this way” or “You’re a woman, we’ll treat you this other way.” But there’s enough difference that we need to be sure to study all aspects of the question. In particular, we need to enroll enough women in clinical trials to detect any male-female differences.

What’s more likely to happen is that you might eventually be treated according to the molecular profile of your cancer rather than your sex. Your tumor gets a DNA profile and you do too, and treatment is prescribed accordingly–for instance, based on how you metabolize chemotherapy drugs together with what your particular tumor’s genetic profile is susceptible to. But all this is a little way down the road.

Even now, though, lung cancer is becoming a more exciting field to work in, because we have more to offer our patients. For example, 25 years ago for people in stage four of non-small-cell lung cancer, the most advanced form of the disease, the typical survival time was measured in weeks. Today it’s not uncommon for patients to survive beyond two years. And for patients with earlier-stage disease, we have significantly increased cure rates.

HH: That’s great, but not great enough for us to ignore prevention.

KA: Certainly not. In the near term what’s needed is greater awareness about lung cancer and smoking. I think the public knows that smoking causes lung cancer, but they don’t know how much at-riskness you maintain after not smoking for years or after having been exposed to smoke. For instance, someone who smoked 21 or more cigarettes a day and quit five years ago still has about the same risk of lung cancer as when she or he was smoking. Only after that does the risk start to decline, and at best it remains four times as great as for someone who never smoked.

By the way, does the Reader have tobacco ads?

HH: Yes.

KA: In the past that’s stopped these stories, especially in the major magazines that accept tobacco advertising. But again, this is beginning to change. The Tribune did a story on women and lung cancer this fall. This past year Newsweek quoted me in its issue on women’s health. Lung cancer got half a page–the first time a major newsmagazine in this country has addressed the lung cancer problem in a meaningful way.

Art accompanying story in printed newspaper (not available in this archive): photo/Lloyd DeGrane.