The stigma problem
Before it can find its champion, lung cancer will have to shed its stigma. Last summer, advocates released an ad campaign aimed at shocking the public into examining its biases against people with lung cancer.
Posters featuring a young man with geeky glasses and a plaid scarf began popping up across the country. "Hipsters deserve to die," they read. "Cat lovers deserve to die," read another.
The point was provocation, said Kay Cofrancesco, a spokeswoman for the Lung Cancer Alliance, which sponsored the ads. When a person hears that an acquaintance has lung cancer, she said, a question immediately springs to mind: Did he or she smoke?
The answer often is no. Yet the stigma persists, even though lung cancer among nonsmokers is rising, with women accounting for two-thirds of these diagnoses. One famous example is Dana Reeve, the singer-actress and widow of Christopher Reeve. A nonsmoker, Reeve was just beginning to emerge from the grief of losing her husband when she was diagnosed with stage 4 lung cancer at age 44.
Yet blaming smokers who fell prey to cigarette marketing seems inconsistent – after all, society condemns tobacco companies for deceiving customers and even maximizing the addictiveness of cigarettes. We should "vilify the tobacco industry instead of vilifying patients," said Dr. Carolyn Dresler, an official with the Arkansas Public Health Department.
Lung cancer can be caused by such factors as exposure to radon, asbestos and other toxins. About 10 percent of lung cancer deaths are linked to heredity, said Ann Schwartz, a researcher at Wayne State University in Detroit. Yet lung cancer's image as solely a smoker's disease can undercut support for research that looks at other causes, such as heredity.
Changing the money
Many lung cancer advocates and researchers have called for a reassessment of the way money is distributed at the country's largest funder of cancer research, the National Cancer Institute.
Research grants from the NCI are the most important financing a cancer researcher can get. But the NCI's funding, allocated by Congress, has remained nearly flat since 2003, though it did get an additional $1.26 billion as part of the stimulus package of 2009.
Congress does not dictate how much NCI can spend on each type of cancer. Instead, NCI funds the cutting-edge science most likely to move the entire field of cancer research forward.
Lung cancer receives less funding than other cancers under this approach, too. In fiscal year 2012, the NCI will devote $221 million in research grants to lung cancer and $712 million to breast cancer, according to National Institutes of Health estimates.
NCI officials caution against reading too much into these numbers. Most of the research it funds is basic research applicable to multiple types of cancer. The institute also funds tobacco control and financed the National Lung Screening Trial, a large, multiyear study that showed that screening smokers via low-dose CT scans reduces the number of lung cancer deaths.
But some researchers, like Carbone, say the problem with the NCI's prerogative of funding the most advanced cancer research, regardless of what organ it involves, is that research on some types of cancer is further along than others. Breast cancer, for example, has been better funded for longer and had earlier breakthroughs that attracted more top researchers and more funding, from the federal government and other sources. "The infrastructure in the one disease is better than the other. It's a self-perpetuating problem," Carbone said.
Cancer research is increasingly focused at the molecular level instead of at the organ level. Researchers now know that cancers at different sites in the body can be caused by some of the same genetic mutations. But a single mutation can behave differently in different organs, so it is still necessary to look at particular cancers such as lung cancer, Carbone said.