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    Women and Lung Cancer: The Growing Threat

    It may not be politically correct, but Dr. Trudy Bush of Baltimore is trying to get her message to the masses: breast cancer is a problem, but lung cancer is much worse.

    "There has been a slight increase in the numbers of cases of breast cancer," said the University of Maryland epidemiologist and preventive medicine specialist, "possibly due to earlier diagnosis, but no increase in mortality."

    That's far from true for lung cancer. "Since 1987," Bush said, "lung cancer has killed more women than breast cancer, and I don't hear anyone screaming about that. As a public health person, it's distressing to see this virtually ignored."

    According to the American Cancer Society, the rate of breast cancer cases has remained virtually flat since 1930 - about 25 cases per 100,000 women. But look at the lung cancer rates - in 1930, about five women per 100,000 died of the disease. That number began to rise dramatically in the mid-1960s, and today, there are almost 43 cases of lung cancer per 100,000 women.

    Bush partly blames the media and its lack of attention to the issue for the public's ignorance about this tragic public health issue. The media shouldn't be swayed by what they think the public wants to hear or expects to hear, she said.

    "I had one of my students do a search on articles on women and lung cancer. There are 500 articles on breast cancer for every one on lung cancer. It's a shame because we don't have a lot of clues about the cause of breast cancer, but we do have a lot of clues about the cause of lung cancer. It's one tumor we know how to prevent."

    The other reason breast cancer overshadows lung cancer?

    "Women with lung cancer don't live long enough to become political advocates," Bush said. "There are a lot more breast cancer survivors than lung cancer survivors."

    As for the possible connection between hormone replacement therapy and breast cancer, Bush said that "there are just as many studies showing that estrogen has no effect or has a protective effect as there are studies showing that taking estrogen is a greater risk. It's such a terrifically difficult body of literature to summarize because you can find studies to support whatever you believe."

    Bush also said that studies linking hormone replacement therapy to breast cancer usually gain more attention than those that conclude there is no correlation between the two.

    "My philosophy of science is this: truth exists and we try to discover the truth. Every time we do a study, we take a sample of the truth."

    Women who can take estrogen after menopause should because the benefits of hormone replacement therapy far out weigh the risks, Bush said.

    "No drug is entirely without risk, and I think we have enough experience with estrogen to know (that) . . . taking estrogen has benefits and every woman and physician should evaluate them together."

    On the plus side, postmenopausal women who take estrogen have fewer cardiovascular problems, and suffer less osteoporosis, colon cancer and dementia than their peers who do not take estrogen. As for increasing the risk for breast cancer, Bush said that there also is no increase in breast cancer among women with a family history of the disease who take hormone replacement therapy.

    There are those who cannot take estrogen because of the risk of gall bladder problems, blood clots and embolisms (traveling blood clots that can be fatal).

    "My goal," Bush said, "is to help women identify their realistic threats."



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