Leading magazine downplays value of lung cancer screenings, to the detriment of advances in early detection research.

SAN CARLOS, Calif., March 20, 2013 /PRNewswire
-- 
The following statement was issued by Bonnie J. Addario regarding the March cover article in Consumer Reports: The cancer tests you need--and those you don't:

"I am appalled by the March 2013 Consumer Reports cover story (The cancer tests you need--and those you don't), because of the misleading and misguided message it sends to people who really need life-saving cancer screening tests, and how it discredits the value and importance of proper early detention cancer screening tests.

"The article's irresponsible reporting is best summed up in this statement on page 31: 'But most people shouldn't waste their time on screenings for bladder, lung, oral, ovarian, prostate, pancreatic, skin or testicular cancers.'

"Consumer Reports is one of the most trusted publications in America. Anyone, whether they know they are low or high risk, will read that statement and walk away believing early detection cancer screening tests are unnecessary. The six-page article mentions only twice that its ratings apply only to asymptomatic, low-risk population.

"Shame on Consumer Reports. We are talking about people's lives here.

"I myself am a lung cancer survivor. For more than a year I was misdiagnosed and not given an early detection screening test, even though I was in a high-risk category. When I was finally diagnosed I was stage 3B. Unlike so many others, I beat the odds. But my odds would have been better with an early detection cancer screening test. I founded the Bonnie J. Addario Lung Cancer Foundation seven years ago to advocate and raise money for better research, education, early detection and treatment. Because something must be done.

The stats are staggering.

• Lung cancer kills more people than the next five biggest cancers combined.
  
• Eighty percent of new lung cancer cases are former smokers or never smokers.
  
• Yet the five-year survival rate has been unchanged for more than 40 years. Only 15 percent of diagnosed patients live longer than five years.
  
• More funding and better research will lead to more effective early detection screening, which will save and prolong lives.
  

"Cancer screening and treatment are certainly at a crossroads, as the article states. This is made clear as well by recent legislation to direct more tobacco settlement money to early lung cancer detection programs. But the article's irresponsible representation of the value of screening tests, I fear, might damage the progress my lung cancer foundation has made over the past seven years - just as we are making great strides.

"People cannot readily see symptoms of lung cancer. Symptoms are deep in the lungs, unlike breast cancer, where lumps can be felt and are visible. When you are diagnosed with lung cancer it is often at stage four, when it's too late.

"The Consumer Reports article makes only one responsible and thoughtful statement: 'Weighing the risks and benefits of cancer screening is best done in the context of a patient-doctor relationship.'

"Consumer Reports should stay out of the health care advice business, and stick to writing about toasters and washing machines. I wouldn't approach my doctor about whether I should buy a Honda or a Ford. And likewise, people should not consult Consumer Reports to help them decide whether or not to have a potentially life-saving cancer screening test."

About the Bonnie J. Addario Lung Cancer Foundation 

The Bonnie J. Addario Lung Cancer Foundation is one of the largest philanthropies (patient-founded, patient-focused, and patient-driven) devoted exclusively to eradicating Lung Cancer through research, early detection, education, and treatment. The Foundation works with a diverse group of physicians, organizations, industry partners, individuals, survivors, and their families to identify solutions and make timely and meaningful change. BJALCF was established on March 6, 2006 as a 501c(3) non-profit organization and has raised more than $9 million for lung cancer research.

This article was originally published at About.com on January 10th, 2013 by Lynne Eldridge, MD.
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Studies have shown that when it comes to breast cancer, older women are more likely to be diagnosed with advanced stages of the disease.

Not so with lung cancer - at least in recent studies in Denmark and England. Instead, it seems the slogan reads "early age later stage."

Researchers in Denmark set out to evaluate the stage of lung cancer at which different age groups are diagnosed. Looking at people aged 65-69, those aged 70 to 74 were 18% less likely to be diagnosed with late stage disease. The trend continued on: Those aged 75 to 79 were 26% less likely, 80 to 84 were 27% less likely, and those over 85, 34% less likely to have a diagnosis of late disease. Since the stage at diagnosis makes a tremendous difference in long-term survival from lung cancer, this is something to stand up and take note of.

Why would younger people be less likely to diagnosed with lung cancer until it's reached the later stages of the disease? Or to ask the question in another way: Why does age seem to have a protective effect against late stage lung cancer diagnosis? Possibilities shared with me by Georogios Lyratzopoulous MD, one of the investigators in another study in England demonstating "early age later stage" include:

• There may be more "opportunistic" diagnosis among the older patients. This means that since older patients have more medical conditions, they are more likely to have their lung cancers "accidentally" diagnosed when a scan is done for some other reason.
  
• Young people may tolerate lung cancer symptoms more resiliently. This means that younger people may be able to "get by" or ignore lung cancer symptoms such as shortness of breath longer before they consult a doctor.
  
• My own speculation was that perhaps older people are more familiar with the symptoms that could be lung cancer by virtue of having had friends and acquaintances who have had lung cancer.
  

The conclusion based on these findings is that efforts to diagnose lung cancer early need to be tailored to different age groups. The stage of a lung cancer at the time of diagnosis can have a huge impact on younger patients with lung cancer. In the study above from Denmark, only 17% of the cancers were diagnosed at stage 1 and stage 2. To tailor the diagnostic process for different age groups, we need to focus on more diagnostic research instead of just treatment research.

Sources:

• Dalton, S. et al. Socioeconomic position, stage of lung cancer and time between referral and diagnosis in Denmark, 2001-2008. British Journal of Cancer. 2011. 105(7):1042-8.
  
• Lyratzopoulos, G. et al. Variation in advanced stage at diagnosis of lung cancer female breast cancer in an English Region 2006-2009. British Journal of Cancer. 2012. 106(6):1068-75.
  

In 2012, the National Cancer Institute will devote nearly $18,000 per death in research grants to breast cancer. They will devote under $1,500 per death to lung cancer.

Lung cancer programs receive a fraction of the grants devoted to types that take fewer lives, data show. The stigma of smoking looms large.

by Bridget Huber
This article was originally published in The Orange Country Register on November 15th, 2012.

Lung cancer takes more lives than any other cancer. This year it will kill an estimated 160,340 Americans – more than breast, colon and prostate cancers combined.

While lung cancer remains largely a death sentence – just 15.9 percent of those diagnosed are alive five years later – the federal government funds far less research on the disease than on other common cancers. The discrepancy is starkest when death rates are taken into account. In 2011, the two federal agencies providing most of the research money funded breast cancer research at a rate of $21,641 per death while spending $1,489 per lung cancer death.

It has been 41 years since President Richard Nixon signed the National Cancer Act, effectively declaring war on cancer. But there will be no victory without winning the battle against lung cancer, which causes more than one in four U.S. cancer deaths. Advocates say efforts to improve lung cancer patients' chances have been stalled by unexamined biases among health officials and the public as well as by scant research funds. They also cite the paradoxical invisibility of a disease that claims so many lives but has few champions of the sort who have brought breast cancer to national prominence.

The stigma of smoking is largely to blame. Anti-tobacco campaigns have done their job too well, leading many to see lung cancer as self-inflicted. That stigma keeps some families and patients from speaking out, while corporate donors stay away from the disease, and some scientists and policymakers question whether scarce research dollars should be devoted to a smokers' illness.

But an estimated 15 percent of lung cancers are diagnosed in people who never smoked. If lung cancer in these people was considered a separate disease, it would still be the sixth-leading cancer killer in the U.S., ahead of liver, ovarian and esophageal cancers. Researchers estimate that an additional roughly 50 percent of lung cancer cases involve former smokers who quit the habit years ago.

"This is a public health problem that needs to be addressed regardless of how it came about," said Dr. David Carbone, a leading lung cancer researcher at Ohio State University. "We need to take care of those who are sick and need to do everything we can from a public policy perspective to reduce the number of people at risk in the future."

Funding questions

Recent breakthroughs in cancer genetics and lung cancer screening have added urgency to advocates' calls for more money for lung cancer research, which will get $231.2 million this year from the two main federal agencies funding such work. "We are at a precipice where we could really break through," said Kim Norris, president of the Lung Cancer Foundation of America.

But these advances have come at a time when funding for all research is scarce. And many influential scientists balk at letting pressure from advocates influence research priorities. In their view, it could set the entire cancer research field back by creating a quota system for research on specific cancers that could divert funds from the most cutting-edge science.

Carbone, however, says unless a portion of federal funds is specifically directed to lung cancer, advances in the field will remain baby steps. "We didn't send people to the moon because we happened to have a rocket ship sitting around. We sent people to the moon by saying, 'That's what we want to do.' And then we figured out how to do it."

Making that moonshot will mean convincing the public and policymakers that lung cancer victims are worthy of support. Part of the challenge is that the disease is so deadly that there is no critical mass of survivors to raise its profile. Most people are diagnosed at an advanced stage and die within six months, said Jeffrey Borgia, a cancer researcher at Rush University Medical Center in Chicago. "There's not much time to fit a walkathon in," he said.

In contrast, breast cancer advocates have raised millions through everything from road races to galas. The White House is lit pink each October for Breast Cancer Awareness Month. Pink ribbons have been attached to items including pistols and fried chicken buckets, becoming so ubiquitous that some question whether the cause has become too commercialized. Lung cancer groups, however, have struggled to attract attention. The original color for lung cancer ribbons was clear – as in, invisible.

Perhaps the best example of how strong advocates can spur scientific research is the Defense Department's medical research program. In 1992, the National Breast Cancer Coalition, led by a breast cancer survivor and lawyer Fran Visco, persuaded the Defense Department to create a breast cancer research program funded by Congress. The resulting Congressionally Directed Medical Research Program has been allocated $2.8 billion for breast cancer research in the past two decades.

But even though the armed forces skew heavily male and military members smoke at high rates (cigarettes once were included in soldiers' rations and have been sold at cut-rate prices on military bases), it was 17 years before the program began researching lung cancer in 2009.

"It's really challenging now. There just isn't a champion," said Regina Vidaver, executive director of the National Lung Cancer Partnership.

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.

The other side of the argument is represented by Dr. Harold Varmus, the NCI's director. He declined to be interviewed, but in a speech at the National Press Club in September, he said he would "object dramatically" to efforts such as legislation that would force the NCI to set aside specific pots of money for certain cancers. This approach, advocated by some groups over the years, would "take the decision-making about grant making out of the hands of the NCI and [put] it in the hands of advocacy groups," he said.

by By Lynne Eldridge MD
This article was originally published at About.com on
November 29th, 2012.


As Lung Cancer Awareness Month draws to a close I'm glowing from hearing about all of the events - and how each year there are more and more advocates investing their precious time and energy to spread awareness and provide funding for lung cancer research. But amidst that glow is a sadness. It seems just when I get excited about a new organization or another medical institution promoting awareness, I read the second line. "The key to reducing lung cancer deaths is to launch more anti-smoking campaigns."

Yes, those campaigns are important. But if we want to reduce lung cancer deaths, anti-smoking campaigns just aren't going to do it. Or even come close.

I'm sure many of you are saying, what in the world is she talking about?

A statistic may help:

• Nearly 80% of people diagnosed with lung cancer now, in 2012, are non-smokers. All of the anti-smoking campaigns imaginable are not going to make a difference for this 80%.
  

Maybe a few numbers will make it even clearer. In 2008, the last year from which we have numbers available, there were 158,592 deaths from lung cancer in the United States, including 70,051 deaths in women. (Note that in the same year, there were 40,589 breast cancer deaths in women.) Using the 80% statistic, 126,874 of these deaths could not have been prevented by anti-smoking campaigns.

So why are we focusing on anti-smoking campaigns? Why are we focusing our attention on only 20% of people who develop lung cancer? Don't get me wrong. This group of 20% who are current smokers deserve our love and attention just as much. But what about the other 80%?

Since one of my pet peeves is listening to people rant who don't have a solution in mind, I'll offer a few.

Perhaps we should be focusing more attention on other known causes of lung cancer. Radon is the second leading cause and is totally preventable. Checking for radon in your home doesn't even take willpower. Occupational exposures need more attention as well.

And we need to focus more energy on treatment research. Even if we focus our efforts on the 20% with smoking cessation programs, many of those people will still develop lung cancer due to their history of smoking in the past.

To do this we need funding. To get funding, lung cancer needs to recognized. 

Thanks to everyone who worked so hard to make this year's Lung Cancer Awareness Month more visible. Blessings to all of you.

Sources:

• Centers for Disease Control and Prevention. Breast Cancer Statistics. Updated 04/30/12. http://www.cdc.gov/cancer/breast/statistics/
  
• Centers for Disease Control and Prevention. Lung Cancer Statistics. Updated 04/30/12. http://www.cdc.gov/cancer/lung/statistics/index.htm
  

Last year, as part of Lung Cancer Awareness Month, Stanford physicians got together to create and share a message of hope and educate the public about this devastating disease.  Please take about four minutes to watch this video and share it with friends and family

A heart-felt "Thank You" to the Stanford School of Medicine, Stanford Hospitals and Clinics, Liat Kobza, and Todd Holland for producing this EXCELLENT video.

October 23rd Update:  Check out Kelcey on TV's "The Doctors" HERE.

August 9th Update:  Check out this video about Kelcey from Jill's Legacy.

***The following article was written by Kelcey Harrison and published on The Huffington Post on July 31st, 2012.***

Kelcey is a native San Franciscan and is a major marathoner and lung cancer advocate. On July 30th 2012, after leaving her job at New York County’s District Attorney’s office, the 24 year old Harvard grad set out on her Great Lung Run – a 3,500-mile run from New York’s Times Square to downtown San Francisco. Harrison expects to arrive in November 2012 and will be blogging  and tweeting her adventures until then. 

Kelcey Harrison:

I don't know if I am in denial, am extremely naive, or if I truly am confident that this is exactly what I am supposed to be doing right now, but for some reason the fact that I've started running 30 miles a day and won't stop until I reach San Francisco doesn't seem to stress or scare me. Maybe it's just that crazy people don't realize they're that crazy?

I'm just your average 24-year-old who grew up in San Francisco, went to Harvard University, and moved to New York soon after college. For the last two years I worked at the New York County District Attorney's Office. Although I had the best time working there, I realized that law school was not really the route I wanted to take, and I was feeling a pull to make a change coupled with a very strong desire to contribute more to Jill's Legacy, I began thinking about some new options. 

This is where I break from the normal... The idea that I came up with was to run from New York to San Francisco to raise money and awareness for lung cancer. Lots of people asked, why? Couldn't I have done something a little less risky? But for me, it made perfect sense. I am using a skill that I have been blessed with -- running long-distance -- to make a difference and to draw people's attention to a topic that deserves greater discussion, awareness, and funding. I am doing something really big and out there, which was what Jill was all about.

Jill and I first met when we attended kindergarten together. We went to school together from kindergarten through high school and remained good friends through college. While we were in school, there was a group of about five of us that was inseparable. She was a friend who was always there for me and had been in my life for so long that I always expected her to be around for life's big moments.

When she was diagnosed with lung cancer at just 21 years old, it was a huge shock. I certainly did not know how to handle it, but she did. She lived with more grace, determination, strength, and joy than most people will ever demonstrate in their lifetimes. After her diagnosis she did a lot of advocacy work with the Bonnie J. Addario Lung Cancer Foundation. In the last year of her life, Jill was named Pac-10 Women's Athlete of the Year, she graduated Cal Berkeley with a 4.0 and she led the Cal Women's crew team to a national championship. A few weeks after, Jill passed away. After her passing a group of young people with connections to Jill and/or the foundation formed Jill's Legacy, an advisory board to the foundation. Our goal is to mobilize young people to use their voices and power to raise awareness for lung cancer and to really start a movement to demand a change.

Our goal is to debunk the stigma that faces lung cancer patients. The common belief that lung cancer is a smoker's disease or one that only affects older people is wrong. The first question people always ask in response to a diagnosis is, "Oh, you were a smoker?" The underlying message that comes across with this question is the idea that lung cancer patients somehow brought the disease upon themselves and so it is the last disease to get funding for research. This has to change. Nobody deserves to get cancer for any reason and, of equal importance no one deserves to get a disease for which there simply is not enough support. The survival rate for lung cancer has not changed in 40 years and that fact simply boggles my mind. With the technology we have today, there should be better options for early detection and treatment so that fewer lives will be lost. Why aren't people talking about this! For those of us who knew Jill, it drives us nuts.

So, my journey has begun and I already have so much to share! Follow my Twitter account, as I will be Tweeting the wild adventures and characters I encounter along the way.

I can't articulate how thankful I am for all of the support I have already received. I am already overwhelmed by the responses. We have raised over $100,000 since announcing the Great Lung Run just one month ago. I would be so appreciative of any support that readers can offer, whether that be in the form of a wave, a tweet or a penny. To support, visit www.thegreatlungrun.com, follow me on Twitter, or email me at [email protected]. 

by Linkda Geddes, New Scientist Magazine
Premium Health News Service
[This article was originally published August 22nd, 2012 in the Chicago Tribune.] 

It started with a sharp pain in her right side whenever she coughed or sneezed. At first, Stephanie Dunn Haney thought she'd broken a rib, so she decided to wait and see if the pain went away by itself. A year and a half later it was still there, so she went to her doctor, who performed an X-ray and found nothing. During the next 18 months, she had MRI scans, ultrasound, physiotherapy and chiropractic therapy. Still the pain didn't go away.

Dunn Haney began to suspect something more serious, but her doctor reassured her.

"She told me that she couldn't promise it wasn't something like cancer, but there was nothing to indicate that's what it would be," Dunn Haney recalls.

She had never smoked and had no family history of cancer, but Dunn Haney eventually persuaded her doctor to do a CAT scan. It revealed a shadow on her lung -- probably an old infection. She was referred to a specialist to double-check. He too said it was unlikely to be cancer, but Dunn Haney insisted on undergoing surgery to remove a sliver of lung tissue for testing.

In October 2007, 3-1/2 years after her symptoms first appeared, she was diagnosed with stage IV lung cancer -- as advanced as it can get.

Worldwide, more people die of lung cancer than from any other form, and the main risk factor is smoking. But lung cancer in people who've never smoked seems to be on the rise. In the U.S., 17.5 percent of lung cancers occur in this group, and among women the figure is even higher. In Southeast Asia more than 50 percent of women who get lung cancer have never smoked.

In fact, if this kind of lung cancer was regarded as a separate disease, it would rank as the seventh most common cause of death from cancer worldwide -- the sixth in the U.S.

"You're talking about three or four times as many people who have never smoked dying from lung cancer as die from cervical cancer," says Mick Peake, a respiratory physician at the University of Leicester, UK.

New research suggests lung cancer in those who've never smoked is indeed a very different disease. And if lung cancer patients were promptly referred for genetic testing and tailored treatment, rather than all being lumped together, they could have better survival prospects. Meanwhile, a study presented at a meeting of the American Society of Clinical Oncology in Chicago in June shows that such prompt referral is feasible, even for those without access to specialist cancer centers.

People who've never smoked may be genetically predisposed to lung cancer or may get it from exposure to air pollution. Sometimes second-hand smoke is to blame -- even as the number of people who smoke is diminishing in many countries as a result of public health campaigns.

Yet these health warnings seem to have had an unintended effect. Although they have dramatically cut smoking rates, they may also have stigmatized lung cancer patients and left both the public and some medical practitioners believing the disease is inevitably fatal. Recent research suggests that these factors mean people with lung cancer are less likely to be referred to an oncologist than those with other cancers.

In a 2007 study of 672 family doctors in the U.S, 34 percent said they would refer a patient with advanced breast cancer and a poor prognosis to a cancer specialist. Just 20 percent said they would take this action with a lung cancer patient in similar health (Journal of Thoracic Oncology).

"The nihilism associated with lung cancer is a big problem," says Joan Schiller of the University of Texas Southwestern Medical Center in Dallas, who supervised the study.

A new study of 36 lung cancer patients in Wisconsin raised similar concerns.

"A key issue is a lack of symptom recognition among primary physicians, particularly for patients without a smoking history," says Regina Vidaver, executive director of the National Lung Cancer Partnership, Madison, Wis., who's leading the work. "There's a lot of delay in getting the patients to diagnosis." In one case, she says, a lung specialist refused to refer a patient to an oncologist because he believed nothing could be done. "He was simply told to go home and get his affairs in order."

Many suspect this negative attitude may explain why lung cancer gets a fraction of the funding allotted to other cancers. In the UK, lung cancer received just 5 percent of the funding targeted at specific types of cancer in 2010, while 19 percent went to breast cancer (see chart, above). If you compare how much gets spent against the death rates for various cancers, the picture is even more startling. In the U.S., every death from breast cancer receives $26,398 of research funding, compared with just $1,442 per lung cancer death.

And yet what research is being done into lung cancer paints an unexpected picture of the disease -- one in which lung cancer in those who've never smoked is emerging as a separate illness with its own outlook.

GOOD MUTATIONS

Several years ago, Dr. Paul Paik at Memorial Sloan-Kettering Cancer Center in New York City and his colleagues discovered that people who've never smoked survived about twice as long with lung cancer as current or former smokers. Since then, they've been trying to figure out why.

In May, they published an analysis of tumors from 293 never-smokers and 382 current or former smokers. The study revealed significant differences in three genes that encode key cell-signaling proteins. Mutations in these genes can drive cancer growth.

The never-smokers were more than twice as likely as current or former smokers to possess mutations in the EGFR gene and six times as likely to carry a mutation in ALK. Meanwhile, 10 times as many current or former smokers as non-smokers carried a mutated form of a third gene, KRAS (Cancer).

"Never-smokers seem to have more good-prognosis mutations. Survival for patients with KRAS mutations is much worse," says Paik.

Some of Paik's colleagues have also been studying lung cancer patients who only smoked for a few years, typically while at college. The mutations driving their cancers seem to fall somewhere in between those of smokers and never-smokers.

The good news is that we can test for many of these genetic mutations, and even target them with drugs. Leading this wave are erlotinib (sold as Tarceva), which targets EGFR mutations, and crizotinib (sold as Xalkori), which does the same for ALK mutations. Drugs targeting KRAS mutations are also in clinical trials.

Targeted drugs seem to be particularly effective in never-smokers, whose tumors tend to have just one or two mutations. Tumors in smokers can contain hundreds of different mutations and are therefore harder to treat.

"While we're not talking about a cure, a lot of people who have the EGFR or ALK mutation do spectacularly well on these targeted drugs," says Peake. "The cancers usually do come back, but you can add 18 months or more on a life."

The challenge now is to change healthcare workers' perception of lung cancer to ensure that people get prompt and tailored treatment, rather than being dismissed as a lost cause.

"The main barriers are the availability and awareness of molecular testing," says Thomas Zander, of University Hospital, Cologne, Germany.

At the Chicago meeting in June, Zander explained how, with colleagues in Cologne, he founded a genomic medicine lung cancer network. The network provides a molecular testing service to non-specialist hospitals in the area. In its first 18 months, it handled 2,000 samples from nearby hospitals. In almost 80 percent of cases a molecular diagnosis was possible.

Until networks like Zander's are more common, many patients face an uphill battle to get the right diagnosis and access to potentially effective drugs.

The first oncologist Dunn Haney saw offered her standard chemotherapy and told her molecular testing was pointless at that stage.

"I said that you need to understand, I'm 39 years old and I have a 2-1/2-year-old and a 4-1/2-year-old at home. I have got to beat this," she says. "I was told that's very good, working with fighters is good. The only challenge is sometimes they don't know when to stop fighting."

She sought a second, and then a third opinion. Finally, she found a doctor in Pennsylvania who pointed out that while advanced lung cancer generally isn't curable, it can be managed just like diabetes or heart disease. After chemotherapy, Dunn Haney was put onto Tarceva and Avastin, drugs that kept her cancer in check for two years. When it started to grow back, her cancer tested positive for the ALK mutation so she switched to Xalkori.

It's now eight years since her symptoms began.

"I have fairly normal energy levels and no one really knows I'm sick," she says. Her doctor also has a back-up plan if Xalkori fails: an experimental drug called LDK 378, which targets the ALK mutation in a slightly different way.

Her daughters, Libby and Allie, are now 9 and 7, and for every childhood milestone that passes, Dunn Haney feels grateful.

"Whether it's teeth or sports wins or finishing a grade, it's not so important that I see them as it is that they know their mother was there to see them," she says.

On July 29th, Kelcey Harrison took off from NYC & began running across the country, averaging 30 miles/day until she reaches San Francisco in November. Follow Kelcey on twitter.com/greatlungrun or at thegreatlungrun.com.