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When Dana Reeve announced last summer she had lung cancer, the diagnosis seemed particularly cruel. Never a smoker, the actress and singer had lost her mother and her husband, "Superman" star Christopher Reeve, just months before. But she handled the news with the elegant calm and optimism that Americans had come to expect from her during the nearly 10 years she cared for her husband, who was paralyzed from the neck down in a 1995 riding accident. In November, at a fund-raiser for the foundation she and her husband created to help victims of paralysis, a confident Reeve assured the star-studded audience: "I'm beating the odds." In January, she sang at a tribute to hockey legend Mark Messier and got a standing ovation. "She had no intention of dying," says friend Kathy Lewis, president and CEO of the Christopher Reeve Foundation.
But in February, Reeve took a turn for the worse. Last Monday, seven months after her diagnosis, she died at 44--leaving a teenage son behind. (The foundation says friends and family will care for him.)
Reeve rarely spoke publicly about the details of her disease. Still, her well-publicized battle has put lung cancer in the spotlight again and reminded millions of Americans that no one is immune to the nation's deadliest cancer. More than 172,000 people will be diagnosed this year, and almost as many--163,500--will die of it. And it has become increasingly clear that women have special cause for concern. Men account for about 54 percent of new lung-cancer cases, but the gender gap is closing. While the rate of lung cancer among men has decreased significantly in the past 80 years, it's jumped 600 percent among women.
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Much of that can be tied to an increase in the number of women who smoke. But one in five women who have the disease today has never smoked--that's twice the percentage among men. Women who develop lung cancer usually have had less tobacco exposure than men who get the disease, and they're more likely to be diagnosed at an earlier age--by one estimate, 60 percent of cases in women occur under 50.
Though the reasons for such gender disparities aren't entirely clear, many researchers think estrogen--a female reproductive hormone with well-known links to breast cancer--plays a role. In studies, cells taken from lung tumors were covered with estrogen receptors, and tumor cells appear to multiply faster when exposed to the hormone. A recent study of 500 women with lung cancer, in the Journal of Clinical Oncology, found that those who had used hormone-replacement therapy had significantly lower survival rates than those who hadn't (39 months, on aver-age, versus 79 months). Researchers like --Dr. Jyoti Patel, an oncologist at Chicago's Northwestern Memorial Hospital, have also found that the cells in women's bodies have a higher rate of mutations associated with smoking and a lower capacity for repairing DNA. This could make it tougher for them to mend cellular damage caused by carcinogens in cigarettes.
In the days after Reeve's death, there was speculation about what might have caused her cancer. Could she have put herself at risk by singing in smoky bars during the 1980s, when she was a regular cabaret performer? Did the stress of being a caregiver to her husband for nearly a decade make her more susceptible? While secondhand smoke is a known risk factor for lung cancer, it's impossible to know what role, if any, it may have played in Reeve's illness. As for caregiving, a 2003 study by researchers at Ohio State University and the University of North Carolina at Chapel Hill found the stress of caring for chronically ill loved ones over long periods actually accelerates the risk of age-related diseases like osteoporosis, arthritis and even cancer, by prematurely aging caregivers' immune systems. We can only speculate whether such a process was a factor in Reeve's case.
Besides smoking, the risk factors for lung cancer include exposure to environmental pollutants--especially radon, an odorless natural gas that can seep into homes from the soil--and family history. But thousands of cases elude explanation, says Regina Vidaver, of Women Against Lung Cancer. "They're just bad luck." The good news is that female lung-cancer patients tend to survive longer, though the overall survival rates are still grim; nearly 60 percent die within a year of diagnosis, and 85 percent die within five years. But new targeted therapies like Tarceva and Iressa seem to work better in women. Another drug on the horizon--Cell Therapeutics' Xyotax--also shows promise in women.
New therapies are already helping women like Cathy Bernas, a 41-year-old nonsmoking mother of four from Warrenville, Ill., diagnosed with stage IV lung cancer at the end of 2004. "I was ready to write my will and prepare for hospice," she says. But after standard chemotherapy, Bernas was given Tarceva and Alimta, a cancer drug approved in 2004. "I'm still alive and kicking," she says. Reeve wasn't as fortunate. But if the attention she brought to the stealthy killer leads to increased funding, she may help save the lives of thousands of other women.
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