Dannie Woodrum jumped out of bed screaming, “I’m having a heart attack!” The 32-year-old had gone to bed with an aching chest, convinced she was coming down with the flu.

But it wasn’t the flu, and it wasn’t a heart attack. Nor was it the pneumonia two different hospitals diagnosed her with over the next two weeks. Only after her primary care physician referred her to a pulmonologist did Woodrum learn she had lung cancer.

She traveled to Duke, where doctors determined that the cancer had spread only as far as the surrounding lymph nodes. Thoracic surgeon Thomas D’Amico, MD, performed minimally invasive surgery to remove the tumor -- a technique proven to preserve lung function and result in less pain and a faster return to activity than the traditional open-chest procedure.

Eight years after her surgery and subsequent chemotherapy and radiation therapy, Woodrum is cancer-free.

“Dr. D’Amico told me I was lucky,” she says. Woodrum’s frightening wake-up call happened when her relatively small tumor blocked her airway, causing her lung to collapse.

“If that hadn’t happened I could have gone on for several years without knowing what was wrong, and I would have died,” she says.

Incidence Increasing for Women

Unlike Woodrum, most people with lung cancer are diagnosed only after the disease has reached an advanced, incurable stage; the five-year survival rate is just 14 percent.

In women, diagnosis is confounded even more because many people still think of lung cancer as a disease that affects male smokers. But the incidence in men has been steadily dropping, while cases among women climbed 60 percent from 1990 to 2003.

While these numbers largely reflect the growing number of women smokers, many of the women diagnosed with lung cancer today quit smoking long ago.

“We don’t know whether it’s due to environmental factors or an estrogen link or something else, but women are at higher risk than men for developing tobacco-induced lung cancers, even with lower total exposure to tobacco,” says Duke oncologist Jennifer Garst, MD.

“They tend to get cancer at an earlier age, and they’re also more likely to develop non-smoking-related forms of lung cancer.”

Same Treatment, Different Responses

At Duke and other cancer centers nationwide, physician-scientists are beginning to investigate why women are more susceptible to lung cancer, and why different people respond differently to the same therapies.

Last year, for example, a breakthrough study showed that an experimental treatment, the epidermal growth factor receptor (EGFR) inhibitor Tarceva, extended survival by an average of two months in patients with the most common type of lung cancer.

But what’s most intriguing about EGFR inhibitors, says Duke medical oncologist Jeffrey Crawford, MD, is that they work exceptionally well in women, Asian patients, and people who never smoked.

Crawford, who has led trials of the therapies at Duke, says that this year, scientists found out why -- these patients have a particular mutation in the EGFR protein targeted by these drugs.

The findings have already changed clinical practice. At Duke, patients who fit the profile are now tested for the EGFR mutation, and the results used to select their therapy.

“This is the first time in lung cancer treatment that we’ve ever been able to direct therapy based on a biologic feature of a tumor,” Crawford says.

Chemotherapy Benefits

Physicians have also learned that chemotherapy, which has been commonly used for advanced-stage lung cancer, can benefit a wider range of patients.

Last year two landmark studies demonstrated that chemotherapy dramatically improves survival in earlier stage lung cancer patients (stage IB to stage III) who have had surgery to remove cancerous tumors.

Crawford, who led Duke’s participation in one of the trials, says more patients are now being treated with chemotherapy at earlier disease stages, whether after surgery or to shrink the tumor before surgery.

With more patients receiving chemotherapy, guarding against its ravages becomes more urgent. Duke scientists have developed and tested protective agents that can reduce complications of chemotherapy such as fever, infection, or anemia.

White-cell growth factors such as Neupogen (filgrastim) and Neulasta (pegfilgrastim) can prevent fever and infection, and erythropoietic agents can reverse anemia by stimulating red-blood-cell growth.

Many lung cancer patients also suffer weight loss and nutritional deficits which can endanger their health -- problems that can be exacerbated by chemotherapy and other treatments.

Women experience more nausea after chemotherapy than men, so Garst often assigns them to gentler regimens or adds anti-nausea medications. She and her colleagues have also studied the use of flavor enhancers to improve patients’ appetites.

Patient Support Critical

Psychological and spiritual support is also critical, and Duke provides it with an extensive Cancer Patient Support Program.

“The anxiety associated with cancer can be every bit as painful as physical pain, and we work hard to help people manage that, whether through medications, meditation, or exercise such as yoga, which can also improve patients’ breathing capacity,” Garst says.

“Lung cancer is a deadly disease, and there are many situations in which we can’t cure our patients,” she adds. “But we can still care for them. That means supporting them, supporting their family, and giving them the best quality of life we can, for as long as we can.”