Whatever It Takes

I was saddened to learn this morning of the death of Dana Reeve from lung cancer. Today was a reminder of what it was like to be a doctor, unable to provide a cure for a young person afflicted with cancer Each loss was a personal one, and served as a reminder of how much we needed to accomplish to prevent those tragic deaths.

Dana Reeve's death highlights the fact that not every case of lung cancer is caused by cigarette smoke. We will never know what actually caused this disease to occur in this 44-year-old woman, and her death highlights the need for us to better understand the causes of lung cancer in people who have no known exposures to toxic agents like cigarettes.

We also need to reflect at a moment such as this on the hundreds of thousands of families that are affected every year by the loss of a loved one to cancer. Their lives, their loves, their hopes and their accomplishments are all important, and they too are missed.

Celebrity puts some of us in the public spotlight. The lives and deaths of celebrities are magnified in our consciousness. When tragedy occurs, it makes all of us acutely aware of our own mortality and vulnerability. It also makes us more aware of what we don’t know, and what we need to learn to diminish that tragedy for others.

Ms. Reeve was a noble woman, who through her example and support for her husband during his time of need gave light to the problems and hopes of people with spinal cord injuries. She set an example for all of us as to what can be accomplished through love, devotion, and perseverance. Dana Reeve will always be remembered for showing so many what can be done in times of the greatest need. She was a vital and brave woman.

Lung cancer is viewed by many as a disease that is caused by the person whom it afflicts. That is not appropriate. For many, this is a disease that is the result of an addiction that is as powerful as it can be, that grips their bodies and prevents them from being able to break free.

And it is a disease that in many cases has no known cause.

The American Cancer Society reported recently that the number of cancer deaths in the United States has declined for the first time in over 70 years, and that the incidence of lung cancer in women is at a plateau after a continuous increase for decades. Experts have attributed this decline and these changes to cancer prevention, and especially to a decrease in smoking, along with improvements in cancer treatment.

Tobacco use, nevertheless, remains the number one cause of lung cancer, and lung cancer remains the number one cause of cancer deaths. The year 2006 will witness the incidence of 174,470 new cases of lung cancer; 162,460 persons will die this year because of it.

We need to move beyond "victimization" of lung cancer and increase our research efforts into its cause and treatment. We need to better fund our efforts at tobacco control, so fewer of us will have to deal with the horrible effects of this toxin.

It is never too late to quit smoking, clearly, and by any means. Surely the benefits of smoking cessation do outweigh the risks of some measures, for example, those producing a short-term exposure to nicotine, such as nicotine replacement therapies. There are other effective means to help patients stop smoking as well. Bupropion (Zyban) has been successful for some people who quit smoking. Further, counseling and support may also be effective options, and telephone helplines and support groups are available in many communities and in most states.

We need to communicate the importance of smoking cessation to the public and to our patients. We need to help our patients who smoke to quit. And we need to remember, too, that not all patients with lung cancer are smokers, or former smokers.

As oncologists and as a community, we need to do whatever it takes to help prevent these tragic losses.

— J. Leonard Lichtenfeld, MD