A Journey With Lung Cancer

Posted by Kassy Perry

By Amy Docker Marcus
Wall Street Journal
January 8, 2019

Two years ago, at the age of 55, Terri Ann DiJulio was diagnosed with lung cancer—for the second time.

Ms. DiJulio says she was devastated. In the 12 years since her previous bout with cancer, her mother had died from lung cancer and two of her mother’s siblings were still fighting the disease.

Nonetheless, Ms. DiJulio says she was struck by how much had changed in the intervening years, not only for her but also for her family. There were better methods of early detection, more treatments and greater recognition that many people who get cancer, like her mother, never smoked.

During her first lung cancer, Ms. DiJulio had the right lower lobe of her lung removed. This time, the oncologist told her, there was a new method of radiation that would let her avoid a painful surgery and spare the rest of her lung. The approach let Ms. DiJulio, who is an avid bike rider, get back to cycling. In September, she rode 260 miles to raise $10,100 for the Bonnie J. Addario Lung Cancer Foundation.

“I had better options than my mother,” says Ms. DiJulio. “But I want the next generation after me to have better options than I do.”

Tuesday’s report by investigators at the American Cancer Society showed good news in the fight against cancer, with overall cancer mortality rates steadily declining over a 25-year period. The researchers estimated that, mainly due to people stopping smoking and earlier detection methods for many cancers, there were an estimated 2.6 million fewer cancer deaths from 1991 to 2016. There are also growing numbers of new drug treatments for lung cancer, including Merck & Co.’s Keytruda, which was approved by the Food and Drug Administration in 2015 to treat a form of lung cancer.

Still, 25% of all cancer deaths are due to lung cancer, and more people die from lung cancer than breast, prostate and colorectal cancer combined, says Rebecca Siegel, lead author of the American Cancer Society’s report. “We have made great progress,” says Ms. Siegel, the strategic director of surveillance information services at the American Cancer Society. “But the number of deaths from lung cancer is still shocking.”

Ms. DiJulio says her family’s story illustrates some of the ways things have gotten better, along with the many challenges that remain.

Her first lung cancer was found accidentally. Ms. DiJulio says she felt pressure in her chest so her doctor sent her to the hospital, concerned about a possible heart problem. Instead, scans turned up a nodule on her lung. Doctors said they weren’t sure if it was cancer and advised that she be closely monitored with regular scans. Ms. DiJulio, who had smoked around five cigarettes a day from the time she was 17, quit smoking.

Two years later, doctors said the scans revealed the nodule was growing, so Ms. DiJulio underwent surgery. “I woke up without the lower right lobe of my lung,” she said.

Eighteen months after Ms. DiJulio’s surgery, her mother, who never smoked, was also diagnosed with lung cancer. Ms. DiJulio’s mother felt pressure in her chest and went to the hospital thinking she was having a heart attack. She died in 2011 at the age of 79.

After Ms. DiJulio’s mother was diagnosed, doctors recommended that close family members receive screening using low-dose computed tomography. The screening found lung cancer in Ms. DiJulio’s aunt and uncle, who had no symptoms of disease. The disease was caught early, Ms. DiJulio says. They are both still alive; Ms. DiJulio’s aunt is now involved in a clinical trial involving Keytruda in patients who have a recurrence of lung cancer.

The U.S. Preventive Task Force endorsed CT scans to detect lung cancer in high-risk individuals in 2013.

According to the American Cancer Society report, lung-cancer screening has potential to identify tumors much earlier and has been shown to reduce cancer mortality by 20% in current or former smokers with a history of smoking the equivalent of two packs a day for 15 years or more. But many people, including Ms. DiJulio and members of her family, wouldn’t have qualified for screening under those guidelines.

Ms. Siegel says there are still challenges with making screening available to a wider population because the equipment is expensive, and it requires a prior conversation with a physician explaining risks and benefits.

Bonnie Addario, a 14-year lung-cancer survivor and chair of the foundation, says there is a need for more drugs, including targeted therapies. The foundation supports research into an inherited gene found in some lung-cancer patients and the development of early-detection screening methods for family members of lung-cancer patients.

Recently, Ms. DiJulio and her family members started discussing participating in a familial genetics research study. She thinks more personalized treatments may be the best hope, not only in her family’s long-running odyssey with lung cancer, but for improving mortality rates in the coming 25 years, too.

“I have a 20-year-old beautiful and vibrant niece, and I think about her,” says Ms. DiJulio. “My family has benefited from the advances, but we need to do more.”