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Anderson Cooper 360 Degrees

Lung Cancer: The Quiet Killer

Aired March 07, 2006 - 23:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

JOHN ROBERTS, CNN CO-ANCHOR: This is a special edition of 360. Anderson is off tonight. I'm John Roberts in Washington.
HEIDI COLLINS, CNN CO-ANCHOR: And I'm Heidi Collins in New York. Tonight, an in-depth look at lung cancer, the quiet killer.

(BEGIN VIDEOTAPE)

ANNOUNCER (voice-over): What you don't know about Dana Reeve and the quiet killer that took her.

UNIDENTIFIED FEMALE: We have to treat lung cancer as a disease, not a punishment.

ANNOUNCER: The fight we must not ignore, and why experts say they're not getting what they need to win the war on lung cancer.

Seven-time Tour de France winner, cancer survivor and friend of the late Dana Reeve, tonight Lance Armstrong and a life cut short and why money for cancer research should be such a priority.

So like Dana, Sandy, Tammy and Arlene, all with lung cancer, all battling the disease and not ever smoked.

SANDY BRITT, LUNG CANCER PATIENT: Well, I was completely devastated. And I just thought well, I'm dead.

ANNOUNCER: Tonight, a powerful message. What they want you to know so you can save your life.

Call us. 360's panel of medical experts take your calls on the detection, the treatment and the race to find a cure.

That and more, all ahead on this special edition of ANDRESON COOPER 360. "Lung Cancer: The Quiet Killer".

(END VIDEOTAPE)

COLLINS: This year alone 174,000 Americans will be diagnosed with lung cancer, and more than 90 percent will die from the disease. And you don't have to be a smoker to be a victim. We learned that today with the death of Dana Reeve.

Tonight we're going to look back at her remarkable life and at the facts of this quiet killer. We'll also be talking to cancer survivors, including Lance Armstrong. And we want to hear from you, too. Call us. That toll-free number, 877-648-3639. 360 MD Sanjay Gupta is here, and so are the experts. Susan Mantel, she's the executive director of Joan's Legacy Lung Cancer Foundation; and Dr. Kathy Albain, a professor of medicine.

Again, the number to call, 877-648-3639 -- John.

ROBERTS: And Heidi, we begin this hour with a life that was tragically cut short. Dana Reeve, the widow of Christopher Reeve, was diagnosed with lung cancer seven months ago. Yesterday she died from the disease -- and only 44 years of age.

She leaves behind three children, and the lasting legacy of a courageous woman who never gave up.

(BEGIN VIDEOTAPE)

UNIDENTIFIED MALE, CNN CORRESPONDENT (voice-over): When Dana Reeve was diagnosed with lung cancer last year, she faced a familiar question -- how do you cope with it all?

DANA REEVE, LUNG CANCER VICTIM, 1961-2006: We're going to get through this like we got through everything else.

CNN CORRESPONDENT: Her smile masked a tremendous will, one that got her through all but impossible times. So difficult, few people could imagine.

D. REEVE: Life keeps me going. I'm basically a happy person. I don't need a lot of prompting to keep going.

CNN CORRESPONDENT: Dana Reeve's first passion was the theater, studying in London, and finding a home at the Williamstown Theatre Festival in Massachusetts, where she met the man who would become her second passion.

The Reeves were married in 1992. He made movies; she acted and sang cabaret. They had a son, Will.

In 1995 their world fell apart. Christopher Reeve was paralyzed in a riding accident. Dana, he said, gave him the strength to go on, telling him he was still the same person she married just three years before.

CHRISTOPHER REEVE, DANA'S HUSBAND: And then you realize how lucky you are to have people who are there for you no matter what. Yes, it may be an achievement to fly solo, but there's a great deal more true satisfaction in flying together.

CNN CORRESPONDENT: For a decade, Dana Reeve was her husband's rock. Nursing him through a painful rehabilitation. Together, raising public awareness of and money for spinal cord research. And speaking out for the rights of the disabled.

D. REEVE: He now faces what hundreds of thousands of disabled men and women face daily in this country and around the world -- limitations, frustration, sorrow, anger, humiliation, injustice. But also, on a daily basis, he experiences great joy.

CNN CORRESPONDENT: She made sure the public saw the man and not just the wheelchair. But she didn't abandon her own acting career, appearing on stage, and on the small screen in the TV dramas "Law & Order" and "Oz."

D. REEVE: I'd like to add your name to the list.

CNN CORRESPONDENT: When Christopher Reeve died in October 2004, Dana Reeve was soon back in the public eye.

D. REEVE: As I proudly introduce our friend and declare my vote for the next president of the United States, John Kerry.

CNN CORRESPONDENT: Turning her private pain into public clout, championing stem cell research to honor her husband's struggle.

D. REEVE: He worked so hard and his work was so important that we really need to go forward.

CNN CORRESPONDENT: She went forward herself, returning to the stage and the cabaret. But fate dealt her another blow -- lung cancer.

D. REEVE: It's just when you think you're coming out, you know, and you think, OK, it's all right, I see the light at the end of the tunnel, and then I got this diagnosis in the summer. But I think I learned a long time ago that life just isn't fair, so you better stop expecting it to be.

CNN CORRESPONDENT: Dana Reeve lived her final months as she had lived her whole life, with a smile and a song. One of her last public appearances, a January tribute to hockey legend Mark Messier.

(END VIDEOTAPE)

ROBERTS: She really lived her life in a way that truly defined the word grace. And across the nation tonight, people are wondering how she ever did it -- Heidi.

COLLINS: Oh boy, you got that right, John.

Well, earlier we had the chance to speak with Lance Armstrong, the cancer survivor and champion athlete who was a friend of Dana Reeve. And he shared his thoughts about her.

(BEGIN VIDEOTAPE)

COLLINS: You have to have every ounce of fight to be fighting a disease like this. And then to add in this very, very complicated extra layer of being a celebrity. And there are obligations there, I would imagine, too. How do you handle all of that at the same time?

LANCE ARMSTRONG, LANCE ARMSTRONG FOUNDATION: Well, I don't know. You know, fortunately when I was diagnosed, I was -- it made news, but it didn't make huge news, so I was able to sort of live my life and fight my disease in a fairly private way.

For Dana, I mean, through the process on the heels of Christopher's death, you know, it was tough. It had to be very private and they wanted to be private.

But now that she's unfortunately passed away, it brings a whole new level of awareness to the disease. And I think Peter Jennings' passing was huge for cancer. I mean, we don't ever want to lose anybody, but when Peter Jennings dies of lung cancer, people say, oh my God. What? Peter Jennings died?

When Sheryl Crow was diagnosed with breast cancer, people said, oh my God. Sheryl Crow has breast cancer?

I mean, it brings a spotlight to the illness that we desperately need. And so you have to take these opportunities and ask hard questions of the people who make the big decisions, and say, hey, enough is enough. You know, it's been a long time since we've decided to fight this war, and we're not doing enough.

I looked at -- it's ironic because I looked at my disease and I was -- let's say it was a coin toss when I was diagnosed. And that doesn't sound very good. I mean, I don't want to flip a coin for my life right now. But I'd actually looked at lung cancers that are 3 percent or 4 percent survival rate. I said, boy, I'm glad I'm not that guy.

And so, you know, other people might be a 95 percent cure rate, or whatever. And as we said just on "LARRY KING," I mean, we should not -- I mean, the patient walks in and says what are my chances? Give me my number, Doc. Is it 50 percent? Is it 2 percent? Is it 98 percent? We're not numbers.

And so you have to go in, you have to ask the hard questions, get second, third, fourth, fifth opinions, whatever it takes to find the place that you feel like you'll be best served.

And after that, you know, you sit down and you say, I'm here. This is my place and I'm going to believe in these doctors. I'm going to believe in the medicine. I'm going to believe in the procedures. And I'm going to believe I'm going to make it. And if I don't make it, I want to die in peace, knowing I tried everything.

And I got to a place when I ended up at the Indiana University, I said, look, you know, if this doesn't work out, boy I can't question anything.

(END VIDEOTAPE)

COLLINS: Lance Armstrong is not there by accident, I am certain of that.

And there's an awful lot we know about lunch cancer, but certainly there may be much more that we do not. So here to give us a quiz of sorts on this quiet killer is our own 360 MD Dr. Sanjay Gupta.

OK, some true or false questions here. Number one, lung cancer cannot be prevented, true or false?

SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: That is absolutely false. And I think a lot of people understand this already. Talking about smoking, far and away the number one cause -- a preventable cause, I should say, of lung cancer. It's not to say that a certain percentage of men and women who never smoke don't get lung cancer. About 10 percent of men who have lung cancer never smoked. It's actually higher for women -- 20 percent of women who get lung cancer never smoked as well. But smoking is a preventable cause.

COLLINS: It's so scary, though. And as you say, smoking, by far the number one cause of lung cancer. But radon, the leading cause of nonsmokers' cancer -- true?

GUPTA: That is true. Radon is the -- you could call it the second leading cause of lung cancer. You can call it the number one cause in people who have never smoked. That's radon. Again, it's just a naturally occurring gas and actually it's a uranium byproduct. It's in the soil. You can test for it in your homes.

If you've had an older home, you can actually test for it in the basements. About one in 15 homes have radon levels that are too high in this country. And you can do something about that. It may involve putting gravel around your basement, covering it with plastics. You can talk to your builders about this. But it's important, because about 12,000 to 20,000 cases of lung cancer every year because of radon exposure.

COLLINS: All right, so the last one then -- some cancer drugs actually might work better for women, true or false?

GUPTA: That is true. And this is interesting. We're learning a lot about how these drugs certainly work. There's a couple of drugs out there, they're called the targeted therapies.

Tarceva is one of the drugs. Tarceva appears to have some additional benefit in women vs. men. We're not entirely sure why.

There's also another drug out there called Iressa, I-R-E-S-S-A. It's an important name if you're someone who's taking the drug. It's found to have a significant benefit in women vs. men. You can't get it anymore for new patients because it wasn't found to have a significant benefit overall. But women seemed to respond to this drug a little bit better.

COLLINS: Because of the estrogen?

GUPTA: You know, estrogen is an important hormone here. Maybe it's fueling the cancer in different ways. I don't know. I don't that anyone really knows how these play a role, but estrogen is probably something that makes the cancer a little bit worse in women.

COLLINS: All right. 360 MD Dr. Sanjay Gupta, thank you for that.

John, back to you. ROBERTS: Heidi, over and over today, we heard people say just how shocked they were that someone as young as Dana Reeve, a nonsmoker, could have died from lung cancer. But the reality is that thousands of nonsmokers -- many of them women, get lung cancer each and every year. And when they do, they face the same grim odds that every lung cancer patients faces.

Here's CNN's Rob Marciano.

(BEGIN VIDEOTAPE)

ROB MARCIANO, CNN CORRESPONDENT (voice-over): Tammy Willet (ph) watched Annie smoke, get cancer and eventually die. Tammy never smoked, but she got cancer anyway.

TAMMY WILLETT, CANCER VICTIM: It's not a smoker's disease. It can happen to anyone. I'm a prime example.

MARCIANO: About a year ago, Tammy was feeling fantastic. On a Caribbean vacation with her husband and 9-year-old daughter. But as she returned, she had trouble breathing. At the hospital, they told her why.

(On camera): What was your reaction the day you found out you had lung cancer?

WILLETT: That they were wrong. That there was no way, because I had never smoked. And then I was in shock.

MARCIANO: In her home no one ever smoked. And she tested for radon, but never found any. But here she is at age 46 with late-stage lung cancer. Tammy figures that means something.

WILLETT: Maybe I'm supposed to do something else. Maybe I'm supposed to help with this fight.

MARCIANO: Tammy joined the Lung Cancer Alliance and plans to go to Washington to lobby for more research money. She's determined to make a difference and survive.

WILLETT: But you think about, you know, what you can do to make it work, what you can do to keep going. And you know, you just don't want to get on that downside where you think it's not going to be OK. Because it is. I've got to see her go to college. I've got to see her get married. You know, it's got to be OK.

MARCIANO: Giving up is not an option.

Rob Marciano, CNN, Atlanta.

(END VIDEOTAPE)

ROBERTS: And ahead, we'll meet two more women who never dreamed that they would get lung cancer. One was told by her doctor not to worry, that she couldn't possibly have lung cancer because she had never smoked. He was wrong. And that mistake may cost her her life. This woman, though, was lucky. Her doctor tested her for lung cancer even though she had never smoked. The test saved her life. And today for the first time she's telling her story.

And we want to hear from you as well. Call us toll-free at 877- 648-3639 with your questions about lung cancer. Our panel of experts, including Dr. Sanjay Gupta, will be standing by to answer them.

All that ahead, on 360.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

KATHY LEWIS, PRESIDENT, CHRISTOPHER REEVE FOUNDATION: She is my hero, and because she is beautiful inside and outside and I think a role model for all of us.

(END VIDEO CLIP)

COLLINS: If you thought you were immune to lung cancer because you don't smoke, well, it's just not true. As the death of Dana Reeve proves.

But since most lung cancer is caused by smoking, there's a chance that diagnosis may be missed in nonsmokers. Missed because the patient doesn't fit the profile. That's what happened to Sandy Britt.

Here's CNN's Dan Simon.

(BEGIN VIDEOTAPE)

DAN SIMON, CNN CORRESPONDENT (voice-over): Sandy Britt exercises, eats a low-fat diet, doesn't drink and has never smoked a cigarette in her life. So four years ago when a chest x-ray revealed a small spot on her lung, cancer didn't seem likely. She says her doctor told her it was nothing.

SANDY BRITT, LUNG CANCER PATIENT: And he said, no, you're fine. You don't have anything to worry about. And there's no need to follow up.

SIMON: Sandy was relieved. She'd seen her father and brother both die of lung cancer. It would be too painful for her mother to lose her last child, especially to the same disease.

Three years after that visit to the doctor, Sandy developed a cough. She thinks that small spot on her lung had in fact been cancer. By now, the tumor had grown to the size of a golf ball. It was stage four cancer.

BRITT: Well, I was completely devastated. And I just thought, well, I'm dead. Because that's what I knew about lung cancer. My brother died in three weeks and my father died in six weeks.

SIMON (on camera): One doctor told Sandy she, too, had less than a year to live. But Sandy beat those odds. She responded to a relatively new drug called Iressa. It seemed she had a fighting chance, only to learn in the past several months that the drug is no longer working and the cancer is growing again.

BRITT: I'm terrified. I mean, you know, I've spent the last several months writing my will, making my funeral arrangements. I just bought a crypt for myself, to be buried with my father.

SIMON: Sandy, now 47, is dedicating the rest of her life to raising awareness about lung cancer, especially that nonsmokers like herself can get the disease.

BRITT: There's 25,000 people a year who get lung cancer who never smoked a day in their life. Dana Reeve was one of them. I'm one of them.

SIMON (voice-over): Because she didn't smoke, no one thought Sandy would get lung cancer. That apparent misdiagnosis, she says, will cost her her life.

Dan Simon, CNN, San Francisco.

(END VIDEOTAPE)

COLLINS: Clearly, lung cancer is not just a smoker's disease. And when care is taken to remember that, it can mean a difference between life and death. Here's what happened when a doctor looked for lung cancer, even though the patient did not fit the profile. And now the patient who once hid her disease, wants everyone to know her story. Here's CNN's Rick Sanchez.

(BEGIN VIDEOTAPE)

RICK SANCHEZ, CNN CORRESPONDENT (voice-over): Arlene Bronstein is strong-willed. Two years ago she made a very personal decision. She would never talk about her lung cancer, except with her closest friends. She didn't want to seem a victim.

But with the news of Dana Reeve today, she changed her mind.

ARLENE BRONSTEIN, LUNG CANCER SURVIVOR: I was stunned.

SANCHEZ: Bronstein was diagnosed with lung cancer after a routine chest x-ray. Her doctor saw a mass on her lung, but the last thing she wanted was pity.

BRONSTEIN: I didn't tell people when I was first diagnosed because I didn't want people looking at me as a lung cancer victim. I mean, that's what people do as a cancer victim, oh poor you. That's not me at all.

SANCHEZ: Brownstein was extremely lucky, because most doctors would never look for lung cancer in a non-smoker like her.

BRONSTEIN: If you say you have lung cancer, they always assume you've smoked. Which is simply not true. SANCHEZ (on camera): It bothers you that people immediately assume you're a smoker.

BRONSTEIN: I think it's very important that the general public sees that I'm a 57-year-old healthy woman who exercises regularly and I have a lung cancer -- or had lung cancer, however you want to put it.

SANCHEZ: Dr. Daniel Libby, who diagnosed Bronstein, says he's seeing more and more nonsmoking women with lung cancer.

DANIEL LIBBY, DOCTOR, NEW YORK WEILL CORNELL MEDICAL CENTER: There's really no reason lung cancer should have such a bad rap. In my opinion, if we catch it early, they should have a very good prognosis. Meaning, after removal, the person should be cured.

SANCHEZ: No one is sure why this trend is happening, but Dr. Libby insists the best prevention is early detection.

LIBBY: Since 1995, I would say 2,000 -- it's very common for a pulmonologist, like myself, to see lung cancer in nonsmoking women.

BRONSTEIN: OK. No problem.

SANCHEZ (on camera): Nobody knows that better that Bronstein. She's living proof that cancer doesn't have to be a death sentence. Still, every six months when she goes for her checkups, she's scared. It could come back.

So you go in thinking the best...

BRONSTEIN: Yes.

SANCHEZ: ... but you got some butterflies?

BRONSTEIN: Oh, of course. Oh, absolutely. It's impossible not to.

SANCHEZ: You're a little scared?

BRONSTEIN: Sure.

SANCHEZ (voice-over): Most people who work with Bronstein at this major law firm don't even know she had lung cancer. After this interview, they likely will.

Bronstein says that's OK if more women opt for regular checkups to overcome this quiet killer.

Rick Sanchez, CNN, New York.

(END VIDEOTAPE)

ROBERTS: A difficult question when 360 continues, why is so little research money spent on a form of cancer that kills so many people? We'll get to that. But first, Erica Hill, from "HEADINE NEWS," joins us with some of the other stories that we're following tonight -- Erica.

ERICA HILL, CNN CORRESPONDENT: Hi again, John.

Sixteen controversial provisions of the Patriot Act will not expire this week after all. The House of Representatives voted tonight 280 to 138 to renew the provisions. They've been bottled up in December by a bipartisan group of senators who were seeking to reign in some of the authority Congress gave law enforcement after 9/11. President Bush has said he'll sign the bill.

Another storm victim's body found in New Orleans six months after Katrina. Authorities were led to the cadaver by trained dogs after a report from a man who had been digging for scrap metal behind a house. A body was also found earlier in the day by someone who was combing through rubble in the lower Ninth Ward.

Across the country it is usually the test takers who make the mistakes, but this time, the test giver. About 4,000 students who took the main S.A.T. college entrance exam last October, received incorrectly low scores because of problems with the scanning of their answer sheets. Now, the College Board, which owns the exam, notified college admissions offices of the mistake. It provided the proper scores for affected students.

And the country lost an extraordinary rarity today. Gordon Parks passed. He was the director of the 1971 movie, "Shaft." Also a photographer, writer, painter, composer and social activist. Parks was 93 -- John.

ROBERTS: Erica, thanks.

And back to the issue at hand, and a question even tougher than how a nonsmoker ends up dying from lung cancer. The question is this: If it is such a horrible disease, with good treatments on the horizon, where is the money to get there? We'll investigate.

And we'll be taking your calls -- Dr. Sanjay Gupta and company. The number again, 877-648-3639.

This is a special edition of 360.

(BEGIN GRAPHIC)

2004 Research Funding

Breast cancer: $566.2 million Prostate cancer: $308.5 million Lung cancer: $276.5 million

(END GRAPHIC)

(COMMERCIAL BREAK)

ROBERTS: Every year lung cancer kills more women than breast and ovarian cancer combined. So why does breast cancer research get so much more federal funding? A simple question, with no simple answer.

Here's CNN's Joe Johns.

(BEGIN VIDEOTAPE)

JOE JOHNS, CNN CORRESPONDENT (voice-over): This is Dr. Jim Herman's world.

JAMES HERMAN, DOCTOR, JOHNS HOPKINS MEDICAL CENTER: In this room we have what are called PCR machines. These amplify DNA from...

JOHNS: The Johns Hopkins Medical Center here in Baltimore. His slice of the cancer mystery, how certain genes mutate, while others don't.

HERMAN: Our hope is we can use those changes for understanding the biology of the cancers, hopefully directing therapy according to the changes that occur.

JOHNS: There's great optimism here about the promise of genetic research to help identify lung cancer at its earliest stages. Though there's also great frustration because the money to fund the research has fallen way behind the science.

(On camera): One of the realities researchers face is that most, but not all of the people who get lung cancer are smokers. Which may be part of the reason why some scientists say lung cancer has not gotten the kind of funding they think it deserves.

(Voice-over): The facts are hiding in plain sight. Lung cancer is the deadliest form of cancer for both men and women. Almost 163,000 deaths are expected this year. But for such a deadly disease, the funding levels for lung cancer are relatively low.

Compare the number of deaths to the amount of funding, and the picture is stark -- nearly $14,000 for each breast cancer death; more than $11,000 for every prostate cancer death; and just $1,700 per lung cancer death.

Dr. Chi Van Dang (ph) is vice dean of research at Hopkins. He says federal funding increases have failed to keep pace with inflation. He compares the process of finding a cure to other demands for spending.

CHI V. DANG, DOCTOR, JOHNS HOPKINS MEDICAL CENTER: If you look at the war on cancer, in total and compare it to other wars that we invested in and really it's really quite miniscule in fact.

JOHNS: Still, with more money, Dr. Dang is optimistic about a cure.

DANG: The money that goes into lung cancer research will eventually -- and I think very soon, make a different to your loved ones who are afflicted with lung cancer.

JOHNS: For researchers looking for weapons against lung cancer, it doesn't matter how patients get sick. But that doesn't change the perception, the automatic conclusion of most people, that lung cancer is a self-inflicted disease. Smokers assume the risk by lighting up.

Public attitudes set public funding priorities. So Dana Reeve's death could be important in changing those attitudes because she didn't smoke and still died of lung cancer.

HERMAN: I think in some ways it's helpful when somebody without a history of smoking comes forward and is willing to speak up about it. Because I think in that case it's really impossible to blame her for the development of her disease.

JOHNS (on camera): And with many battles left to fight in this war, Dana Reeve's legacy could live on in the research labs.

Joe Johns, CNN, Baltimore

(END VIDEOTAPE)

COLLINS: We hope that is the case, certainly.

Well, if you have a question about cancer, or about the warning signs, or about treatment, go ahead and give us a call right here tonight, 877-648-3639. Dr. Sanjay Gupta and cancer specialists will answer your questions.

Plus, remember those massive legal settlements? Big tobacco forking over billions of dollars. How much of that money do you suppose actually went to lung cancer research?

That story and more when our special report continues.

(BEGIN GRAPHIC)

Smoking and Lung Cancer

Estimated number of American smokers: 45 million

Annual lung cancer deaths attributed to secondhand smoke: 3,000

(END GRAPHIC)

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

D. REEVE: We are a family that has dealt with a lot of adversity and a lot of challenges. And I think that he can trust that life has a lot of joy and laughter, even amidst pain and hardship. It's a life lesson I wouldn't have wished on him, but at the same time, he has coping skills that I think a lot of 12 year olds might not.

(END VIDEO CLIP)

COLLINS: And young Will is certainly someone I think the entire country is thinking about tonight, John. He is 13 now, surrounded by family and friends, we understand. And for that, of course, we are very grateful.

ROBERTS: Such a tragic story, the young boy with no parents now.

Now we cant to get to your calls. That number again is 877-648- 3639. And joining us on your calls, Dr. Sanjay Gupta in New York. In Chicago, we want to say hello to Oncologist Kathy Albain of Loyola University Medical School. Also in New York, Susan Mantel of Joan's Legacy Lung Cancer Foundation.

Dr. Albain, let's welcome you by throwing a quick question to you as we set up our calls. There's evidence that women develop lung cancer at an earlier age than men, with less exposure to smoke. Do we know why?

KATHY ALBAIN, DOCTOR, LOYOLA UNIVERSITY: Well, there are a lot of clues coming in now about this fact. And probably the greatest reason may be that women may metabolize carcinogens, toxic substances differently than men. And that you may inherit different profiles of the so-called metabolizing genes differently in women than in men. That's one aspect of this.

And there is also a lot to be learned about hormones and the stimulation that they may give to lung cancer growth and genes that cause the development of estrogen from precursors that may be different in men than in women.

ROBERTS: So, we're talking about estrogen potentially causing a number of different cancers in women, are we?

ALBAIN: Well, maybe not causing so to speak, but potentiating the growth of lung cancers. In both our normal lung tissue and in lung tumors, there are receptors for estrogen just like in the breast and in breast cancers, for example.

COLLINS: We know that you have a lot of questions out there, everybody, so we want to let you know we are opening up the phone lines and our first caller is Jack from Toronto:

Hi Jack.

JACK, TORONTO (on the phone): Hi, how are you?

COLLINS: Good, thank you. What's your question?

JACK: My question is that I quit smoking like five years ago when (unintelligible) and my aunt died two months ago from lung cancer, and have many family just with stomach cancer and all kinds of cancer. And I guess that smoking was two months ago and I had a cough and it's bothering me right now. And I'm not feeling too good. And even -- what is the likelihood x-rays and it's -- I think it's fear, but still have the cough in the morning and for the whole day.

COLLINS: OK. What's your question, Jack.

JACK: Is that the sign that I could develop lung cancer, or what's going on? COLLINS: Sounds like, Sanjay...

GUPTA: Yes, I mean first of all, Jack, it's good that you quit smoking five years ago. And I don't know if you said that you started up again. First of all, you should absolutely stop if you started up again. And I guess you've probably already gotten that from our show tonight and from other people that you've talked to.

A couple of things. If your cough has been persistent, and usually mean more than a couple of weeks -- I was trying to listen to your voice, too, Jack, because hoarseness that lasts more than a couple of weeks can also be a risk factor. If you're concerned -- you said you're not feeling well, I don't know exactly what you mean by that, but it sounds like you have enough concerns where you probably should go and see your doctor and talk about a couple of things. One might be a chest x-ray to actually look at your lungs. And maybe even more specifically, a CAT scan of your lungs, if you're concerned about cancer and your doctor's concerned after examining you.

I'm glad you called, but you know, this is clearly something you should get checked out. I hope a lot of people are listening to you tonight.

ROBERTS: All right. Good advice.

Up next, we've got Jill in Florida on the line.

And Jill, what's on your mind?

JILL, FLORIDA (on the phone): Comment and a question. Some of the survivors that I know with lung cancer all had surgery. So my question is why is surgery not used more as a common practice and where do you go if your doctor says you cannot have surgery?

ROBERTS: Dr. Albain, do you want to pick that one up?

ALBAIN: Yes. I think we're learning more and more the importance of surgery in the care of lung cancer survivors; and in particular, across different stages of lung cancer. So that it's very important that if you are diagnosed with lung cancer, that you have a multidisciplinary opinion. Meaning, you go to a place where you can see a medical oncologist, a thoracic surgeon, a radiation oncologist, as a team, where all of these different modalities that we use to treat lung cancer are discussed with you upfront.

COLLINS: All right, thank you so much for that, Dr. Albain.

More calls when we come back. More of your questions for our experts. That toll-free number once again, 877-648-3639.

Plus, we'll follow the money that was supposed to go from tobacco companies to cancer research and smoking prevention and a whole lot more. See where billions of dollars are going instead.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

C. REEVE: All my life I prided myself on being so self- sufficient. I didn't realize how lucky you are to have people who are there for you no matter what. Yes, it may be an achievement to fly solo, but there's a great deal more. True satisfaction is flying together.

(END VIDEO CLIP)

ROBERTS: Dana Reeve, in her passing, is generating the kind of news coverage that could help to save lives.

Tonight, we've been fielding your calls about cancer. And I think it's safe to say, Heidi, that we're all learning from this.

COLLINS: Absolutely. We hope so, in fact. And we want to get back to answering those questions now. We have an e-mailer, Barb from Virginia, and she asks this question.

"My mother who's now 90 was diagnosed with lung cancer more than a year ago. She had quit smoking probably 45 years ago."

Susan, maybe you can tackle this one. How common is it? I know you speak with a lot of people, a lot of survivors and a lot of people who are dealing with family members who've contracted the disease.

SUSAN MANTEL, JOAN'S LEGACY LUNG CANCER FOUNDATION: I do, Heidi. And although I don't have the pleasure of speaking to that many 90- year-olds, I do speak to a surprising number of people who quit several decades ago and are then diagnosed with lung cancer. And they're just as surprised as people who never smoked because they figured at that point it wouldn't be an issue for them.

ROBERTS: Tom, in Florida, is on the line with us.

Tom, what's your question tonight?

TOM, FLORIDA (on the phone): Hi, I'm a stage four lung cancer survivor myself. Never smoked. Diagnosed at age 49, and that was two years ago. So, hanging in there.

ROBERTS: Oh, good for you. We're glad to hear that.

TOM: I have both a bit of a statement and a question. First, I'd like to inform your viewers about a website called, neversmokers.com. It's developed by patients and leading oncologists and it's a survey and database to see what we have in common...

ROBERTS: Right.

TOM: ... and hopefully aid in research. Secondly, my question is with the hundreds of millions of dollars that each state is getting from tobacco settlement money each year, how do we get them to spend it on something other than building prisons or stuff they're giving to the wars or something like that?

ROBERTS: Right. Right. We're going to go into that in a little bit more depth.

TOM: But what does the common man do? You know, what do we do to get this money to go for health-related issues?

ROBERTS: Right.

Susan, do you want to handle that, since you're on the efficacy end of things?

MANTEL: Yes, absolutely.

Well, one thing you should know is that an amicus brief has been filed for some federal funding on a lawsuit that's going on. And one way to get some of that funding directed is -- I'd urge you to go to lungcanceralliance.org and look at some of their lobbying efforts.

Again, making your voice heard is so important in this. And that's one of the ways to do it is through coordinated lobbying in Washington.

COLLINS: And now we have Eric in North Carolina.

And Eric, are you with us? What's your question tonight?

ANNA, FLORIDA (on the phone): Yes. Are you there?

COLLINS: Yes, I am.

ANNA: OK. OK. My ex-husband was recently diagnosed with COPD. And his family's calling my daughter and telling her that she -- it's hereditary. And my husband -- my ex-husband smoked, smoked like a train for several years, as did everybody in his family. And she spent quite a bit of time with him. But from what I've read, COPD is not hereditary, but she does get -- when she gets -- she gets lung infections and stuff easily every winter. I was wondering if I needed to get her in and get a lung diagnosis of some sort.

COLLINS: OK. Dr. Albain, why don't you take that one.

ALBAIN: Well, I think we're learning more and more about hereditary lung cancer now in lung cancer families. So, if it's in your family, I think it is important that you get her in and have her see a good specialist, have her evaluated for her symptoms, and have your family history taken very carefully. Because there may be some stepped up follow up and screening that would be done for your family that may not be needed in the average family, for example.

COLLINS: All right. Oncologist Kathy Albain, tonight, thank you so very much.

And thanks also, to Susan Mantel. She is with Joan's Legacy.

And also our own CNN's 360 MD Sanjay Gupta, as always, thank you, Dr. Gupta.

John, back up with you. ROBERTS: More of our special, "Lung Cancer: The Quiet Killer", is just ahead.

But first, let's get back to Erica Hill, from "HEADINE NEWS," for some of the business stories that we're following tonight.

Hi Erica.

HILL: And John, we start off tonight, though again, with the Enron trials. Some compelling testimony today. Fighting tears, the company's former Chief Financial Officer Andrew Fastow described how he hid losses to boost profits and reassure investors. He said former CEO Jeffrey Skilling encouraged his actions. Enron Founder Ken Lay and Skilling blamed Fastow for Enron's implosion.

Pixar Animation, and what might be its last results before becoming part of Walt Disney, beating Wall Street estimates today. Pixar's net income and revenue were each $10 million more than what analysts had expected. The company behind "The Incredibles," has big hopes for its next film, "Cars." That is set for release in June.

And former Federal Reserve Chairman Alan Greenspan signed a book deal today with Penguin Press. The publisher won a bidding war that sources say guarantees Greenspan at least $8 million. But you shouldn't expect a gossipy tell all here, not that many people would from Alan Greenspan. According to "The New York Times," he advised publishers in his own unmistakable style, quote, "I do not intend to dwell on personality, aberrations" -- John.

ROBERTS: Thanks Erica.

Remember those big lawsuits against the tobacco companies? Weren't they supposed to channel billions of dollars into the fight against lung cancer? We'll follow the money. Wait until you see some of the things that those dollars are paying for.

This is 360.

(COMMERCIAL BREAK)

ROBERTS: Money talks. Eight years ago when the big tobacco companies settled their legal battles with 46 states, it was supposed to speak loudly -- to the tune of $200 billion over 25 years. Money for cancer research and to help defray the cost of caring for smokers who develop disease.

It didn't quite work out that way. And as CNN's Tom Foreman reports, that's not the half of it.

(BEGIN VIDEOTAPE)

TOM FOREMAN, CNN CORRESPONDENT (voice-over): In the shadow of the capitol, Sheila Ross is a rarity. A one-time big smoker, twice diagnosed and treated for lung cancer, yet alive and fighting for change. SHEILA ROSS, CANCER SURVIVOR: This is a political problem. It's not a science problem. The money for research, the money for screening and early detection is going to the cancers that have large political constituency. It's not going to a cancer like lung cancer, even though it's the biggest single killer. Because there are not enough survivors to give it political power.

FOREMAN: It's a terrible truth. The tsunami killed fewer people than died from lung cancer in America last year -- 163,000. And only 15 percent of people diagnosed are alive five years later.

Laurie Fenton is with the Lung Cancer Alliance.

LAURIE FENTON, LUNG CANCER ALLIANCE: More than breast, prostate, colon, liver, kidney, pancreas, melanoma cancers combined. That's what lung cancer does every year, takes the lives of all of those diseases combined, every year. And that has to change.

FOREMAN: The 1998 legal settlement with the big tobacco companies was supposed to change things, sending hundreds of millions of dollars to states to replace money spent on tobacco related illness. But that money has generally not gone to lung cancer research, detection or treatment.

CHERYL HEALTON, AMERICA LEGACY FOUNDATION: It's been spent to build prisons, to build roads, to do heavens knows what things, but all sorts of projects that are not even health related, let alone related to tobacco.

UNIDENTIFIED MALE: 50,000 people die each year from second-hand smoke.

FOREMAN: Some of the settlement money has been used to counteract the $40 million a day big tobacco was using to market its products.

HEALTON: But in comparison of the arsenal on the other side, it is a David vs. Goliath battle, no question about it.

FOREMAN: So the battle to change public policy toward this disease largely falls on the ever falling army of survivors. That's why Sheila Ross, who spent her life working in politics, says she'll spend the rest of it on this issue.

ROSS: It's almost inevitable that my lung cancer will recur.

FOREMAN: You expect it?

ROSS: I fully expect it. But before I get sick again, I'm going to make as much noise as I can on Capitol Hill. Lung cancer is a horrible way to die. We can't continue to ignore it.

FOREMAN: Tom Foreman, CNN, Washington.

(END VIDEOTAPE) COLLINS: "On the Radar" tonight, an outpouring of compassion for Dana Reeve and her family. The e-mails just keep coming into the blog.

From Jill in Fort Wayne, Indiana, tonight, "Dana's death is heartwrenchingly sad. My heart aches for her son Will. May God guide him through this tragic time."

From Ingrid Rose in Marama, Arizona, "I thought she would make it. After all she has been through, Dana deserved to make it and to watch her son grow up."

And Jamie in Santa Fe, New Mexico, writes, "Life simply isn't fair. All we can do is make a serious effort to take good care of ourselves. And let's not forget to live each day joyfully. The present is truly all we have."

More of 360 in just a moment.

(COMMERCIAL BREAK)

ROBERTS: Thanks for joining us for this special edition of 360, "Lung Cancer: The Quiet Killer". I'm John Roberts in Washington.

COLLINS: And I'm Heidi Collins in New York.

"LARRY KING" is next, remembering the life of Dana Reeve, with guests Lance Armstrong, Maya Angelou, and more.

Good night, everybody.

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