Case 1: Female, 44, pack-a-day smoker for 20 years. Small tumor found early, removed with surgery in August. Prognosis good. Case 2: Female, 58, heavy smoker since teens. Advanced tumors found in lung and brain. Died in about 18 months. Case 3: Fe

A study this year confirms suspicions that women smokers are twice as likely to get cancer as men smokers, probably due to genetics and hormones. Puffing the same amount as a man, a woman tends to get cancer quicker. Even smoking just a little, they're more likely to succumb. Also, despite all the attention paid to breast and colorectal cancer, lung tumors remain the nation's biggest single cancer killer by far with poor survival rates. But good news is emerging, too. The well-known CT scan (a quick X-ray scan of the body in the duration of one held breath) is proving to be very good at finding lung tumors when they are still small and curable, although the jury is still out on whether it will prolong life. New surgical methods and chemotherapy with milder side effects are starting to boost the odds for lung cancer patients. They now have a 35 to 40 percent chance of surviving one year, up from 20 to 25 percent five years ago. For the future, geneticists are trying to mobilize the body's immune system to stamp out tumor cells when they first appear. "The severe pessimism is starting to disappear," says Dr. Kasi Sridhar, a lung cancer researcher and specialist at the University of Miami. "The pendulum has swung back to treating patients with lung cancer instead of just accepting they are going to die." Consider Betty Lazzeri (case 1). A teacher's aide with a son of 21 and a daughter of 17, she had smoked maybe a pack a day of Salem menthols for most of two decades, a moderate amount by tobacco standards. "I had this cough that lasted for weeks. It was a hard cough. I had a sore throat sometimes, too. After a while, I started coughing up blood," Lazzeri says. "Then it was a lot more blood." An X-ray last summer showed something but was inconclusive. Lazzeri tried to keep the C-word out of her mind. Biopsies and finally a CT scan pretty much confirmed it. "I didn't really want to know too much, you know what I mean?" she says. "I didn't think it would be cancer. I was only 44." But they had spotted the tumor while still only 0.5 cm, the size of a pencil eraser. It had not spread to the lymph nodes. Lazzeri agreed to a relatively new surgical method. Doctors removed one-sixth of her lung through a 3-inch incision rather than the standard front-to-back cut that pierces the chest and back muscles. Instead of being in the hospital one to two weeks in great pain, she was home in four days and back at school in two weeks. Her surgeon says she is at low risk for a relapse. "We caught it early in her case," says Dr. Dimitri Pyrros of Margate, Fla. "She was lucky all the way around." Lucky is not a word that comes up often in lung cancer. More than 170,000 new cases arose last year, almost 90 percent attributed to smoking. Lung cancer killed about 160,000 people. Three-fourths of cancer patients will survive at least five years if the tumor is caught at the earliest stage, almost half if it's caught before growing beyond its local area. But only one in seven are detected that early. Most lung cancers attack more aggressively and faster than other cancers. And unlike others, symptoms often do not appear until the lung tumor is large and sometimes not even until it has spread to other parts of the body. By then, the news is usually grim. Overall, only 14 percent of lung patients make it for five years, down at the bottom of the survival list along with liver, esophageal and pancreatic cancers, the National Cancer Institute says. By comparison, the five-year survival rate for breast cancer is 85 percent, prostate cancer 93 percent and skin cancer 88 percent. Terry Stowell lasted about 18 months. "The last year of her life was terrible," says Ginny Ballard, who worked with Stowell as surgical nurses at North Broward Medical Center in Pompano Beach. "She wasted away." Stowell (case 2) had smoked heavily her whole life. She knew the risks. She joked with her friends that she would never die of lung cancer, she would die of a brain tumor. Sure enough, by the time she was diagnosed, her cancer had spread to her brain. "She probably got nagged too much and just wasn't going to stop. The habit was too strong for her, I guess," Ballard says. The continual anti-smoking messages of the past three decades finally are showing up in the numbers, but only in men. Their lung cancer rates peaked in 1988, and by 1998 had dropped by 19 percent. Their death rate fell by 11 percent. Among women, however, smoking rates keep climbing, although they are still one-third lower than among men. Today, 22 million women, plus 1.5 million teenage girls, smoke, along with about 25 million males. "It's a national tragedy," says Dr. Christine Berg, chief of lung and upper digestive cancer research at the National Cancer Institute. Women play a dangerous game when they smoke because they are more susceptible to the carcinogens in it, research shows. A January study finally answered why. Researchers tied the increased cancer risk for female smokers to a gene that is more active in women, and found that the hormone estrogen appears to accelerate tumors in the lung, just as it does in the breast. Edith (case 3), a retiree of 77, wonders if she fits that bill. She had smoked only two packs a week before quitting 20 years ago, but she developed a small tumor last year. A routine chest X-ray and CT scan found it very early. "I was stunned," she says. "I thought you have to be a heavy smoker. I never had any symptoms. No breathing problems, no coughing, no blood."

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