BALTIMORE – She wheezes a little when she walks, even the few steps from the living room to the front door of her middle-class Baltimore home. Other than that there is not much about Naon Prater that gives away her deadly secret.
Prater, 62, is strong-willed and unbowed, “the doer… the matriarch” of her family. But as she tells of her transition from smoker to lung cancer victim, the Baltimore grandmother tears up more than once.
“It is really hurtful what I put my loved ones through,” said Prater, whose family went through therapy to cope with her diagnosis. “That is what I really regret because I could have prevented it.”
Her cancer is now in remission, but Prater knows that the worst is never too far.
“It is non-ending,” she said of her condition. “There is no cure.”
Prater is battling the biggest cancer killer of women in the state – more than even breast cancer. Just 16 of every 100 women diagnosed with lung cancer will live more than five years. And the likelihood of survival reduces with increasing age.
“More women get breast cancer, but the mortality for lung cancer is higher,” said Lynn Khoo, executive director of the Maryland State Council on Cancer Control and the Maryland Cancer Registry.
In 1996, 25 percent of all cancer deaths among women in the state were due to lung cancer, compared to 17 percent for breast cancer.
One reason is that women do not think of themselves as potential victims of lung cancer, which is still thought of as a man’s disease. Few are aware that over the years the disease has found an increasing number of women victims, in direct proportion to the rise in women smokers.
“Today all women know of the advantages of getting a mammogram,” Khoo said, but they often do not detect lung cancer until it is already at a late stage.
While the numbers of Maryland men dying of lung cancer continues to decrease every year, the number of women dying of the disease is increasing. In 1996, the latest year for which statistics are available, 41 percent of all lung cancer deaths in the state were among women.
Experts say there are several reasons. Recent studies have shown that women smokers are twice as likely as men smokers to develop lung cancer, even if they smoke the same amount, suggesting a genetic predisposition for the disease in women.
But anti-smoking advocates say the biggest reason is the increase in women who smoke, and they lay the blame squarely at the door of tobacco companies. They say cigarette makers have been increasingly targeting women in recent years, and especially minority women.
“Studies show that people who quit are usually young, white men with a college education and income of over $35,000,” Khoo said. Consequently, she said, tobacco companies have turned their attention to women.
Virginia Slims’ new “Find Your Voice” ad campaign features minority women, including a geisha girl. The company is also sponsoring a nationwide concert tour of young women singers, tactics that anti-smoking advocates say are designed to woo more young women to cigarettes, especially in minority markets.
Joseph Adams, former president of Smoke Free Maryland, points to a 1987 study in the Journal of Public Health that said in the six years after a 1968 Virginia Slims ad campaign, smoking rates among U.S. girls under age 18 doubled. It is those women who are today’s lung cancer victims, Khoo said.
But a spokeswoman for tobacco giant Philip Morris, which holds over 49 percent of the U.S. tobacco market, said the company’s ad campaigns are designed to appeal to “responsible adult women who choose to smoke.”
The Find Your Voice campaign, said Kati Otto of Philip Morris, had been “mischaracterized by those who infer that it is meant to target the minority community.” Instead, she said, the ads were about “persona expression and individuality.”
But there is no getting around the fact that smoking and lung cancer are inextricably linked, advocates say. Khoo said approximately 80 percent of all lung cancer cases are directly related to smoking.
As Prater’s story shows, lung cancer victims do not have to be heavy smokers. They can be ex-smokers like Prater, who quit in 1990, five years before her cancer was diagnosed. At the time, she never thought her old habit would return to haunt her.
“I was going to become a grandma and I didn’t want to smoke around the baby,” she said.
“I was not even a heavy smoker,” she said. “I smoked a cigarette after meals, but that’s it. A pack would last me a long, long time.”
Prater began to smoke when she was 25 and going through a stressful divorce and continued to “smoke most when I was stressed.” It was a “stupid” thing to do, she admits, but she did it anyway.
And, like most smokers, she thought she was invincible. “I was a doer — the one the whole family came to for strength, the matriarch.”
But things have changed. Although she fights her disease with a strong will, she admits it gets the better of her sometimes. “I used to be a walker … now I can’t any more. I can’t climb…I can’t reach up.”
She says she takes the disease in her stride, “because I cannot let it rule me.” She takes care of her stepfather who, she said, was also a cancer patient. “Looking after him keeps my mind off worrying about me,” she said.
In her 32 years as a medical technologist at Johns Hopkins Hospital, Prater often advised people dealing with cancer to keep a positive attitude. “I would tell them that their approach to the illness would win 50 percent of the battle.”
She pauses a moment to keep her voice from cracking, then continues: “I never thought I would practice what I had preached.”