In her West Bloomfield, Mich., home, Lisa Roffman wiped away tears as she read from a journal she keeps for her 9-year-old daughter, Leah.
"You are a special gift to the world," Roffman read. "You will always be alright. I love you so much. Love, Mommy."
At 44 years young, Roffman is preparing to die.
"There's a limited time period," she said. "There's a sadness and an urgency."
Two-and-a-half years ago, Roffman, a non-smoker, was diagnosed with lung cancer and given less than five years to live.
"It was a complete and total shock," she said. "I certainly thought that it was going to be people who had smoked their whole lives. I always thought it was more men than women. I thought they were people who were 60 or older."
As the number of men with lung cancer declines, the American Cancer Society estimates that 73,020 women will die in the United States of lung cancer this year, more than those who will die from breast, ovarian and uterine cancers combined.
Ill Despite Healthy Lifestyle
While no national studies have yet been done, many lung cancer specialists say they're seeing a disturbing trend of more and more non-smoking women with the disease.
"Many of them have done an excellent job of taking care of themselves," said Dr. Joan Schiller, who specializes in lung cancer in non-smoking younger women at the University of Wisconsin in Madison. "They run. They eat right."
Ten percent to 15 percent of lung cancer victims are non-smokers. Among that group, women are two to three times more likely than men to get the disease. Doctors don't know why. Hormones, second-hand smoke, diet and air pollution all are believed to be factors.
Though lung cancer is deadlier to women than other types of cancer, breast cancer gets almost 10 times more research funding per death than lung cancer, Schiller said.
"These women are tragic victims of the fact that they have a disease that is associated with smoking," Schiller added.
Adding to the deadliness of lung cancer, the symptoms, which include shortness of breath and a chronic cough, often are misdiagnosed as asthma.
New Hope in Study, Drugs
Lately though, there is some hope.
In a search for answers, the National Cancer Institute has funded a grant to the Southwest Oncology Group, a cooperative research group of 283 institutions, to look at gender differences in smokers versus non-smokers with lung cancer. In what will be the largest study of its kind, researchers will look at tumor tissue and healthy tissue from men and women, smokers and non-smokers.
And in the more immediate term, doctors say non-smoking younger women are responding better than others to two new drugs -- iressa and tarceva.
"There are certainly people whose cancer has gone away for years," Schiller said. "Will it last? We don't know.''
Iressa has stalled Roffman's cancer.
Tarceva is wiping out some tumors in Debbie Verhines of Saline, Mich.
"Oh, my gosh: I feel like it's given me my life back," Verhines said. "Yeah, it's a miracle drug."
Contemplating Life and Death
Verhines believes that aside from the drugs, conquering the disease is all in the attitude. As a show of strength she took off her wig.
"A lot of people haven't seen me bald," she said. "Hey, I can relate to people who are going through this. You can either have a happy illness or a sad illness, and I am going to have a happy illness."
The Roffmans understand that one day soon, Lisa may die. Her husband, Barry, contemplates life without her.
"I don't want to go in that room," he said. "I go right to the door and I don't open it. I just turn around and run the other way."
Every second is cherished as though it is the last. Lisa's daughter, Leah, prepares for her mom's death as the two share a kiss.
"Her soul and her spirit will always be with me," Leah said. "And her love."