By the time a 2001 chest X-ray detected a mass in then-47-year-old Donald Koppers' lung, it may have been too late, according to region physicians.
Koppers, of Crown Point, held on for four more years through chemotherapy and radiation, but ultimately became one of the 5,689 people killed by lung cancer between 1999 and 2010 in Lake, Porter and LaPorte counties.
Cancer of all types was the second-leading cause of death in the region within that time period, causing 20,120 deaths, a Times computer-assisted analysis of federal mortality data shows.
Lung cancer was by far the leading cause of death within that category, accounting for 28 percent of all cancer deaths, the data show. The next deadliest types were colon cancer, listed as the cause in 1,733 cases, and breast cancer, in 1,551 cases.
In nearly all cancer cases, the earlier it can be detected, the better chance of survival, region physicians say. And in the case of lung cancer, not all detection methods are created equal.
Koppers, a smoker of 30 years, fit the profile of so many who have died from the disease, state and region medical officials said.
And at age 52, he also fit what some health officials call an alarming number of people dying of the disease long before the average life expectancy.
One in three of the region people who died from lung cancer were younger than 65, The Times' analysis shows. The ratio was identical for people dying of all types of cancer.
A challenge for improving survival numbers lies largely in changing addictive behaviors and culture, region health officials said.
While strides in curbing smoking have been made in recent years, the percentage of Northwest Indiana smokers still eclipses the rest of the state.
In Lake County, the region's most populous county, an estimated 26 percent of adults smoke, according to health rankings culled by the nonprofit Robert Wood Johnson Foundation.
One region doctor and nurse practitioner both agree improving that percentage is key to reducing region cancer, but reformed smokers shouldn't have a false sense of health just because they quit.
Koppers had just quit smoking in spring 2001 when he developed a cough, something he chalked up to his lungs clearing the remnants of a three-decades-long habit, recalled his daughter, Carrie Skripac.
Skripac, 37, of Hobart, said her father visited a physician, who initially believed Koppers needed allergy medication.
By June of that year, the cough persisted, and an emergency room visit and chest X-ray revealed a mass in Koppers' lung. A subsequent surgery determined it was cancer, Skripac said.
Then 47, the man who Skripac looked upon as "Superman" — the caring father and grandfather who loved planning annual family trips to Disney World — began the fight of his life.
He took a year off work, undergoing regular radiation and chemotherapy treatments.
"The first year he couldn't work was the worst because he was used to working for his family," Skripac said. "I went over every Tuesday to give him a shot to boost his red and white blood cells."
At first, the family had hope Koppers was improving. He appeared to remain clear for about year after the treatment ended, and he went back to work at a tool business in Manteno, Ill.
But then spots began developing on his lungs again, requiring more radiation treatment. In 2004, Koppers started retaining water and couldn't breath well, Skripac said.
His lungs were continually filling with fluid, and a surgical drain was installed that Koppers could use to empty his lungs for relief.
In October 2005, he went back into the hospital, where he ultimately died, Skripac said. He was 52.
Beyond the pain and discomfort Koppers experienced leading up to his death was the emotional impact on his surviving family members, something Skripac said she still feels eight years later.
"Every girl thinks her dad is Superman," Skripac said. "Seeing him break down like that took a toll."
Dr. Alexander Stemer, president of Munster-based Medical Specialists, said early detection of lung cancer — and with the right type of equipment — is key to fighting the disease.
Those who are at risk, including current or past smokers and those working in heavy industry or other at-risk professions, should be screened by their physicians using CAT scan technology, not just chest X-rays, he said.
By the time a cancer tumor is large enough to be detected on an X-ray, it's more likely to be fatal, Stemer said. Through three-dimensional imaging, CAT scans pick up growths when they're much smaller, increasing the chance of successful treatment, he said.
The cost of not being proactive means "it's far more likely you will die a slow and expensive death," Stemer said.
"Lung cancer is a very painful way to die," said Linda Gatto, a nurse practitioner who works with lung cancer patients. "You end up having so much trouble breathing. It's just a miserable way to go."
But catch it early, Gatto said, and you have a good chance of living a full life.
Regardless of technological strides in detecting and treating the disease, Stemer and Gatto agree prevention remains the best cancer-fighting tool.
And that means continuing to change individual behaviors and culture.
Stemer said Indiana remains one of the cheaper states — at least regionally speaking — for buying cigarettes. This helps continue a smoking culture, he said.
At an excise tax rate of 99.5 cents per pack, Indiana ranks 32 out of all states, meaning only 18 other states have cheaper cigarette tax rates, according to the Washington-based Federation of Tax Administrators. Neighboring Illinois' cigarette taxes are almost double Indiana's.
"You still see people with Illinois plates coming over to Indiana to buy cigarettes," Stemer said. "Why? Because we have lower taxes here. Indiana should exert a little discipline in this area and raise the taxes on cigarettes. They should use the tax proceeds for stop-smoking education.
"Smoking is still a big part of our culture, and that's one of the biggest problems," Stemer said.
Top retail companies re-evaluating the overall benefit of tobacco sales also helps, Gatto said.
She said CVS's recent decision to stop selling cigarettes — forfeiting major revenue in the process — "was a phenomenal statement that really takes a stand."
Insuring a future
Gatto also believes pressuring insurance companies to cover smoking-cessation programs is another key to curbing lung cancer cases and deaths.
Medicaid currently provides coverage for medications that help smokers quit, she said. Medicare covers some counseling but not the medications, she said.
And private insurance companies are hit and miss on covering medications and programs for clients who want help kicking the habit.
When the biggest challenge of all is getting people to change their behaviors, Gatto said the health care system, including insurance, should be doing all it can to attack the problem.
"Why treat the problem?" Gatto asked. "Why not prevent it in the first place?"