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Chest

Volume 112, Issue 4, Supplement, October 1997, Pages 229S-234S
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Women and Lung Cancer: Waiting to Exhale

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Lung cancer is now the leading cause of cancer deaths among women. In the United States, 64,300 women are expected to die of lung cancer in 1996. Smoking is responsible for about 80% of lung cancer cases. Unfortunately, the prevalence of smoking among women remains unacceptably high at about 22% and is expected to surpass the rate in men by the year 2000. Smoking rates are highest among young girls and the less educated. Whether lung cancer represents a different disease in women than in men is unclear. Data are conflicting regarding the magnitude of the relative risk of developing lung cancer due to smoking between the genders. There appears to be a difference in the relative distribution of lung cancer histologic features between men and women that is not explained entirely by differences in smoking patterns. Women who smoke appear to be at higher risk of developing small cell lung cancer than squamous cell lung cancer, whereas men who smoke have a similar risk for the two histologic conditions. Furthermore, women smokers are more likely to develop adenocarcinoma of the lung, and estrogens may play a causative role in this phenomenon. Data are unclear regarding whether the outcome of lung cancer treatment differs between genders. Solutions to the lung cancer epidemic among US women include (1) prevention of the disease by reducing smoking rates, (2) improving early detection methods, and (3) exploring new therapeutic strategies.

Section snippets

Scope of the Problem

Lung cancer is now the leading cause of cancer deaths in women, having surpassed breast cancer in that role in 1987. Estimates of the leading causes of cancer deaths in women for 1996 are presented in Table 1.1 At least 79% of lung cancer cases in women are related to smoking.2 Thus, cigarette smoking is the main culprit for this lung cancer epidemic. Women started smoking in significant numbers during and following World War II. Although overall smoking rates have declined since reaching a

Nature of the Problem: Is Lung Cancer a Different Disease in Women than in Men?

Until fairly recently, lung cancer was a relatively uncommon disease among women. As a result, available data on women and lung cancer are not plentiful and, in fact, often conflict.

Prevention

Since about 80% of lung cancer cases are attributable to smoking, it is clear that the most effective intervention to halt the lung cancer epidemic for both women and men is to reduce smoking rates to zero. It is believed that if everyone were to stop smoking, lung cancer would again be a rare disease.

Convincing people to stop smoking is no easy task. Despite the overwhelming evidence that smoking causes lung cancer, as well as other fatal health problems, smoking rates remain unacceptably

Conclusion

In conclusion, lung cancer has reached epidemic proportions in women. As is the case for men, lung cancer is now the leading cause of cancer deaths among women. It is expected to take the lives of over 64,000 US women in 1996 compared to an expected 44,000 deaths due to breast cancer. The vast majority of lung cancer cases are attributable to smoking, and smoking prevalence rates in women are expected to rise slowly into the next century. Whether the etiology of lung cancer differs in women and

References (64)

  • Reducing the health consequences of smoking: 25 years of progress: a report of the Surgeon-General. Rockville, Md: US...
  • Chollat-TraquetC

    Women and tobacco

    (1992)
  • PierceJP et al.

    Trends in cigarette smoking in the United States: projections to the year 2000.

    JAMA

    (1989)

  • Cigarette smoking among adults—United States, 1993.

    JAMA

    (1995)
  • National Center for Health Statistics. The National Health Interview Survey Design, 1973–1984 and Procedures,...
  • US Department of Health and Human Services. Smoking, tobacco and cancer program 1985–1989 status report. US Department...
  • AndrewsJL et al.

    Lung cancer in women—Lahey Clinic experience, 1957-1980.

    Cancer

    (1985)
  • SilverbergE et al.

    Cancer statistics, 1970.

    CA Cancer J Clin

    (1970)
  • SilverbergE

    Cancer statistics, 1980.

    CA Cancer J Clin

    (1980)
  • SilverbergE et al.

    Cancer statistics, 1990.

    CA Cancer J Clin

    (1990)
  • RischHA et al.

    Are female smokers at higher risk for lung cancer than male smokers? A case-control analysis by histologic type.

    Am J Epidemiol

    (1993)
  • HarrisRE et al.

    Race and sex differences in lung cancer risk associated with cigarette smoking.

    Int J Epidemiol

    (1993)
  • ZangEA et al.

    Cumulative tar exposure: a new index for estimating lung cancer risk among cigarette smokers.

    Cancer

    (1992)
  • WilliamsRR et al.

    Association of cancer sites with tobacco and alcohol consumption and socioeconomic status of patients: interview study from the Third National Cancer Survey.

    J Natl Cancer Inst

    (1977)
  • SchoenbergJB et al.

    Variation in smoking-related lung cancer risk among New Jersey women.

    Am J Epidemiol

    (1989)
  • OsannKE

    Lung cancer in women: the importance of smoking, family history of cancer, and medical history of respiratory disease.

    Cancer Res

    (1991)
  • OsannKE et al.

    Sex differences in lung-cancer risk associated with cigarette smoking.

    Int J Cancer

    (1993)
  • ZieglerRG et al.

    Carotenoid intake, vegetables, and the risk of lung cancer among white men in New Jersey.

    Am J Epidemiol

    (1986)
  • SchoenbergJB et al.

    Occupation and lung cancer risk among New Jersey white males.

    J Natl Cancer Inst

    (1987)
  • TaubesG

    Claim of higher risk for women smokers attacked.

    Science

    (1993)
  • HorwitzRI et al.

    An ecogenetic hypothesis for lung cancer in women.

    Arch Intern Med

    (1988)
  • WuAH et al.

    Previous lung disease and risk of lung cancer among lifetime nonsmoking women in the United States.

    Am J Epidemiol

    (1995)

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    Reprint requests: Elizabeth H. Baldini, MD, MPH, Joint Center for Radiation Therapy, Brigham and Womens Hospital, 75 Francis St, Boston, MA 02115

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    Copyright © 1997 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.