Women Smokers, Higher Risk But Lower Death Rates from Lung Cancer

Women who smoke appear to be more susceptible to lung cancer than men who smoke, though women smokers have a lower rate of lung cancer-related death, according to a study in the July 12 issue of JAMA.

In 2006 in the United States, it is estimated that lung cancer will cause 73,020 deaths in women, proportionately only slightly fewer than the estimated 90,470 deaths in men. Lung cancer now accounts for more deaths in women than any other cancer, more even than the second and third cancer killers (breast and colon cancer) combined, according to background information in the article. It has been hypothesized that women are more susceptible to tobacco carcinogens than men, but after diagnosis of lung cancer, they have better survival rates than men.

Claudia I. Henschke, Ph.D., M.D., of Cornell University, New York, and investigators with the International Early Lung Cancer Action Program examined the lung cancer risk of women compared with men, accounting for age and history of smoking, and also compared the rate of fatal outcomes between sexes.

The study included 7,498 women and 9,427 men, at least 40 years of age, who had a history of cigarette smoking and were screened for lung cancer in North America between 1993-2005.

Lung cancer was diagnosed in 156 women and 113 men (rates of 2.1 percent and 1.2 percent, respectively). The researchers also found that women had a lower rate of lung cancer-related death, when controlling for pack-years of smoking, disease stage, tumor cell type and resection.

“If lung cancer risk for women who smoke is indeed higher than the risk for men of the same age who smoke, as indicated by the evidence presented here, this suggests that antismoking efforts directed toward girls and women need to be even more serious than those directed toward boys and men,” the authors write.
(JAMA. 2006;296:180-184.

Editorial: Women and Lung Cancer - Gender Equality at a Crossroad?

In an accompanying editorial, Alfred I. Neugut, M.D., Ph.D., and Judith S. Jacobson, Dr.P.H., M.B.A., of Columbia University, New York, comment on the study by Henschke et al.

“The reasons women live with lung cancer longer than men are unclear,” they write. “Do women fare better because of their body size, better health behaviors, hormonal and reproductive factors, different cigarette smoking histories or patterns, or other factors? Women’s stage-for-stage advantage in survival appears to be a host effect and applies to all the major histological types of lung cancer.”

“The once prevalent adage, ‘You’ve come a long way, Baby!’ geared to female smokers, unfortunately now applies to increased smoking prevalence and lung cancer risk among women. To prevent gender equality in lung cancer from becoming a reality, it’s now time to turn back.”

American Medical Association (AMA)

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Revision date: June 11, 2011
Last revised: by Jorge P. Ribeiro, MD