Lung cancer in women is a 21st century epidemic

04/08/04

Northwestern Memorial lung cancer specialist publishes 'special communication' in JAMA calling for targeted research on women

CHICAGO – Future lung cancer research needs to include gender-specific studies to address the important differences that exist between men and women with lung cancer, according to a paper published in the April 14 issue of the Journal of the American Medical Association (JAMA).

"Lung cancer appears to be a different disease in women," says the paper's lead author Jyoti Patel, M.D., an oncologist at Northwestern Memorial Hospital and an instructor of medicine at the Feinberg School of Medicine of Northwestern University. Differences include female smokers' increased predisposition to lung cancer and longer survival rates as compared to men. Female smokers are also more likely than men to develop adenocarcinoma, the most common form of lung cancer. In addition, women who have never smoked are more likely to develop lung cancer than men who have never smoked.

Mounting evidence suggests that these differences could be due, in part, to estrogen signaling. Genetic, metabolic and hormonal factors also play a role in the way women react to carcinogens and lung cancer. However, women's longer survival periods once they have lung cancer cannot be accounted for solely by a longer life expectancy or an imbalance of other prognostic factors, says Dr. Patel.

"As researchers, we need to do our part to best address what has become an epidemic in American women," says Dr. Patel. "From 1990 to 2003, there was a 60 percent increase in the number of new cases of lung cancer in American women, while the number of men diagnosed with lung cancer remained stable. This is a dramatic increase and is clearly in excess of normal expectancy."

Lung cancer is the leading cause of cancer death in the United States and will cause more deaths in American women this year than breast cancer and all gynecological cancers combined. In 2003, an estimated 80,100 American women were diagnosed with lung cancer, and 68,800 died from their disease. "The majority of lung cancer is caused by cigarette smoke, yet despite all we know about the health hazards of smoking, one in four women continue to smoke," says Dr. Patel. Following the increase in tobacco use in American women over the past century, the death rate from lung cancer increased 600 percent from 1930 to 2003.

Although smoking prevalence in men has decreased by nearly 50 percent from its peak in the 1960s, smoking prevalence in women has decreased by only 25 percent in the same period. In recent years, smoking rates among women in the United States have remained stable. However, rates among women in Africa and Asia have risen significantly. "Attacking the rising use of tobacco among women is one of the greatest disease prevention opportunities in the world today," says Dr. Patel.

Dr. Patel's paper reports that the improved survival of women with lung cancer has important implications in the design and interpretation of lung cancer trials. "When a clinical trial of today is compared to one from 15 years ago, the increase in the proportion of women participants because of their increase in rates of lung cancer will cause survival improvement, regardless of treatment effect. Future trials would benefit from stratification by gender," says Dr. Patel.

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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