Jyoti D. Patel, M.D., of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues write that the death rate from lung cancer in U.S. women rose 600 percent from 1930 to 1997, surpassing breast cancer as the leading cause of cancer death by nearly 20,000 patients a year. The authors cite data that indicate "an estimated 80,100 U.S. women were diagnosed as having lung cancer in 2003 and 68,800 died from their disease."
However, the authors point out that women are targeted in tobacco advertising, and teenage girls are often drawn to cigarette smoking under a variety of social pressures, and also that "smoking remains the primary cause of lung cancer, and nearly one-quarter of women in the United States continue to smoke. Whether women are more susceptible to the carcinogenic effects of tobacco smoke than men is debatable. What is not debatable, however, is that important differences exist among men and women with lung cancer. Women smokers are more likely than men to develop adenocarcinoma of the lung. Women who have never smoked are more likely to develop lung cancer than men who have never smoked. Mounting evidence suggests that this could be due, in part, to estrogen signaling."
The authors add that in the past, major studies for lung cancer prevention and early diagnosis have excluded women. "... it is critical that future lung cancer research specifically include a proportion of women that reflects the true incidence of lung cancer in women."
According to the authors, one of the most important challenges lies in avoiding the U.S. scenario in other parts of the world.
"Sociocultural constraints that previously discouraged tobacco use by women continue to weaken in many developing countries. Smoking prevalence among women continues to increase in these countries, often accelerated by aggressive advertising campaigns targeted directly to women. The extraordinary increase in lung cancer rates seen among U.S. women in the 20th century will be repeated among women in developing countries during this century unless effective tobacco control measures are implemented. Curtailing the increase in tobacco use among women in developing countries represents one of the greatest opportunities for disease prevention in the world today," the authors conclude.
(JAMA. 2004;291:1763-1768. Available post-embargo at JAMA.com)
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JAMA