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APRIL 13, 2004
Why Women Shouldn't Light Up A new report says their incidence of lung cancer now represents an "epidemic" -- and smoking may be more deadly to them than to men While lung-cancer death rates among men have been steadily declining since the early '80s, a wide-ranging new medical review has found that lung cancer is killing U.S. women at a rate that has soared 600% from 1930 to 1997. Once the seventh-leading cause of cancer death in women, lung cancer by 1987 had surpassed breast cancer to become No. 1. It now takes the lives of nearly 20,000 more women each year than breast, uterine, and all other gynecological cancers combined. "Lung cancer in U.S. women occurred suddenly and in numbers clearly in excess of normal expectancy," the report says. The article, appearing in the Apr. 14 issue of the Journal of the American Medical Association (JAMA), reviews a large number of current studies and data on what it terms a "contemporary epidemic of lung cancer in women." The cause is the equally dramatic rise in the numbers of women who smoke, since 85% to 90% of lung cancer victims are current or former smokers. About 25% of adult U.S. women smoke cigarettes, and to make matters worse, the authors report that some evidence indicates that women may be more susceptible to the carcinogenic properties of cigarettes. "IT'S A CRIME." This epidemic is also sure to worsen, says Dr. Mark G. Kris, chief of thoracic oncology at Memorial Sloan-Kettering Cancer Center in New York and a co-author of the study. "Lung cancer can still occur years after someone quits smoking, and smoking rates among teenage girls rose steadily throughout the 1990s." The JAMA study reports that in 2000, 30% of high school senior girls reported having smoked in the past 30 days. The data don't surprise lung cancer specialists. Dr. Fred Grannis, head of thoracic surgery of City of Hope Hospital in Los Angeles, says the proportion of women patients with lung cancer that he treats has steadily increased from a handful when he started 30 years ago to over half now. "Smoking in men is a tragedy because a lot of the damage was done in the 1940s and 1950s, before the tobacco industry was aware of how dangerous cigarettes were," says Grannis. "But in women it's a crime because the cigarette companies made a conscious decision to market to women in the 1960s, after they knew, and a lot of women are now addicted as a result." The JAMA report cites data that an estimated 80,100 U.S. women were diagnosed with lung cancer in 2003 and 68,000 died from it. The authors note several studies that show women smokers at increased risk of developing lung cancer, including a 1993 Canadian study that found the chances of developing lung cancer for those with a 40-pack-a-year history, when compared with nonsmokers, was 27.9% in women vs. 9.6% in men. ESTROGEN'S ROLE. Another U.S. study found that women with a lifelong exposure to cigarette smoke had a 1.5-times higher estimated relative risk of developing lung cancer than men. Women who never smoked also have a higher rate of lung cancer -- though unusual -- than men who never smoked. The one positive piece of data the researchers highlighted is that women with lung cancer usually live slightly longer after treatment than men with the disease. The researchers suggest that the hormone estrogen may have some role in the development of lung cancer, explaining in part the gender disparities. "Given these differences and given the enormous toll this disease has on U.S. women, undertaking sex-specific research in lung cancer is crucial," the report says. The authors also warn that tobacco-control measures targeted specifically toward women should be quickly instituted in the developing world before women in these countries take up smoking at the same rates as their U.S. counterparts. The authors conclude: "Curtailing the increase in tobacco use among women in developing countries represents one of the greatest opportunities for disease prevention in the world today."  By Catherine Arnst in New York
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