Lung Cancer in Women: The Differences in Epidemiology, Biology and Treatment Outcomes

Maria Patricia Rivera


Expert Rev Resp Med. 2009;3(6):627-634. 

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Expert Commentary

Although there is controversy as to the differences between men and women in the relative risk of lung cancer in smokers, there are ample data to support the concept that the biology of the disease is different between the sexes and that lung cancer appears to be a different disease in women. Lung cancer is the leading cause of cancer deaths in both men and women, and kills more women each year than breast, ovarian and uterine cancers combined. Cigarette smoking remains the primary cause of lung cancer and, as noted earlier, nearly a quarter of women in the USA continue to smoke.[3] Women may be more susceptible to the dangers of tobacco carcinogens due to hormonal influences, decreased DNA repair capacity and increased levels of DNA adducts. Without doubt, the most effective form of intervention aimed at stopping the lung cancer epidemic in both women and men is to reduce smoking rates to zero. As such, extensive support should be given to campaigns of smoking prevention in youngsters (especially girls).

Women are more likely to develop adenocarcinoma and tend to be younger when diagnosed with lung cancer. Women who do not smoke are more likely to be diagnosed with lung cancer than men who do not smoke. Knowledge of these differences in risk for lung cancer should help us when evaluating female smokers and nonsmokers with persistent respiratory symptoms. Until now, early detection of lung cancer, even among former women smokers, has only been performed in two prospective studies of lung cancer screening.

Female sex has been identified as a 'good prognostic' indicator following treatment for lung cancer; however, the impact of HRT on mortality from lung cancer has not yet been fully defined. Given the results of recent studies, female current smokers using combined HRT should discontinue tobacco use.[46]

There are very clear differences in the biology, natural history and response to therapy between men and women with this disease, and emerging literature provides a biological basis for these differences. These differences will be important considerations in the design of future trials of therapy and screening in lung cancer.


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