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

Maria Patricia Rivera


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

In This Article

Cigarette Smoking & Lung Cancer Risk

While the prevalence of smoking has decreased in men by almost 50% since its peak in the 1950s, it has only minimally decreased in women, from 33.9% in 1965 to 21% in 2000.[1] The percentage of white men who are current smokers has been decreasing since the first Surgeon General's report in 1964, which linked cigarette smoke to lung cancer. Conversely, the prevalence of smoking among women has increased significantly in many countries, including the USA.[2] In 2007, the prevalence of smoking among women in the USA was reported to be 17.4%,[3] and a study by Wallace et al. that analyzed prevalence and trend data from 1991 to 2007 in girls' cigarette use, revealed that approximately 25% of all eighth-grade girls in the USA had used cigarettes in their lifetime; nearly 10% reported being current smokers (30-day use), almost 4% reported smoking daily and 1.3% reported smoking half a pack or more of cigarettes per day.[4]

Cigarette smoking is by far the major cause of lung cancer, and owing to the increased prevalence of smoking in women in the USA, a sharp increase in the incidence of lung cancer has occurred, from six cases per 100,000 in 1960 to more than 40 cases per 100,000 in 1990.[5] It appears that the incidence of lung cancer among women in the USA is still increasing, albeit at a much slower rate than in previous years.[6,7] It is projected that 219,440 individuals (129,710 men and 107,280 women) will be diagnosed with lung cancer, and that 163,790 individuals (92,240 men and 71,550 women) will die from lung cancer in the USA by the end of 2009.[7] Without doubt, changes in smoking habits have contributed to the increasing relative risks for lung cancer;[8] however, the rate of increase in the incidence of lung cancer among women in the USA is more rapid than would be expected based on changing smoking habits alone. What has become increasingly more apparent in the past decade is that the relative risks of specific types of lung cancer, the association between smoking and lung cancer, and the response to the treatment of lung cancer, regardless of the stage of the disease, may not be the same between men and women. An important question raised by the increased incidence of lung cancer in women is whether women are indeed more at risk for developing lung cancer.


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