Thoracic Oncology
Lung Cancer and Women
While the overall incidence of lung cancer (LC) has decreased among both men and women, the decline among men has been steeper compared with women. Further, in women born in the 1950s to 1960s, the incidence has actually increased and cannot be fully explained by sex differences in smoking behavior (Jemal, et al. N Engl J Med. 2018;378:1999). Data suggest that women may be more susceptible to the harmful effects of tobacco and that the biology of LC may be different in women. In addition, LC in nonsmokers is more likely to occur in women.
LC is the leading cause of cancer death in both women and men worldwide, but the dramatic rise in the mortality rate from LC in women was qualified as a “full blown epidemic” in the Surgeon General’s 2001 Women and Smoking report.
The benefits of lung cancer screening (LCS) in the National Lung Screening Trial (NLST) were higher in women than in men and significantly greater in the subset of women (16%) that entered the Nelson trial – reduction in 10-year LC mortality of 61% vs. 26% in men (De Koning, et al. J Thorac Oncol. 2018;13[10]: suppl S185. Abstract PL02.05). A retrospective review of patients diagnosed with LC between 2005 and 2011 showed that only 37% of women vs. 50% of men met LCS criteria (Wang, et al. JAMA 2015;313[8]:853).
Lung cancer needs to be recognized as an important women’s health issue, and there is need for continued attention to sex differences in LC risk, LCS criteria, and outcomes.
Anne Gonzalez, MD, FCCP
Steering Committee Member