Lung cancer in women is a 21st century epidemic

April 13, 2004

CHICAGO - Future lung cancer research needs to include gender-specific studies to address the important differences that exist between men and women with lung cancer, according to a paper published in the April 14 issue of the Journal of the American Medical Association (JAMA).

"Lung cancer appears to be a different disease in women," says the paper's lead author Jyoti Patel, M.D., an oncologist at Northwestern Memorial Hospital and an instructor of medicine at the Feinberg School of Medicine of Northwestern University. Differences include female smokers' increased predisposition to lung cancer and longer survival rates as compared to men. Female smokers are also more likely than men to develop adenocarcinoma, the most common form of lung cancer. In addition, women who have never smoked are more likely to develop lung cancer than men who have never smoked.

Mounting evidence suggests that these differences could be due, in part, to estrogen signaling. Genetic, metabolic and hormonal factors also play a role in the way women react to carcinogens and lung cancer. However, women's longer survival periods once they have lung cancer cannot be accounted for solely by a longer life expectancy or an imbalance of other prognostic factors, says Dr. Patel.

"As researchers, we need to do our part to best address what has become an epidemic in American women," says Dr. Patel. "From 1990 to 2003, there was a 60 percent increase in the number of new cases of lung cancer in American women, while the number of men diagnosed with lung cancer remained stable. This is a dramatic increase and is clearly in excess of normal expectancy."

Lung cancer is the leading cause of cancer death in the United States and will cause more deaths in American women this year than breast cancer and all gynecological cancers combined. In 2003, an estimated 80,100 American women were diagnosed with lung cancer, and 68,800 died from their disease. "The majority of lung cancer is caused by cigarette smoke, yet despite all we know about the health hazards of smoking, one in four women continue to smoke," says Dr. Patel. Following the increase in tobacco use in American women over the past century, the death rate from lung cancer increased 600 percent from 1930 to 2003.

Although smoking prevalence in men has decreased by nearly 50 percent from its peak in the 1960s, smoking prevalence in women has decreased by only 25 percent in the same period. In recent years, smoking rates among women in the United States have remained stable. However, rates among women in Africa and Asia have risen significantly. "Attacking the rising use of tobacco among women is one of the greatest disease prevention opportunities in the world today," says Dr. Patel.

Dr. Patel's paper reports that the improved survival of women with lung cancer has important implications in the design and interpretation of lung cancer trials. "When a clinical trial of today is compared to one from 15 years ago, the increase in the proportion of women participants because of their increase in rates of lung cancer will cause survival improvement, regardless of treatment effect. Future trials would benefit from stratification by gender," says Dr. Patel.
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About Northwestern's Cancer Program
The Cancer Program at Northwestern Memorial Hospital is nationally recognized for providing a comprehensive range of clinical and support services for patients and their families while advancing the science of cancer diagnosis and treatment. The Cancer Program is affiliated with the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, the only National Cancer Institute-designated comprehensive cancer center in Illinois and the only Illinois member of the National Comprehensive Cancer Network.

About Northwestern Memorial Hospital
Northwestern Memorial Hospital (NMH) is one of the country's premier academic medical centers and is the primary teaching hospital of Northwestern University's Feinberg School of Medicine. Northwestern Memorial and its Prentice Women's Hospital and Stone Institute of Psychiatry have 744 beds and more than 1,200 affiliated physicians and 5,000 employees. Providing state-of-the-art care, NMH is recognized for its outstanding clinical and surgical advancements in such areas as cardiothoracic and vascular care, gastroenterology, neurology and neurosurgery, oncology, organ and bone marrow transplantation, and women's health.

Northwestern Memorial was ranked as the nation's 5th best hospital by the 2002 Consumer Checkbook survey of the nation's physicians and is listed in the majority of specialties in this year's US News & World Report's issue of "America's Best Hospitals." NMH is also cited as one of the "100 Best Companies for Working Mothers" by Working Mother magazine and has been chosen by Chicagoans year after year as their "most preferred hospital" in National Research Corporation's annual survey.

Northwestern Memorial HealthCare

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