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Lung Cancer

Signs of a Gender Gap

Scientists are trying to pinpoint why women seem to be more likely than men to contract lung cancer.


There won't be a dry eye in the house if Michele Reed gets to walk down the aisle in April and promise to love her new husband "till death do us part." Less than a year ago, doctors told the 28-year-old Albuquerque secretary she had terminal lung cancer. She may not survive long enough for her wedding.

A light smoker, Reed never imagined that, at her age, backaches and neck pains could be the first signs of lung cancer. Neither did her doctors. By the time they ruled out stress, allergies and asthma, a tumor in her lung had grown to 4 inches wide and the cancer had spread to her bones.

"I seriously thought it was stress-related," Reed said recently, after letting out a long, deep cough. "I would get this fluttering feeling in my chest. I didn't know what it was. Now I do."

Lung cancer is deadly for both sexes, but it is now killing more women than ever. That's no surprise. The surge in female smoking that began in the 1930s started to ebb in the 1960s but continues to take its toll. What is surprising is that young women like Reed are dying from the disease.

Scientists have suspected a lung cancer gender gap since 1995, when a prominent cancer journal reported that women smokers are nearly twice as likely as men to develop the disease.

The debate has been ongoing since, said Curtis Harris, the head of the National Cancer Institutes' Laboratory of Human Carcinogenesis. "There are a number of studies showing that women have an increased risk of developing lung cancer if they are smokers," he said. "But there are also papers that don't show a difference. So it's an unresolved issue."

Now scientists are finding evidence that the gender gap is real. Female smokers appear to develop the disease earlier. They don't seem to need to smoke as much as men to get ill. And nonsmoking women are more likely than nonsmoking men to develop the disease.

The interaction of cell biology, genetics and tobacco smoke may be the reason the disease seems to play itself out differently in men and women.

For years, lung cancer was a man's disease. Men put down their pipes and cigars when cigarettes became fashionable around the turn of the century. And because society considered cigarette smoking unladylike until the 1930s, men started getting lung cancers first.

But by the time the U.S. surgeon general's landmark report on smoking and cancer came out in 1964, cigarettes had begun to take a toll on women too. With that report came the "war on cancer," and people began giving up smoking. At the same time, cigarette makers, who once targeted women by promoting their product as a way to lose weight, went for a liberation link with campaigns such as "You've come a long way, baby . . ."

The lung (and bronchus) cancer rate for men has declined from a peak of 75 deaths per 100,000 in 1990 to 68 deaths per 100,000 in 1996, according to age-adjusted data from the National Cancer Institute. The death rate for women has not declined. Although the sharp increases of the 1970s and '80s have slowed, the rate has grown from 13 per 100,000 women in 1973 to 34 per 100,000 in 1996.

Survival Rate Has Barely Improved

In general, cancer is not the death sentence it was in the 1960s. With early detection and better treatment, people now survive many once-fatal cancers. Lung cancer, however, is usually not one of them. From 1975 to 1990, the average survival rate for all cancers except lung cancer--that is, the percentage of cancer patients alive five years after diagnosis--rose from 56% to 67%. During that same period, the lung cancer survival rate hardly budged, moving from 13.4% to 13.9%.

This bleak disparity stems in part from the lack of a screening test for lung cancer similar to mammography for breast cancer or colonoscopy for colon cancer. Doctors usually detect the disease only after people develop symptoms. By then, it is almost always too late. Lung cancer kills about 160,000 people each year in the U.S.--more than breast, colon and prostate cancer combined. Lung cancer is also different from other cancers in that it is almost completely preventable. Between 85% and 90% of all lung cancer patients are current or former smokers. Yet, even as cigarette smoking becomes unacceptable in many once-welcoming settings--such as airplanes, break rooms and restaurants--about 25% of the national population still smokes.

That rate has essentially held steady for adults over the last decade. Smoking rates are even higher for teenagers and actually went up during the mid-1990s, peaking at 35% in 1997, according to the federal Centers for Disease Control and Prevention. The rate is leveling off and may even be declining for male students but remains virtually unchanged for females.

Most smokers start in their teens, but the cancers don't usually kick in for about 40 years.

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