Lung Cancer Awareness Month and The Great American Smokeout – Nov. 17

Woman breaking cigrette in half

Lung Cancer and Women: What You Need to Know

According to the American Lung Association (ALA), lung cancer diagnoses have risen a startling 84% among women over the past 42 years while dropping to 36% among men, even as number of lung cancer cases remains steady. The American Cancer Society (ACS) 2022 lung cancer projections for lung cancer in the U.S. include:

  • about 236,740 new cases of lung cancer (117,910 in men; 118,830 in women.)

  • about 130,180 deaths from lung cancer (68,820 in men; 61,360 in women.)

Approximately 20% of women diagnosed with lung cancer today are lifelong non-smokers. By contrast, only 1 in 12 men with lung cancer have never smoked. The latest data show a lung cancer incidence rate in nonsmoking women ranging from 14.4% to 20.8%. For nonsmoking men with lung cancer, the rate is between 4.8% and 13.7%.  While men still make up most of lung cancer diagnoses, the gender gap is increasingly narrowing, with lung cancer increases occurring in women with no obvious behavioral reason for developing the disease.

Women between 30-49 years of age are being diagnosed with lung cancer at higher rates than men, at the same age and in many high-income countries, according to a 2020 study published in the International Journal of Cancer. Even though smoking is the major risk factor for developing all forms of lung cancer, researchers note differences in smoking between men and women don’t completely explain the pattern.

The study determined higher lung cancer rates in women were largely driven by increases in adenocarcinoma, a type of lung cancer typically seen in people who smoke. However, adenocarcinoma is also the most common lung cancer type seen in those who don't smoke and is more prevalent in young women.

Women with lung cancer consistently tend to be younger, have lower smoking histories than men (31 versus 52 pack-years, respectively), are 2 to 3 times more likely to be nonsmokers and are more likely to develop adenocarcinoma, according to the National Institutes of Health (NIH.)

The ALA states secondhand smoke can increase your risk for developing lung cancer by almost 30 percent. Even brief secondhand smoke exposure can damage cells in ways that start the cancer process.

While more men are diagnosed with lung cancer each year, more women live with the disease, the ALA further iterates.

November is Lung Cancer Awareness Month, with November 17 designated The Great American Smokeout, a day for smokers to begin their journey toward enjoying smoke-free, healthier lives. Your local Capital Women’s Care team of women’s health experts share important information about lung cancer, including adenocarcinoma and how it affects women; lung cancer symptoms, tests and treatments; and how to reduce you and your family’s lung cancer risk, including environmental influences beyond smoking (including exposure to secondhand smoke), so you can optimize your lung health and enjoy a long quality life. 

Lung Cancer Types

About 49% of new lung cancer diagnoses in the U.S. occur in women. Lung cancer is the leading cause of cancer deaths in women, killing more women each year than breast, uterine and ovarian cancers combined.

While smoking is the top cause of developing lung cancer, about 16% of women who develop the most common types of lung cancer never smoked.

Lung cancer occurs at a slightly younger age in women than in men, and almost half of lung cancers in young adults occur in women. Researchers have also found that among adults ages 30 to 54 years, women are more likely than men to develop lung cancer, and this change in incidence rate can't be explained by differences in smoking behaviors.

Women are more likely to be diagnosed with one of two types of NSCLC:

Non-small cell lung cancer (NSCLC) accounts for almost 85% of all lung cancer cases and takes 1 of 2 forms:

  • Squamous cell carcinoma is a cancer affecting the lungs’ airways and is linked to smoking. Today, it makes up 25-30% of all lung cancers, with the incidence lower in women than in men. About 37% of lung cancers in women are squamous cell carcinoma.

  • Lung Adenocarcinoma is a more common cancer that forms within the outer regions of the lungs, usually occurring without noticeable symptoms for many years before diagnosis.

    In many instances, it will have metastasized to other areas of the body (including bone metastases) before diagnosis occurs. Both former and current smokers are susceptible, yet it is the most prevalent lung cancer occurring among non-smoking females. Approximately 44% of lung cancer diagnoses in women are adenocarcinoma, making it the most common type for females.

    Adenocarcinoma in Situ (AIS), previously called Bronchioalveolar Carcinoma (BAC) and formerly considered a 3rd type of NSCLC, is now distinctively recognized. AIS is increasingly common amidst younger female nonsmokers, both in the U.S. and worldwide. This subtype is 2 to 4 times more common in women, particularly in female nonsmokers in contrast with male nonsmokers, accounting for 3.6% of all cases.

Small cell lung cancer (SCLC), also known as oat cell cancer/carcinoma or small cell undifferentiated carcinoma, is the more aggressive type of lung cancer, as its cells grow quickly and travel faster, causing metastases. It accounts for 17% to 34% of lung cancers in women in contrast with 15% to 20% in men.

Early SCLC diagnosis is crucial for positive outcome. However, diagnosis tends to be made after metastasis takes place, as SCLC usually is asymptomatic in presentation until it has spread, offering poor prognosis and outcome.  

Differentiating Symptoms of Lung Cancer in Women

As symptoms of heart attacks often differ between men and women, signs of lung cancer compared between sexes may also vary. This is primarily because men and women are susceptible to different types of NSCLC, each of which causes its own set of symptoms. Presentation of symptoms also seems to be related to biological differences, causing different reactions and responses within the body.

Because men are more likely to be diagnosed with squamous cell carcinoma, their earliest signs of cancer are usually related to problems associated with the major airways, including experiencing chronic cough or coughing up blood.

The first symptoms of lung cancer in women are frequently signs of adenocarcinoma, in which tumors usually begin within the periphery of the lungs, which are located away from major airways, thus having less likelihood of developing distinguishing persistent cough.

Instead, the early symptoms of lung cancer in women may be more nuanced in nature and include:

With lung cancer progression, women develop additional symptoms that may include:

  • chronic cough with or without blood or mucus
  • wheezing
  • discomfort when swallowing
  • chest pain
  • fever
  • hoarseness
  • unexplained weight loss
  • and/or poor appetite.

Oftentimes, women don’t experience symptoms until lung cancers have spread (metastasized) to other regions of the body:

  • Metastases to the brain may cause eye symptoms, numbness or weakness.
  • Metastases to bones can cause bone pain, back pain, chest pain or shoulder pain.
  • Other symptoms may occur that are related to metastatic cancer in general, including unintentional weight loss.

Causes and Risks

Women have a 1 in 16 chance of developing lung cancer during their lifetime. A variety of lifestyle, environmental and biological factors can impact the threat of developing lung cancer:

  • Smoking. Tobacco remains the largest risk factor for lung cancer in women and is responsible for between 80% - 90% of cancer-related deaths among females.

    Women over age 60 years have the highest mortality rates due to lung cancer. These women were adolescents at the peak of the U.S. smoking epidemic and their early and frequent exposure to tobacco, as a smoker or via secondhand smoke, may be reasons for high rates.

    Researchers note female smokers are less able to repair damaged DNA caused by smoking when compared to male smokers, which may contribute to the fact that cigarette smoking seems to put women at greater risk for specific types of lung cancer.

  • Estrogen Factor. One of the most significant areas of research for women and lung cancer is the study of estrogen's influence on tumors. There is evidence supporting estrogen makes cancer cells grow or makes women more sensitive to carcinogens.

    Among data collected, researchers also discovered a connection between early menopause (when estrogen levels drop) and reduced lung cancer risk. Estrogen-progestin therapy isn’t linked to higher lung cancer risk; however, it is linked to higher risk of mortality due to lung cancer.

  • Gene Mutation. Different cancer cells contain gene mutations that control how the cancer grows or spreads. Research is finding ways to target these mutations and treat cancer more effectively.

    Among women, certain mutations are more common and through genetic testing, may be identified. Two mutations specifically identified as important for women when determining lung cancer risk are:

    Epidermal Growth Factor Receptor (EGFR). This type of protein is found on the surface of lung cancers. It is most common in women and nonsmokers. Researchers have found that lung cancer patients with mutations in EGFR tend to respond better to gefitinib, a chemotherapy drug that blocks EGFR proteins.

    Kirsten Rat Sarcoma Viral Oncogene Homologue Gene (KRAS).  This genetic mutation makes proteins that promote cell division and growth, potentially making lung tumors more aggressive. One study showed women might be 3 times more likely than men to carry the KRAS mutation. No medications have been found to target this mutation, but through identifying it, healthcare providers can better determine subsequent treatment.

  • Additional Risk Factors. Other factors that may increase likelihood of developing lung cancer include:

Talk with your primary care physician about your lung cancer risk factors to determine if your practitioner recommends that lung cancer testing be incorporated within your personal health plan. 

Lung Cancer Screening

Lung cancer screening is recommended for older adults who are longtime smokers and don't have any signs or symptoms of lung cancer. If you have a personal or family history of lung cancer, are a former heavy smoker who quit, have chronic obstructive pulmonary disease (COPD) or experience secondhand smoke, radon, asbestos or environmental or occupational exposures (arsenic, chromium and nickel) that increase lung cancer risk, you should also consider lung screening.

Your doctor may recommend:

MRI scan, PET scan or bone scan may be prescribed to determine if metastasis has occurred.

If lung cancer is detected at an early stage, it's more likely to be cured with treatment. By the time lung cancer signs and symptoms develop, the cancer is usually too advanced for curative treatment. Studies show lung cancer screening reduces risk of dying of lung cancer.

Treatments

Treatment plans are usually based on the stage of the disease and are the same regardless of one's sex. However, research shows that women consistently respond better to these treatments.

The reason is unclear, but it may be due to hormonal differences.

The treatment plan you and your healthcare provider choose likely incorporate combination of therapies:

  • Surgery. There are several different types of lung cancer surgery that may be chosen depending on the size of your tumor and its location. Women who have lung cancer surgery tend to fare better than men with these procedures. In one study, the 5-year survival rate post-surgery was 75.6% for women versus 57.9% for men.
  • Radiation Therapy. This is used in early-stage cancers that are inoperable, after surgery to eradicate residual cancer cells or before surgery combined with chemotherapy to reduce tumor size for eventual surgical removal, or as palliative treatment to ease pain and extend life.
  • Chemotherapy. Often used with surgery to help kill cancer cells, or exclusively as a palliative treatment. Women respond better to chemotherapy than men. In 1 study, the treatment for adenocarcinoma resulted in a 42% survival rate for women versus 40% for men.
  • Targeted Therapies. These therapies are used exclusively or in combination with other treatments when an identified gene mutation is present to target specific cells. More treatments are in clinical trials with exciting initial findings relating to treatment of lung cancer in women.
  • Immunotherapy. This is an exciting new approach to treating cancer that has effectively helped boost the immune systems of those with NSCLC so they can fight cancer. Research suggests that women respond differently to immunotherapy compared to men. Studies are looking for ways to combine antiestrogen drugs with immunotherapies to make them more effective for women.
  • Clinical Trials. The National Cancer Institute (NCI) recommends those with lung cancer consider participating in clinical trials. These trials not only help advance lung cancer research but can offer life-extending treatments that aren’t otherwise available. Among the clinical trials that apply to women, there have been ongoing studies regarding the effectiveness of estrogen-related cancer therapies.

    You can search NCI's online database for trials currently enrolling participants.

Lung Cancer Prognosis

While the survival rate for lung cancer in women is higher than for men at all disease stages, the overall 5-year survival rate is still only 23% for women (vs. 16% for men). These rates have been increasing and are expected to continue to improve as treatment and diagnostics improve, giving hope to those diagnosed.

Reducing Lung Cancer Risk

There's no sure way to prevent lung cancer, but you can reduce your risk:

Don't smoke. If you've never smoked, don't start. Tobacco use remains the leading preventable cause of death in the U.S., accounting for about 1 in 5 deaths each year. On average, people who smoke die about 10 years earlier than people who have never smoked. Eliminate use of pipes, chewing tobacco, cigars and vape/e-cigarettes as well.

Talk to your children about not smoking so they can understand how to avoid this major lung cancer risk factor. Begin conversations about the dangers of smoking with your children at an early age so they know how to manage peer pressure.

Stop smoking. Stop smoking now. Quitting reduces your risk of lung cancer, even if you've smoked for years. Talk to your doctor about strategies and stop-smoking aids that can help you quit. Options include nicotine replacement products, medications and support groups. The Great American Smokeout on November 17 is a great day to start reclaiming your lung health.

Avoid secondhand smoke. If you live or work with a smoker, urge him or her to quit. At the very least, ask him or her to smoke outside. Avoid areas where people smoke, like bars and restaurants, and seek out smoke-free options.

Test your home for radon. Have the radon levels in your home checked, especially if you live in an area where radon is a known issue. High radon levels can be fixed to make your home safe. For information on radon testing, contact your local department of public health or a local chapter of the American Lung Association.

Avoid carcinogens at work. Take precautions to protect yourself from exposure to toxic chemicals at work. Follow your employer's precautions. For instance, if you're given a face mask for protection, always wear it. Ask your doctor what more you can do to protect yourself at work. Your risk of lung damage from workplace carcinogens increases if you smoke.

Eat a diet full of fruits and vegetables. Choose a healthy diet with a variety of fruits and vegetables. Food sources of vitamins and nutrients are best. Avoid taking large doses of vitamins in pill form, as they may be harmful. For instance, researchers hoping to reduce the risk of lung cancer in heavy smokers gave them beta carotene supplements. Results showed the supplements increased cancer risk in smokers.

Exercise most days of the week. If you don't exercise regularly, start slowly. Try to exercise most days of the week, doing activities you enjoy. Talk with your practitioner for guidance on implementing a physician-recommended exercise plan.

Your Capital Women’s Care team of health experts is here to answer your questions or concerns relating to lung cancer and any women’s health issue. Our compassionate, knowledgeable health professionals offer you and your family integrated, comprehensive health care so you enjoy a long quality life.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312492/
https://www.verywellhealth.com/symptoms-of-lung-cancer-in-women-2249393
https://www.medicalnewstoday.com/articles/319483
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