Young women and lung cancer - should you be worried?
The headlines were concerning: Younger women are getting lung cancer at higher rates than men, according to a recent study published in JAMA Oncology.
But the story is more complicated than that, according to Jeffrey J. Spillane, MD, FACS, a general and thoracic surgeon with Cape Cod Healthcare.
“The main takeaway is that people at high risk should be screened with a CAT scan,” he said. “Nationally, it’s a very dismal percentage of the eligible population that we’re screening.”
The gender differential in the study by researchers at the American Cancer Society is small – one or two more cases among every 100,000 women than among men between the ages of 35 and 54. According to the ACS, lung cancer is the second most common cancer in both men and women.
So far, the difference hasn’t been explained, but Dr. Spillane offered some thoughts.
“There’s a suggestion that women may metabolize nicotine differently,” he said. “Did they smoke the same type of cigarettes? I talked about this study with my father last night, and he said, ‘Well, women have smaller lungs,’ which is true. So, there are biologic differences. It’s worth further study.”
Elephant in the Room
The “elephant in the room, said Dr. Spillane, is smoking.
“One in five smokers get lung cancer. When you’re trying to reduce your risk, it’s not about whether you were born a man or a woman. It’s did you smoke? Are you still smoking? To me, that’s the crux of the thing.”
So who should be screened?
“If you're a man or a woman between the age of 50 and 80, and you've had a smoking history of 20 pack years – half a pack for 40 years or one pack for 20 years – then you're eligible for a screening exam,” he said.
Early detection is key because symptoms often don’t occur until the later stages of the disease, he said. “The lung tissue itself doesn’t have much in terms of nerve fibers, so you can grow a baseball-sized tumor in the middle of your lung without any symptoms.
The biggest symptom is persistent cough, said Dr. Spillane. “That's the one that makes my ears perk up. If I hear somebody has a persistent cough for a month or two and it’s not going away, that’s concerning. Coughing up blood, chest pain and weight loss all could be symptoms of a more advanced tumor. But most of those folks with the oncologic stage one and stage two tumors have no symptoms. If you’re waiting to cough up blood as a symptom to go see your doctor, you’re not doing well.”
Studies on cancer rates in different populations are “fascinating,” Dr. Spillane said, “but I just care that people recognize that smoking’s the risk. And if they have smoked or are smoking, A: stop, and B: get screened.”
Dr. Spillane said there’s one certainty in all of this. “The best way to cut your risk of lung cancer: don’t smoke, don’t smoke, don’t smoke.”
