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Published on March 30, 2021

One dangerous way women are achieving equality with men

WH Smoking

The lung cancer cases thoracic surgeon Jeffrey J. Spillane, MD, sees are evenly divided between men and women, but that wasn’t always the case. Most patients used to be men.

As the women’s rights movement gained traction in the 1970s, so did cigarette smoking. Manufacturers pounced on the opportunity, directing their marketing towards women with new enthusiasm. Most notable was the advertising catchphrase for Virginia Slims, which exclaimed, “You’ve come a long way, baby.”

“Women were encouraged to smoke,” said Dr. Spillane.

Lung cancer rates among women in the United States rose, eventually surpassing breast cancer as the leading cause of death from cancer, he said. Breast cancer is more commonly diagnosed than lung cancer (behind skin cancer, which is the most commonly diagnosed cancer) in American women, according to the American Cancer Society.

The organization estimates that in 2020, there were 228,820 new cases of lung cancer, of which 112,520 (49 percent) will be women; and 135,720 people will die of lung cancer, of which 63,220 (47 percent) will be women.

In some aspects of lung cancer, women fare worse than men or face risks unique to being female. According to Smokefree.gov, a National Cancer Institute project, female smokers:

  • Die of COPD (chronic obstructive pulmonary disease) more often than men and are more likely to develop severe COPD at a younger age.
  • Get cervical cancer more often than women who don’t smoke.
  • Die from an abdominal aortic aneurysm more often than male smokers.
  • Die of heart disease more often than male smokers. (Taking birth control pills while smoking greatly increase this risk.)
  • Have more difficulty getting pregnant than other women.
  • More frequently suffer from irregular or painful periods and experience menopause at an earlier age, with more severe symptoms.
  • Have lower estrogen levels.
  • Are more likely to have premature babies, or have babies who have low birth weight, birth defects, abnormal brain development and a greater risk of dying from Sudden Infant Death Syndrome (SIDS).

A study of data from 40 nations published Aug. 1, 2020 in the International Journal of Cancer found more women between ages 30 and 49 are being diagnosed with lung cancer than men of the same age range in several countries, including the United States. But the authors said more research is needed to identify the causes, as sex differences in smoking patterns don’t fully explain the findings.

Part of the phenomenon may be due to increases in the occurrence of adenocarcinoma, a type of non-small cell lung cancer.

“There is some difference” between the sexes, Dr. Spillane said. “We are seeing more adenocarcinoma of the lung in elderly (female) patients.”

This might be due to increases in longevity and women tending to outlive men, he explained, adding that most people will develop some form of cancer, if they live long enough. In the 1970s, when most lung cancer cases occurred in men, it frequently was squamous cell carcinoma, another variety of cancer, Dr. Spillane said.

“I see people who have been smoking for a while,” he said. This is because it typically takes many years for the habit to result in lung or other cancers. Smoking-caused cancers include kidney, esophageal, colon, bladder, mouth and throat, larynx, liver, pancreatic, stomach and blood, according to the Centers for Disease Prevention and Control.

Most of the lung cancer patients Dr. Spillane sees are in their 60s, 70s, and 80s, although he has had a patient who was 28 years old, he said.

Health officials refer to “pack-years” of exposure when assessing a smoker’s habit. A pack year is the equivalent of smoking a pack of 20 cigarettes every day for a year. Dr. Spillane suggested that because women’s bodies are typically smaller, exposure to tobacco smoke may be more harmful to them than men who smoked the same number of pack years.

Women may also differ from men as to how they become hooked on nicotine in tobacco. A small study at Yale University in 2014 used brain scans to examine rapid changes of the neurotransmitter dopamine in 16 smokers – eight men, eight women. The men experienced those changes in an area of the brain associated with reinforcement of the effects of drugs, including nicotine. Rapid changes in the women took place in another area of the brain, one associated with forming habits.

Dr. Spillane urged women to quit smoking, or at least reduce their habit.

“If you can’t stop, almost everybody can cut it in half,” he said. “There’s definite benefits of doing that.”