Cancer discriminates

April 26, 2004

WHAT WOMEN don't know - or don't act upon - can kill them. Lung cancer causes more women to die each year than breast cancer and gynecological cancers combined, with 68,800 deaths last year. And the vast majority of cases are preventable, through lifestyle changes, awareness campaigns and targeted medical care.

Some still prefer to think of lung cancer as largely a male affliction, but the number of women falling ill has grown steadily during the last two decades, reflecting the increase in the number of women who have started smoking since the 1960s. While the number of men dying of the disease each year is greater, that number is declining while the number of women is ticking up. And we may be exporting this tragic trend: Smoking is on the rise among women in Africa, Japan and China, where U.S. and local cigarette brands are widely advertised.

Smoking is disproportionately damaging to women, according to a new review of research and data on lung cancer in the latest issue of The Journal of the American Medical Association. For example, lung tumors from female patients showed higher rates of genetic damage than those from male patients, though the male patients, on average, smoked much more. And compared with men, a greater number of women - up to 22 percent - who contracted lung cancer had not been smokers; they'd been exposed to secondhand smoke, asbestos or radon gas.

Maryland recorded 1,581 new cases and 1,302 deaths from lung cancer among women in 2000 compared with 1,956 new cases and 1,620 deaths among men, according to the state's Department of Health and Mental Hygiene.

Baltimore health officials say 87.6 percent of school-age girls are saying no to smoking, far more than the national average of 70 percent, but that's still too many lighting up. "Illegal" and "potentially fatal" don't seem to sway these young immortals.

From the JAMA review, this much becomes certain: Just as the disease treats women differently from men, so must doctors. The treatment must fit them, not just be a smaller dosage of the medicine prescribed for men. Some studies suggest that certain medicines and treatments work better on nonsmokers' cancers than on those of chronic smokers, and that the female hormone estrogen may affect both the rate of growth of the cancer and the body's ability to repair the DNA damage.

However, women have been rare among clinical study subjects, mainly because there were fewer with lung cancer and because it was thought there were not such differences between women and men.

More female-targeted research is needed.

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