Lung Cancer in Women
Lung cancer is the deadliest cancer in women. In the last decade, the first measurable decline in disease-related mortality has occurred and in the last 5 years, the first decline in lung cancer incidence in women in the United States has been reported. Five-year survival rates are much higher in early-stage disease, making effective screening a priority. Data on screening with low-dose computed tomography are controversial; existing guidelines are not sex specific and recommend testing only for patients at high risk for the disease. Although cigarette smoking remains the predisposing factor that is most often associated with tumor development, the advent of molecularly targeted therapy and the growing evidence that susceptible targets are more prevalent in never-smoking women have brought more attention to this particular subpopulation. Studies of both surgery and systemic therapy suggest that not only never-smoking women but also women overall experience better outcomes than men. Identifying all of the factors contributing to these sex differences presents us with an opportunity to identify potentially a distinct tumor biology in women who would warrant a distinct personalized treatment approach.
For the last 50 years, lung cancer (LC) in women has been a focus of healthcare advocates. With a steady rise in incidence, LC surpassed breast cancer as the leading cause of cancer-related death in women in the United States in 1987. This trend has plateaued, whereas in men the incidence has been declining for nearly 3 decades. These disparate trends have sparked investigation into sex-specific patterns of cigarette smoking, the biologic response to cigarette smoking, the composition of cigarettes, sex differences in genetic susceptibility, the prevalence of LC among never smokers, the impact of hormone therapy (HT), viral mediation of disease, histology of tumors, and the molecular profile of tumors. This, along with the advent of molecularly targeted therapies and the generally higher response rates among women, particularly never-smoking women to those therapies, have led some to postulate that the disease in women is an entirely distinct entity from that in men. Understanding the unique features of LC in women may alter current approaches to both screening and treatment.
Abstract and Introduction
Abstract
Lung cancer is the deadliest cancer in women. In the last decade, the first measurable decline in disease-related mortality has occurred and in the last 5 years, the first decline in lung cancer incidence in women in the United States has been reported. Five-year survival rates are much higher in early-stage disease, making effective screening a priority. Data on screening with low-dose computed tomography are controversial; existing guidelines are not sex specific and recommend testing only for patients at high risk for the disease. Although cigarette smoking remains the predisposing factor that is most often associated with tumor development, the advent of molecularly targeted therapy and the growing evidence that susceptible targets are more prevalent in never-smoking women have brought more attention to this particular subpopulation. Studies of both surgery and systemic therapy suggest that not only never-smoking women but also women overall experience better outcomes than men. Identifying all of the factors contributing to these sex differences presents us with an opportunity to identify potentially a distinct tumor biology in women who would warrant a distinct personalized treatment approach.
Introduction
For the last 50 years, lung cancer (LC) in women has been a focus of healthcare advocates. With a steady rise in incidence, LC surpassed breast cancer as the leading cause of cancer-related death in women in the United States in 1987. This trend has plateaued, whereas in men the incidence has been declining for nearly 3 decades. These disparate trends have sparked investigation into sex-specific patterns of cigarette smoking, the biologic response to cigarette smoking, the composition of cigarettes, sex differences in genetic susceptibility, the prevalence of LC among never smokers, the impact of hormone therapy (HT), viral mediation of disease, histology of tumors, and the molecular profile of tumors. This, along with the advent of molecularly targeted therapies and the generally higher response rates among women, particularly never-smoking women to those therapies, have led some to postulate that the disease in women is an entirely distinct entity from that in men. Understanding the unique features of LC in women may alter current approaches to both screening and treatment.
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