Lung Cancer Incidence Now Higher in Younger Women – Does Smoking Fully Account for This Change?
BACKGROUND AND PURPOSE:
Lung cancer is the leading cause of preventable cancer deaths in the US
Smoking accounts for 80% of lung cancer deaths
Lung cancer rates between men and women have converged and recent data suggests higher incidence rates in young women vs young men
Jemal et al. (N Engl J Med, 2018) sought to determine whether the higher rates of lung cancer in young women compared to young men were maintained in contemporary birth cohorts and whether these differences could be explained by sex differences in smoking behaviors
Nationwide population-based incidence of lung cancer according to sex, race or ethnic group, age group, year of birth, and calendar period of diagnosis (1995-2014)
Data extracted from North American Association of Central Cancer Registries (NAACCR)
Female-to-male incidence rate ratios were calculated
The prevalence of cigarette smoking was also measured using the National Health Interviews Survey
Incidence of lung cancer has generally decreased among individuals age 30 to 54 years all races and ethnic groups
Steeper decline seen in men
Among non-hispanic whites, the female to male incidence rate ratios have therefore increased
1995-1999: Ratio 0.88 (95% CI, 0.84 to 0.92)
2010-2014: Ratio 1.17(95% CI, 1.11 to 1.23)
Ratio crossed 1.0 the age groups of 30 to 34, 35 to 39, 40 to 44, and 45 to 49 years
Among other races/ethnicities, this crossover phenomenon occurred only among Hispanic women
1995-1999: Ratio 0.79 (95% CI, 0.67 to 0.92)
2010-2014: Ratio 1.22 (95% CI, 1.04 to 1.44)
Change in sex-specific ratio (from lower to higher incidence) is specific to the birth cohort born since the mid-1960’s
The prevalence of smoking in women have approached but not surpassed smoking rates in men since 1965
Use of tobacco products other than cigarettes (e.g., cigars) remains much lower among women, compared to men
The incidence of lung cancer is now higher in younger white and Hispanic women compared to their male counterparts, but this change cannot entirely be explained by smoking behaviors
Among Hispanic women, smoking prevalence is substantially lower in women compared to men
Evidence that women are more susceptible to lung cancer is inconclusive
Since 15% of lung cancer in women and 10% in men is unrelated to smoking, other exposures may be related to the results seen in this study (e.g., men may no longer be exposed to levels of asbestos and arsenic in the workplace)
While more studies are needed, authors state in the their conclusion that their results
…may foreshadow a higher future burden of overall lung cancer among women than among men as younger cohorts age, which further underscores the need to intensify antitobacco measures to decrease smoking among young women”
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