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Shira Kupperman Boehler, then just 43 years old, underwent a full-body MRI to get an overview of her health. When a white spot appeared on his lung, he had a low-dose CT scan immediately after the six-mile run. He thought the CT scan would rule out anything serious. Instead, he was diagnosed with early-stage aggressive lung cancer and had to undergo surgery to remove half of his right lung.
“The whole thing was scary and I felt physically terrible after the surgery, but I quickly realized that I was very lucky to receive the diagnosis so early,” said Kupperman Boehler. “But I’m not the only one with this diagnosis. This is not an uncommon cancer.”
Read: Even though I had no symptoms, my lung cancer was detected early enough to treat >>
Because it is the type of cancer that kills most people worldwide, lung cancer is anything but rare. In fact, lung cancer is the leading cause of cancer death in the United States, accounting for approximately one in five cancer deaths. More people die from lung cancer each year than the total number of deaths caused by colon, breast and prostate cancer.
The American Cancer Society (ACS) reports that lung cancer is the second most common cancer among men and women in the United States. Only skin cancer occurs more frequently overall.
However, lung cancer does not affect both genders equally. The ACS estimates that doctors will diagnose about 229,000 cases of lung cancer in the United States this year. Of these, around 118,000 will be women.
Just as smoking was widespread among men decades before women, lung cancer cases now reflect those trends, Dr. Narjust Florez of the Dana-Farber Cancer Institute in Boston, who studies lung cancer and women’s health. “Lung cancer rates have been declining in men over the last few decades, but this has only been the case in women in the last decade,” he said. “This delay in lung cancer rates in women is due to the fact that they started smoking 30 to 40 years later than men.”
Likewise, women whose husbands smoked are now increasingly susceptible to lung cancer. “Women are almost three times more likely to develop lung cancer because their husbands smoke passively,” Florez said. “I saw many women in my clinic who had never touched a cigarette, but whose lungs looked like they had smoked for 30 years.”
Women who have never smoked are more likely to develop lung cancer than men
Secondhand smoke isn’t the only risk factor for lung cancer that’s more common in women: the chest radiation that women undergo to treat certain forms of breast cancer increases the risk of later developing lung cancer. “We’ve gotten very good at treating breast cancer, but most of these patients receive radiation therapy that goes directly to the lungs,” Florez said. “Five, 10 or 15 years later, these women have a higher risk of lung cancer because of this pretreatment.”
Women are also more likely to develop genetic mutations that cause lung cancer. “Approximately 80% of lung cancer cases are associated with tobacco use, but a significant portion of the other 20% of cases are associated with genetic mutations, including EGFR gene mutations, which are more common in women and particularly in Asian American women,” said Dr. David Tom Cooke, chief of general thoracic surgery at UC Davis Health in California. “When tumors have an EGFR gene mutation, that person will develop lung cancer, regardless of environmental factors such as tobacco.”
Lung cancers with mutations in the EGFR gene, such as Kupperman Boehler’s, have a high risk of becoming adenocarcinomas, the most common type of lung cancer. “More than 60% of adenocarcinomas have a genetic mutation, meaning patients can receive targeted therapies instead of chemotherapy,” Florez said. “Through targeted therapies, patients take one tablet a day, avoiding the worst side effects of chemotherapy and often living longer.”
“This is ultimately good news for women when it comes to lung cancer,” Florez said.
Women wait longer for a diagnosis
Part of Florez’s research focuses on diagnostic differences between men and women with lung cancer. “Unfortunately, there is bias among physicians in diagnosing women with lung cancer,” she said. “My research has shown that the average woman must undergo several additional visits compared to men to receive a lung cancer diagnosis, even when their insurance, symptoms, age and risk factors are the same.”
While non-smokers are not eligible for lung cancer screening, Cooke agrees that doctors should do more to ensure that all eligible people, especially women, receive lung cancer screening. “If you look at all the women in this country who are eligible for breast cancer screening with mammography, about 75% of them get a mammogram,” she said. “But if you look at all the women in this country who are eligible for lung cancer screening with low-dose CT, less than 10% of them are actually screened.”
Cooke said the lung cancer screening rate at UC Davis Health is just above 50% due to an ongoing campaign to educate and motivate all primary care providers to refer appropriate patients for lung cancer screening.
Florez believes that societal norms have conditioned women to accept unequal treatment in health care. “Society has taught women that their needs are the last priority. I have patients who prioritize their husbands, parents, in-laws and even their pets over their own medical needs,” she said. If you try to stand up for your rights, many will think that you are pushing too hard and that you are a difficult woman, but I encourage my patients to get past that.”
This educational resource was created with support from Daiichi.
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