Shira Kupperman Boehler, then just 43 years old, had a full-body MRI performed to get an initial picture of her health. When a small spot appeared on her lung, she had a low-dose CT scan immediately after returning from a six-mile run. She thought the scan would rule out anything serious. Instead, she was diagnosed with early-stage, aggressive lung cancer and underwent surgery to remove half of her right lung.
“This whole journey was scary and I felt terrible physically after the surgery, but I soon realized that I was very lucky to receive the diagnosis at such an early stage,” said Kupperman Boehler. “But I’m not an isolated case with my diagnosis. This is not a rare cancer.”
Read: Even though I had no symptoms, I discovered my lung cancer early enough to treat it >>
As the most common cause of cancer death 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-fifth of all cancer deaths. More people die from lung cancer each year than from colon, breast and prostate cancer combined.
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.
But 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 became popular among men decades before it became common among 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. “Lung cancer rates have been declining in men over the past few decades, but have only been decreasing in women for about a decade,” she said. “There is this delay in women getting lung cancer because they started smoking 30 to 40 years later than men.”
Likewise, women whose husbands smoked are increasingly susceptible to lung cancer. “Women are almost three times more likely to develop lung cancer because of their husbands’ exposure to secondhand smoke,” Florez said. “I saw a lot of these women in my clinic who may have never touched a cigarette, but whose lungs looked like they had smoked for 30 years.”
Non-smoking women are more likely to develop lung cancer among men
Secondhand smoke isn’t the only risk factor for lung cancer that’s more common in women: the chest radiation women receive to treat some forms of breast cancer increases their risk of developing lung cancer later. “We have become very good at treating breast cancer, but most of these patients receive radiation treatments that go directly to the lungs,” Florez said. “Five, 10, 15 years later, these women have a higher risk of lung cancer because of the previous treatment.”
Women are also more likely to develop genetic mutations that cause lung cancer. “Approximately 80% of lung cancer cases are related to tobacco use, but a large portion of the remaining 20% of cases are due to genetic mutations, including EGFR 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 mutation, the person developed that lung cancer regardless of environmental factors such as tobacco.”
Lung cancers with EGFR mutations, like Kupperman Boehler’s, are likely adenocarcinomas, the most common type of lung cancer. “More than 60% of adenocarcinomas have a genetic mutation, meaning patients can receive targeted therapy instead of chemotherapy,” Florez said. “With targeted therapy, patients take one tablet per day and thus avoid the worst side effects of chemotherapy, and they also generally live longer.”
“In conclusion, this is some good news regarding women and lung cancer,” Florez added.
Women wait longer for a diagnosis
Part of Florez’s research focuses on diagnostic differences between women and men with lung cancer. “Unfortunately, provider bias in diagnosing women with lung cancer still exists,” she said. “My research has shown that, on average, a woman requires several additional visits to diagnose lung cancer compared to men, even when insurance status, symptoms, age and risk factors are the same.”
Even though 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 the country who are eligible for breast cancer screening through mammography, about 75% get a mammogram,” he said. “But if you look at all the women in the country who are eligible for lung cancer screening with a low-dose CT scan, less than 10% of them are actually screened.”
Cooke said the lung cancer screening rate at UC Davis Health is slightly above 50% thanks to an ongoing campaign to educate and encourage all primary care physicians 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 come last. I have patients who put their children, their spouses, their parents, their in-laws and even their pets above their own medical needs,” she said. “If you try to advocate for yourself, many will see you as a pushy and difficult woman, but I encourage my patients to go beyond that.”
This educational resource was created with support from Daiichi.
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