Lung Cancer in Women

How is Lung Cancer Different in Women?

generations of women
How is lung cancer different in women than men?. Flickr.com/Lisa Ann Rogers/Creative Commons

Lung cancer in women differs from lung cancer in men in many ways. Yet, despite obvious differences in our appearance, we tend to lump men and women together when talking about lung cancer. This is unfortunate, since the causes, response to various treatments, survival rate, and even symptoms to watch for differ. What are some facts about lung cancer in women?

Statistics About Lung Cancer in Women

Lung cancer is the leading cause of cancer deaths in women, killing more women each year than breast cancer, uterine cancer, and ovarian cancer combined.

While smoking is the number one cause, 20 percent of women who develop lung cancer have never touched a cigarette.

Once considered a “man’s disease,” lung cancer is no longer discriminatory. In 2016 it's estimated that 117,920 men and 106,470 women will be diagnosed with the disease.

While lung cancer diagnoses have been decreasing for men, they are staying relatively stable for women. That is, with the exception of one group. Lung cancer is increasing in young, never-smoking women. 

Lung cancer in women occurs at a slightly younger age in women than in men, and almost half of lung cancers in young adults occur in women.

Causes of Lung Cancer in Women

Even though smoking is the number one cause of lung cancer in women, a higher percentage of women who develop lung cancer are life-long non-smokers. Some of the causes may include exposure to radon in our homes, secondhand smoke, other environmental and occupational exposures, or a genetic predisposition.

Recent studies suggest infection with the human papillomavirus (HPV) may also play a role.

Smoking Status

Some, but not all, studies suggest that women may be more susceptible to the carcinogens in cigarettes, and women tend to develop lung cancer after fewer years of smoking.

Lung Cancer Types in Women vs Men

Whereas men are more likely to develop squamous cell lung cancer, another form of non-small cell lung cancer, adenocarcinoma is the most common type of lung cancer found in women.

BAC (Bronchioalveolar carcinoma) - a condition which has been reclassified as a form of lung adenocarcinoma - is a rare form of lung cancer that is more common in women. For unknown reasons, the incidence of BAC appears to be increasing worldwide, especially among younger, non-smoking women.

Symptoms of Lung Cancer in Women

We hear about the symptoms of a heart attack being different in women from in men. The same could hold true for lung cancer. Squamous cell lung cancer (the type more common in men) grows near the airways and often presents with the “classic symptoms” of lung cancer, such as a persistent cough and coughing up blood. Adenocarcinomas (the type of lung cancer that is more common in women), often develops in the outer regions of the lungs. These tumors can grow quite large or spread before they cause any symptoms. Symptoms of fatigue, the gradual onset of shortness of breath, or chest and back pain from the spread of lung cancer to bone, may be the first sign that something is wrong.

Lung Cancer in Women – The Role of Estrogen

It is likely that estrogen plays a role in the development and progression of lung cancer and research is being done to define this further. Women who have their ovaries removed surgically before menopause may be at higher risk of developing lung cancer. Recent research suggests that treatment with estrogen and progesterone (hormone replacement therapy) after menopause may increase the risk of dying from lung cancer. In contrast, the use of estrogen therapy alone has been associated with a lower risk of dying from the disease.

In contrast, both the use of birth control pills and hormone replacement therapy (excepting those who use hormones after surgical menopause) are associated with a lower risk of developing lung cancer. This contrast between dying from, and development of, lung cancer, suggests that estrogen plays more than one role in lung cancer.

Treatments for Lung Cancer in Women

The treatments you and your doctor choose will often include a combination of therapies. To understand how these are used, it can help to define the purpose of these different treatments.  

  • Local treatments - Local treatments are designed to remove cancer cells at their source - locally - and include surgery and radiation therapy.
  • Systemic treatments - Systemic treatments are designed to address cancer cells anywhere in your body, not just your lungs. This is important if your cancer has spread beyond your lungs, of if there is a chance that at least a few cells have traveled beyond your lungs. Systemic treatments include chemotherapy, targeted therapies, and immunotherapy.

Surgery - For early stage lung cancers (stage I to stage IIIA) surgery may offer a chance for the cure. There are several different types of lung cancer surgery that may be chosen depending on the size of your tumor and its location. Women who have lung cancer surgery tend to fare better than men with these procedures. In one study, the median survival after surgery for lung cancer was twice as long for women as for men.

Radiation therapy - Radiation therapy may be done for several reasons. In early stage lung cancers that are inoperable for some reason, a technique called stereotactic body radiotherapy (SBRT) may offer a chance for a cure. Radiation therapy is commonly done (external beam radiation therapy) following surgery to clean up any remaining cancer cells. It may also be done prior to surgery along with chemotherapy in an attempt to decrease a tumor to a size that can be removed with surgery. Radiation therapy may also be done as a palliative treatment - a treatment designed not to cure the cancer, but to extend life or improve the symptoms of the disease

Chemotherapy - Women historically respond to a few chemotherapy medications used for lung cancer better than men.

Targeted therapies - Everyone who has non-small cell lung cancer should have gene testing (molecular profiling) to look for targetable mutations. At this time, treatments are available for those who have EGFR mutations, ALK rearrangements, and ROS1 rearrangements, with other treatments being explored in clinical trials. One of the new targeted therapies. Tarceva (erlotinib) also appears to be more effective for women.

Immunotherapy - Immunotherapy is an exciting new approach to treating cancer, with 2 medications in this category having been approved for lung cancer in 2015.

Clinical trials - The National Cancer Institute recommends that people with lung cancer consider participating in clinical trials,These trials not only help to advance research in lung cancer, but, at times, offer people life extending treatments that are otherwise not available.

Survival for Women with Lung Cancer

The survival rate for lung cancer in women is higher than for men at all stages of the disease. Sadly, the overall 5-year survival rate is only 17 percent (vs 12 percent for men), but this number will likely increase in the near future. As an example to illustrate this hope, there were more new treatments approved for lung cancer in the period between 2011 and 2015, than during the forty years preceding 2011. It may help to keep in mind that survival rates are estimated based on statistics on how people responded to lung cancer treatments in the past.

Support for Women with Lung Cancer

Unfortunately, until recently there was less support available for women with lung cancer than was available for some other cancers. This is one way in which coping with lung cancer may be harder than coping with breast cancer (of course, coping with ANY cancer is hard and I could not write this without being a breast cancer survivor myself.) But what the lung cancer community lacks in numbers it makes up in depth, and there is a very active and supportive lung cancer community out there. Check out this article on finding lung cancer support groups and support communities. If you are on social media, the hashtag #LCSM may help you find others coping with similar challenges.

Being Your Own Advocate with Cancer

If we were to name the number one thing anyone could do to improve their survival with lung cancer, it would be to advocate for yourself. If you become involved in the lung cancer community, you'll meet several women who are alive only because they became involved and learned about newer treatments. Lung cancer treatments are changing rapidly, and doctors are only human. It's difficult to stay abreast of every new study and clinical trial. Check out these tips on how to research your cancer online, as well as how to be a self-advocate in your cancer care. Thankfully, you don't have to do this alone. In addition to the lung cancer community, several of the lung cancer organizations have worked together to form a lung cancer clinical trial matching service. With this free service, a navigator can review your specific diagnosis and check for clinical trials taking place anywhere in the world that may be an option for you.

When Your Loved One Has Lung Cancer

If it's your loved one who has been diagnosed with lung cancer you may be feeling overwhelmed and helpless. How can you best support your loved one with cancer?  Take a moment to step into her shoes. Here is an article which discusses "what it's really like to live with cancer" and shares comments about what lung cancer survivors wish their family members knew. The most important thing you can do is listen and be there. One of the greatest fears of those with cancer is that they will be alone.

Awareness and Funding

Even though many more women die from lung cancer than breast cancer, much more funding is devoted to breast cancer research than lung cancer research. Many people are working tirelessly to reduce the stigma of lung cancer, and in doing so, hopefully, increase both private and public funding for the disease.

How Can Women Reduce Their Risk of Lung Cancer?

Thankfully, even though lung cancer is the leading cause of cancer deaths in women, there are some things you can do to lower your risk.

Sources:

American Cancer Society. Cancer Facts and Figures 2016. Accessed 07/02/16. http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf

Chlebowski, R. et al. Oestrogen plus progestin and lung cancer in postmenopausal women (Women’s Health Initiative trial): a post-hic analysis of a randomized controlled trial. Lancet. 2009. Sep 18. (Epub ahead of print).

Claque, J., Reynolds, P., Henders, K. et al. Menopausal Hormone Therapy and Lung Cancer-Specific Mortality Following Diagnosis: The California Teachers Study. PLoS One. Published July 31, 2014.

Kazmi, N. et al. The role of estrogen, progesterone and aromatase in human non-small-cell lung cancer. Lung Cancer Management. 2012. 1(4):259-272.

Meinhold, C. et al. Reproductive and hormonal factors and the risk of nonsmall cell lung cancer. International Journal of Cancer. 2011. 128(6):1404-13.

Pesatori, A. et al. Hormone use and risk for lung cancer: a pooled analysis from the International Lung Cancer Consortium (ILCCO). British Journal of Cancer. 2013 Sep 3. (Epub ahead of print).

Yao, Y. et al. Hormone replacement therapy in females can decrease the risk of lung cancer: a meta-analysis. PLoS One. 2013. 14(8):e71236.

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