Shira Kupperman Boehler, then just 43 years old, went for a full-body MRI for a baseline picture of her health. When a small spot appeared on her lung, she followed up with a low-dose CT scan, right after returning from a six-mile run. She thought the scan would rule out anything serious. Instead, it led to a diagnosis of aggressive early-stage lung cancer and surgery to remove half her right lung.
“This whole journey was scary, and I felt physically terrible after the surgery, but I soon realized I was very lucky to get diagnosed at such an early stage,” Kupperman Boehler said. “But I’m not unique in my diagnosis. This is not a rare cancer.”
Read: Even Though I Had No Symptoms, I Found My Lung Cancer Early Enough to Treat It >>
As the leading cancer killer worldwide, lung cancer is anything but rare. In fact, in the United States, lung cancer is the leading cause of cancer death, accounting for about 1 in 5 of all cancer deaths. Each year, more people die of lung cancer than of colon, breast and prostate cancers combined.
The American Cancer Society (ACS) reports that lung cancer is the second most common cancer in both men and women in the United States. Only skin cancers occur more often overall.
But lung cancer does not affect both sexes equally. The ACS estimates that clinicians will diagnose around 229,000 cases of lung cancer in the U.S. this year. Of those, about 118,000 will be in women.
Just as smoking became popular for men decades before it caught on among women, lung cancer cases now reflect those trends, said Narjust Florez, M.D., of the Dana-Farber Cancer Institute in Boston, who studies lung cancer and women. “The lung cancer rate has been dropping among men over the past few decades, but only for about the past decade in women,” she said. “There is this lag of women getting lung cancer because they started smoking 30 to 40 years later than men did.”
Similarly, women whose husbands smoked are now increasingly vulnerable to lung cancer. “Women are almost three times more likely to have lung cancer due to secondhand smoke from their husbands,” Florez said. “I have seen many of these women in my clinic who may have never touched a cigarette, but their lungs looked like they smoked for 30 years.”
Never-smoker women lead men in lung cancers
Secondhand smoke isn’t the only lung cancer risk factor that’s more common among women: the chest radiation that women receive to treat some forms of breast cancer adds to their risk of developing lung cancer later. “We have become very good at treating breast cancer, but most of these patients get radiation treatments that go straight to the lung,” Florez said. “Five, 10, 15 years later, these women have a higher risk of lung cancer because of that previous treatment.”
Women are also more likely to develop the genetic mutations that cause lung cancer. “About 80% of lung cancer cases are related to tobacco use, but a big part of the remaining 20% of cases come from genetic mutations, including EGFR mutations, which are more common in women and especially Asian American women,” said David Tom Cooke, M.D., 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 exposures like tobacco.”
Lung cancers with EGFR mutations, like Kupperman Boehler’s, are likely to be adenocarcinomas, the most common type of lung cancer. “More than 60% of adenocarcinomas have a genetic mutation, which means patients can receive ta rgeted therapy vs. chemotherapy,” Florez said. “With targeted therapy, patients take one pill per day and avoid the worst side effects of chemotherapy, plus they typically live longer.”
“Finally, this is some good news regarding women and lung cancer,” Florez added.
Women wait longer for diagnosis
Some of Florez’s research focuses on diagnostic differences between women and men with lung cancer. “Sadly, provider bias in diagnosing women with lung cancer is alive and well,” she said. “My research has shown the average woman takes several additional visits to be diagnosed with lung cancer compared to men even when insurance status, symptoms, age and risk factors are all equal.”
Although non-smokers are not eligible for screening, Cooke agrees that clinicians should do more to ensure that all eligible people receive lung cancer screening, especially women. “When you look at all the women in the country who are eligible for breast cancer screening with mammography, about 75% get a mammogram,” he said. “But when 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 actually get 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 clinicians to refer eligible patients for lung cancer screening.
Florez believes that societal norms have conditioned women to accept unequal treatment in healthcare. “Society has taught women that their needs come last. I have female patients who put their children, their spouse, their parents, their in-laws and even their pets before their own medical needs,” she said. “If you try to advocate for yourself, many will see you as pushy and a difficult woman, but I encourage my patients to move beyond that.”
This educational resource was created with support from Daiichi.
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