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Female smokers face twice the risk

Women who smoke are twice as likely to get lung cancer as men, a disturbing new study finds.

Published July 12, 2006

It could be the worst side effect of the feminist movement: As women have gained more power in society, the smoking gender gap has narrowed.

But a major new study says that smoking doesn't exact an equal toll between the sexes. Although men still are more likely to smoke, female smokers are almost twice as likely to get lung cancer as their male counterparts.

"The implication to me is that we need to tell young women to stop smoking," said Dr. Melvyn Tockman, oncology and medicine professor at H. Lee Moffitt Cancer Center & Research Institute in Tampa and one of the study's investigators. "We need to tell young women not to start."

Today's study is the largest yet to say that women have a greater risk of getting lung cancer - the biggest cancer killer - if they smoke.

The study, published in today's issue of the Journal of the American Medical Association, followed almost 17,000 smokers over a 12-year period and compared female smokers to men who smoked the same amount.

During that time, 2.1 percent of the women and 1.2 percent of the men were diagnosed with lung cancer.

A JAMA editorial ran with the study, pointing out that the research gives a whole new meaning to the infamous "You've come a long way, baby" ads for Virginia Slims.

"There are differences between men and women that really need to be explored," said Dr. Claudia I. Henschke, radiology professor at Joan and Sanford I. Weill Medical College of Cornell University and the study's lead author. "In smoking cessation efforts, and in treatment efforts, we need to sort out the differences."

The study came with one bright spot: Women were more likely to survive lung cancer than men, a finding that has been reported in earlier studies. Nevertheless, there is not much consolation in that fact. In general, the five-year survival rate for lung cancer is about 15 percent, reports the National Cancer Institute.

The disease remains the biggest cancer killer. More than 162,000 people - about 90,000 men and 72,000 women - are expected to die from lung cancer this year.

Researchers aren't sure why the gender differences exist.

"It's been shown that women's DNA repair mechanism for tobacco smoke is not as good as men," Henschke said.

Or maybe hormones make a difference. Researchers need to look at such biological factors next, Henschke said. If they influence why men and women get cancer, it could mean that men and women respond to treatment differently as well.

Study participants were screened for lung cancer with a new technology that isn't routinely used, so participants were diagnosed earlier than usual, raising the possibility that lung cancer develops earlier in women than in men.

Or maybe the explanation isn't that women are more likely to get early lung cancers, but that men with such cancers are more likely to have died from heart disease or some other problem.

So a big question will be whether the gender gap shows up over the years, Tockman said.

"Whether this will be the final answer, we need to wait for this population to be followed over time," he said.

The relatively small number of smokers who got lung cancer during the study period may downplay the danger, Tockman said. Eventually, about one-third of smokers will die from a smoking-related cause.

The study didn't look at secondhand smoke, but the results "would certainly suggest" that women are more at risk from being exposed to secondhand smoke than men, Henschke said.

Over the past few decades, the percentage of both men and women who smoke has gradually dropped. But men's smoking rates dropped more quickly between 1965 and 1985, leaving a narrower difference between the sexes. By 2004, 23.4 percent of men and 18.5 percent of women were smokers.

The gap is narrower - or nonexistent - among younger smokers. In 2003, 27 percent of white high school girls smoked, compared to 23 percent of white boys. Among black high school students, 11 percent of girls smoked, compared to 19 percent of boys, with the numbers almost even among Hispanic students, 18 percent for girls and 19 for boys.

Can studies such as this one discourage girls from smoking? Henschke and other researchers hope so. But history has shown it's not that easy, said University of South Florida psychology professor Thomas H. Brandon, director of Moffitt's Tobacco Research and Intervention Program.

"Adolescent girls aren't going to be particularly influenced by long-term health messages," Brandon said. "More successful campaigns talk about you're less attractive as a smoker, or that you're being taken advantage of by the tobacco companies."

St. Petersburg resident Emmy McGinty says she isn't sure what message would have gotten through to her in 1954, her first year of college, when she started smoking. Back then, girls would sneak out the dorm windows to light up.

"It was one of those things that kids did because you knew you couldn't," she said. "It was something where you were breaking the rules and you weren't getting caught."

But McGinty, a former nurse who turns 74 today, lost part of her left lung in 2002. Now she's facing her second bout with lung cancer, going through chemotherapy that leaves her drained and weak. She has lost her hair and her appetite.

McGinty isn't sure that hearing about this new study would have made her snuff out her cigarette then. But she knows what she'd like to say.

"Now when I see people smoking, I wish I could go up to people and tell them, 'Please, you don't want to do this,' " she said. "Because this is hell, really. It's hell on earth."

[Last modified July 12, 2006, 06:40:19]

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