The death rate from lung cancer among women in the United States increased by 600% from 1930 to 1997, having surpassed that of breast cancer in 1987, according to a recent report. In contrast, lung cancer rates in men have been declining since the early 1980s. Several factors may be involved, including the higher incidence of cigarette smoking among women than among men.

In the report, Patel and colleagues analyze data published in recent years showing conflicting evidence of whether women are "more susceptible to the carcinogenic effects of cigarette smoke." The role of estrogen has been studied, as have genetic and metabolic factors, in determining why it is that women appear to react differently than men to carcinogens, why when diagnosed with lung cancer they display histologic differences, and why they respond differently to treatment. Patel and colleagues strongly advocate sex-specific research, particularly because most major studies of lung cancer prevention and early diagnosis have excluded women.

They also note the significant rise of cigarette smoking among women in Africa and Asia, stating that stemming the tide of tobacco use among women is one of the greatest disease-prevention opportunities in the world today.-Ellen McLaughlin and Joy Jacobson, managing editor

Patel JD, et al. JAMA 2004;291(14): 1763-8.