Tobacco doubles the mortality of women from lung cancer in 20 years

Lung cancer has long ceased to be a disease of older men: although it remains the most lethal tumor for them, mortality in men has fallen by 29% in the last two decades, but that of women has doubled in the same period. The cause is the same: tobacco.

This difference in trend has meant that the difference in mortality between both sexes due to this tumor —caused in 90% of cases by tobacco— has decreased, so that, if in 2001 the male rate was 10 times higher than the female rate, in 2020 it was only 3.9 times higher, according to the report “Patterns of mortality in Spain”, which has just been published by the Ministry of Health.

And it has its explanation: women started the habit later than men and, therefore, also started to stop later than men, points out Mónica Pérez Ríos, professor at the Department of Preventive Medicine and Public Health at the University of Santiago de Compostela, and Javier De Castro, head of the Oncology Section at the University Hospital of La Paz.

Although men continue to smoke more and the risk depends on the intensity and duration of the habit, there is growing evidence that tobacco has more harmful effects in women.

Taking 2020 as a reference, the prevalence of smoking was 22.1% (11.7% less than in 2014); 16.4% of women and 23.3% of men smoked daily; 64.8% and 46.4%, respectively, have never done it and 16.7% and 27.6% have given up, according to the latest European Health Survey in Spain.

Considering the numbers of former smokers, the percentages are also higher for them and for all age groups. “In men, tobacco consumption has been steadily decreasing since the 1980s, while in women the decline is more recent, since 2001, but the pace is much slower”, observes Pérez Ríos, coordinator of the tobacco group of the Spanish Society of Epidemiology (VER).

Therefore, the decrease in male consumption is already reflected in the reduction of their mortality, something that did not yet happen to women.

Although they continue to smoke more and the risk depends on the intensity and duration of the habit, there is increasing evidence that “in women it causes more damage” even if they smoke less and for a shorter period of time, due to their lower capacity to eliminate the more than 200 carcinogens that this substance has, adds De Castro, secretary of the Board of Directors of the Spanish Society of Medical Oncology (SEOM).

In 2020, 21,918 people died from lung tumors in Spain, of which 16,615 (75%) were men. Of the 22,266 new cases that the SEOM estimates will be diagnosed this year, 9,016 will be women, and this type of cancer remains the third most frequent in them, behind breast and colon.

Expert forecasts are that the female incidence —which has already tripled in relation to 2001— will continue to increase and, with it, mortality, to the point that in the next 2 or 3 years lung cancer is expected to be the most lethal —although breast cancer continues to be the most frequent— for Spanish women, as was the case with North American women in 1987, says the epidemiologist.

Why do women smoke?

Tobacco was something for men until the 1970s, when the incorporation of women into work and the equality and emancipation movements also led to their initiation into the tobacco habit.

That’s why they started, but the reasons they keep doing it now are more playful; To conventional tobacco, they added other derivatives such as vaping, which social networks teach them – defends De Castro – as something innocuous when it is just as harmful, if not more so.

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“Other derivatives, such as vaping, have been added to conventional tobacco, which social networks teach as something innocuous when it is just as harmful, if not more”

Javier DeCastro

To which is added another reason that has more to do with aesthetics: “they believe that it can reduce appetite and anxiety and that smoking can make them lose weight or not”. Tobacco companies know this, so they changed the red on the packs to pink or white and filled them with slim fit cigarettes.

But there is more: especially young women, which is the group with the highest number of smokers, “do not realize that tobacco is associated with cancer and think that lung cancer is a disease of older men”.

social stigma

The Registry of Thoracic Tumors carried out by the Spanish Lung Cancer Group (GEPC) with data from 89 hospitals confirms this perception: the patient’s profile is male, smoker, 60 years old and with advanced disease at the time of diagnosis, which makes it is a less visible and highly stigmatized cancer.

But there are other risk factors, such as exposure to residential radon gas (the main one among those who have never smoked, according to the WHO) and tobacco smoke, certain occupations or environmental pollution.

Lung tumors not associated with tobacco, details the oncologist, are more frequent in women than in men (between 30% and 40% occur in non-smoking women compared to 20% in non-smoking men).

They also tend to occur in a younger population: “I have patients between 20 and 30 years old, who, although rare, do exist, and in them the stigma is double: the social one and the feeling that they have a disease that doesn’t correspond to them” , the Mint.

Screenings and gender perspective

Against this background, it seems obvious that the approach to lung cancer requires a gender perspective; It is already being applied in research and even in the development of clinical trials because the answer is not the same and neither is the pharmacological toxicity, but more campaigns are needed aimed at them.

“Clearly, smoking control policies must be strengthened and specific actions aimed at women must be designed”, aimed above all at preventing the initiation and cessation of the habit, both conventional tobacco and its new forms of consumption, said the SEE specialist.

“Tobacco control policies must be strengthened and specific actions aimed at women must be designed”

Monica Perez Rios

He also believes it is relevant to advance legislation “as quickly as possible”; However, the reform of the anti-smoking law, one of the great promises of the Ministry of Health that expands smoke-free spaces, increases taxation and introduces other measures such as neutral labeling, has been paralyzed for months.

With all this, it is urgent to establish screening in the population at risk (active smokers or former heavy smokers between 50 and 75 years old): only between 20% and 25% of lung cancers are detected in early stages, while the vast majority are detected, being diagnosed in stages III or IV, when the probability of cure is already very low.

“We know that performing low-radiation exams in the population at risk would detect more cases in the early stages and this would increase survival, and this positive impact would also be greater in women than in men”, concludes the oncologist.

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