Small Cell Lung Cancer: Sex and Survival (Editorial‪)‬

Lung cancer is recognized as the most lethal form of cancer in both men and women, now exceeding that of breast cancer in women. In 2003, World Cancer Report (1) reported that the annual new cases of lung cancer totaled 904 746 for men and 337000 for women, of which 80100 occurred in American women, with a death rate of 13%. There is little doubt that the major cause of this epidemic is tobacco, accounting for approximately 90% of lung cancer cases, including both active and passive smoking. In the 732 cases of Ferguson et al, (2) 16% were nonsmokers. Sasco et al (3) reported an increased risk of 16% to 18% in the workplace and 20% to 30% at home. It has been reported (1,4) that passive smoking accounts for 20% to 30% of cases. Marginal causes are radon exposure, asbestos, and so forth. Grivaux et al (5) reported that of 904 women in France with proven primary lung cancer, one third never smoked. Prior to World War I, lung cancer was comparatively rare and occurred in men 10 times as often as in women. Men were tobacco users of all kinds: pipes, cigars, cigarettes, and chewing, whereas women had not yet adopted this habit. World War II changed American culture in many ways. Among them was the entrance of many women into the workplace, for example, Rosie the Riveter, with accompanying independent incomes and greater personal liberation. Large numbers of women began smoking, particularly cigarettes, seduced by cigarette company ads, appealing to diet ("Reach for a Lucky instead of a sweet"), to health ("Not a cough in a carload"), and to liberation ("You've come a long way, baby"). In the 60 years since then, the male-female incidence ratio has changed from 10:1, reaching parity in Connecticut, where the tumor registry survey of 1977 reported that in the 35- to 45-year-old age group, the number of women with lung cancer exceeded that of men. (6) In this respect, equality has been reached, perhaps exceeded. Indeed, you have come a long way, baby. Because many young women regard cigarette smoking as "cool," this is not likely to change. In 2003, the number of new cases of lung cancer among American women was expected to be 337115. (1) Among American women, 80 600 cases were expected, with 68 000 deaths.