Lung Cancer in Men

How Symptoms, Causes, Treatment, and Outcomes Differ

In This Article

Lung cancer in men differs from lung cancer in women in a number of ways. Although men are more likely to get lung cancer due to higher rates of smoking, men who have never smoked are less likely to get the disease than women who have never smoked. Moreover, if a man does smoke, he has lesser odds of getting the disease than a woman. And if he does, it tends to be at an older age.

The types of lung cancer that commonly affect men also differ, as does the effectiveness of therapies used to treat them. Generally speaking, the outcomes in men tend to be poorer, although newer targeted drugs and immunotherapies show promise in terms of improving survival times.

Statistics

Lung cancer is the leading cause of cancer deaths in men, both in the United States and worldwide. Though men are historically more likely to develop the disease than women, the number of men and women diagnosed each year has been slowly reaching parity.

According to 2020 statistics issued by the American Cancer Society:

  • Around 228,820 new cases of lung cancer are projected to be diagnosed in the United States (comprised of 116,300 men and 112,520 women).
  • Around 135,720 Americans will die from lung cancer, 72,500 of whom will be men and 63,220 of whom will be women.

Overall, men in the United States have a one in 15 chance of getting lung cancer compared to women, who have a one in 17 chance. Cigarette smoking is considered the prime cause of this disparity.

However, for reasons that are not entirely understood, men who smoke are less likely to develop the disease than their female counterparts. A 2014 study published in the British Journal of Cancer reported that men who are heavy smokers are 50% less likely to develop the types of lung cancers associated with tobacco smoke.

The same appears to be true of men who have never smoked. Compared to never-smoking women, never-smoking men are around 33% less likely to get lung cancer (a disparity believed to be associated with genetics, body size, and exposure to carcinogens like radon in the home). Even so, male never-smokers who get lung cancer are at greater risk of death than women.

Most Common Types in Men

Men are more likely to get squamous cell lung cancer, a type of non-small cell lung cancer (NSCLC) that develops within the airways of the lungs. It accounts for around 30% of all NSCLC diagnoses and is directly linked to cigarette smoke.

By contrast, lung adenocarcinomas, the type of NSCLC that develops in the periphery of the lungs, predominate in women and non-smokers.

Men are somewhat less likely to get small cell lung cancers (SCLC), a less common but generally more aggressive form of the disease. A 2012 review of studies in the journal Lung Cancer reported that SCLC accounts for up to 20% of lung cancer cases in men versus 34% in women.

However, when heavy smoking is added to the mix, the risk of these diseases can start to equalize.

Men who smoke more than 30 cigarettes per day increase their odds of squamous cell lung carcinoma 100-fold, lung adenocarcinoma 22-fold, and SCLC 111-fold.

A similar pattern is seen in women, wherein smoking over 30 cigarettes daily increases the odds of squamous cell lung carcinoma 63-fold, lung adenocarcinoma 17-fold, and SCLC 109-fold.

Lung Cancer Symptoms in Men

A man who gets a certain type of lung cancer will generally have the same symptoms as a woman who gets the same type. However, because men are more likely to get squamous cell lung cancer, they often exhibit symptoms more profoundly because that kind of tumor lodges itself within the airways rather than the outer edges of the lungs (as occurs with lung adenocarcinoma).

Common symptoms of squamous cell cancer include:

Although these same symptoms can occur with lung adenocarcinoma, many of the more tell-tale signs (such as coughing up blood or wheezing) occur when the tumor has spread (metastasized) from the outer edges to the central airways.

With squamous cell carcinoma, these can occur even before the tumor has metastasized.

Causes

Though smoking is considered the cause of lung cancer in 70% to 80% of women with the disease, it accounts for around 90% of cases in men. The difference in incidence can be largely attributed to the rates of smoking, wherein 17.5% of American men are smokers compared to only 13.5% of American women. Other factors can also contribute to cases in men.

According to a 2017 study in BMC Public Health, occupational exposure to carcinogens accounts for as many as 13% to 29% of lung cancer cases in men. Asbestos is among the main culprits alongside arsenic, benzene, cadmium, coal tar, diesel fuel emissions, formaldehyde, and medical radiation. 

Occupations linked to the occupational risk include metal workers, painters, cleaners, bakers, plumbers and pipefitters, welders, freight handlers, and construction workers.

It is important to note that many men who get lung cancer are not current smokers. In fact, roughly 40% were former smokers at the time of their diagnoses. Compared to never-smokers, men who are former smokers have a four-fold increased risk of lung cancer. Women who are former smokers have a roughly 3.5-fold risk.

Should You Be Screened?

If you are a heavy smoker with a long history of smoking, speak with your doctor to see if you are a candidate for annual lung cancer screening.

The Centers for Disease Control and Prevention currently recommends screening of adults ages 55 to 80 with a smoking history of 30 pack-years or more who are either currently smoking or quit within the past 15 years.

Treatment

There are different treatments available for people diagnosed with lung cancer. Many of the traditional approaches—including surgery, chemotherapy, and radiation—do not differ between men and women.

It is only when newer targeted therapies and immunotherapies are used that the recommended treatments and efficacy rates can vary.

Targeted Therapies

Targeted therapies are drugs designed to recognize, target, and kill cells with specific genetic mutations. These include mutations of the epidermal growth factor receptor (EGFR) gene, the KRAS gene, and the anaplastic lymphoma kinase (ALK) gene.

Women tend to have these specific mutations more than men. As a result, certain targeted drugs like EGFR inhibitors—which include Tarceva (erlotinib) and Iressa (gefitinib)—are 25% less effective in men. Other drugs like ALK inhibitors appear to work equally well.

Immunotherapies

In 2015, immunotherapies were introduced as a novel treatment for lung cancer. These include two drugs classified as PD-1 inhibitorsOpdivo (nivolumab) and Keytruda (pembrolizumab)—that boost the body's immune response to cancer by blocking the programmed death-1 (PD-1) protein. Unlike targeted therapies that recognize specific mutations, immunotherapies respond to the degree of mutations.

According to a 2016 study in Oncotarget, while women have more targetable mutations than men, men have a higher overall tumor mutation burden (TMB). Cells that have multiple gene mutations (i.e, a high TMB) are more likely to be recognized as abnormal and attacked by the body's immune system.

Because of this, PD-1 inhibitors tend to be more effective in men. According to a 2018 study in ESMO Open, PD-1 inhibitors prolonged disease-free survival in men compared to chemotherapy but showed little to no benefit in a matched set of women with lung cancer.

Prognosis

The survival rate, the percentage of people alive after a specific period, can vary by the stage and type of lung cancer involved as well as a person's sex. The current data shows that the survival rate in men is lower than for women at all stages of the disease.

For men, the overall five-year survival rate is only around 16% (compared to 23% in women). This is due in part to delayed diagnoses in men who generally tend to put off seeing a doctor until overt symptoms appear.

A 2019 study in Thoracic Cancer reported that being male, a current smoker, and over age 65 are the top three factors associated with delayed diagnoses in people with lung cancer.

Overall, men with NSCLC have a 27% higher risk of death than women. They also experience shorter survival times with SCLC (six months versus nine months, respectively).

Coping

Generally speaking, men with lung cancer report higher quality of life compared to women, in part because they tend to cope better with treatment and may be less emotionally impacted by things like hair loss. Even so, this shouldn't infer that men can carry the burden of the disease "better" or that all men are the same.

Studies have shown that men with lung cancer can experience isolation, depression, and anxiety as well as feelings of shame, stigma, and discrimination almost as much as women.

Seeking out in-person or online support groups can help ease these burdens by providing interaction with others who have a firsthand understanding of the disease. In fact, men can benefit as equally as women from support groups and counseling.

A Word From Verywell

In the end, there is no such thing as "men's lung cancer" and "women's lung cancer." However, there are variations in risk, treatment responses, and help-seeking behaviors that can impact survival and long-term outcomes in men.

Men can improve these outcomes by identifying their risk of lung cancer, including smoking and hazards in the workplace.

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