Lung Cancer in Women

The disease may present differently in females

In This Article

As is the case with some other health concerns, cases of lung cancer in women have characteristics that differ those in men. Whether due to lifestyle choices, environment, and/or biology, women are more likely to develop lung cancers that are not associated with smoking. They are also more likely to have lung cancer cases that can be managed with treatment.

Long considered by some as solely a “man’s disease,” data proves that that is not the case today. In fact, researchers continually see more than an 80% rise in lung cancer cases in women when looking at data over four decades. This is true despite the overall incidence of the disease having declined over the past generation as rates of lung cancer in men have dropped (though they are still significant). 

Statistics

It's now estimated that about 49% of new diagnoses in the United States are in women. And in what comes as a surprise to many, lung cancer is the leading cause of cancer deaths in women, killing more women each year than breast canceruterine cancer, and ovarian cancer combined.

There is still so much that still needs to be learned about lung cancer and why certain people are at risk. For instance, the connection between smoking and lung cancer is only partially clear.

While smoking is the number one cause of lung cancer, about 16% of women who develop the most common types of lung cancer have never touched a cigarette. In addition, lung cancer is more likely to occur in former smokers (those who have kicked the habit) than women who currently smoke.

Lung cancer occurs at a slightly younger age in women than in men, and almost half of lung cancers in young adults occur in women. Researchers have also found that among adults ages 30 to 54, women are more likely than men to develop lung cancer, and this change in incidence rate can't be explained by differences in smoking behaviors.

Types of Lung Cancer in Women

Lung cancer is usually categorized as either non-small cell lung cancer (NSCLC), accounting for about 85% of lung cancers, or small cell lung cancer (SCLC), accounting for about 15% of lung cancers. SCLC is almost always a result of cigarette smoking and is most common in men.

Women are more likely to be diagnosed with one of two types of NSCLC:

  • Lung adenocarcinoma: These tumors usually first appear in tissue on the outer sections of the lungs. Approximately 44% of lung cancer diagnoses in women are adenocarcinoma, making it the most common type for females.
  • Squamous cell carcinoma: Smokers are at greater risk for this type of cancer, which results in tumors in tissues that line the major airways. About 37% of lung cancers in women are squamous cell carcinoma. 

Adenocarcinoma in situ (AIS), previously called BAC (bronchioalveolar carcinoma), is a rare form of lung cancer that is more common in women and non-smokers. The survival rate with AIS is better than with other forms of NSCLC, especially when it is caught early. 

To a lesser extent, women may be diagnosed with SCLC or less common types of NSCLC, such as large cell carcinoma.

Symptoms of Lung Cancer in Women

Just as symptoms of heart attacks are different in men and women, signs of lung cancer amongst the two groups may vary.

This is due to the fact that men and women are susceptible to different types of NSCLC, each of which causes their own type of symptoms. It also seems to be related to biological differences that cause the body to react differently.

Because men are more likely to be diagnosed with squamous cell carcinoma, their earliest signs of cancer are usually related to problems with the major airways, including having a chronic cough or coughing up blood

The first symptoms of lung cancer in women are frequently signs of lung adenocarcinoma. Because these tumors usually grow in the periphery of the lungs, far from the large airways, they're less likely to result in a cough.

Instead, the early symptoms may include:

As the disease progresses, women will develop additional symptoms that may include:

  • Chronic cough with or without blood or mucus
  • Wheezing
  • Discomfort when swallowing
  • Chest pain
  • Fever
  • Hoarseness
  • Unexplained weight loss
  • Poor appetite

Oftentimes, women do not have symptoms until lung cancers have spread (metastasized) to other regions of the body.

Metastases to the brain may cause eye symptoms, numbness, or weakness. Metastases to bones can cause bone pain, back pain, chest pain, or shoulder pain. Other symptoms may occur that are related to metastatic cancer in general, such as unintentional weight loss.

Less Common Symptoms

Another group of symptoms that are seen occasionally with lung cancer is something called paraneoplastic syndromes. These disorders are caused by hormone-like substances secreted by tumors.

Among the complications that paraneoplastic syndromes can cause are:

  • Hypercalcemia (an elevated calcium level in the blood)
  • Low sodium levels
  • Weakness in the upper limbs
  • Loss of coordination
  • Muscle cramps

Paraneoplastic syndrome is seen most often with small cell lung cancers, squamous cell lung cancers, and large cell carcinomas—cancers that are more common in men.

Causes

Women have a 1 in 16 chance of developing lung cancer over their lifetime. A variety of lifestyle, environmental, and biological factors can impact the threat of developing the disease.

Smoking

Tobacco remains the largest risk factor for lung cancer in women and is responsible for between 80% and 90% of cancer-related deaths among females.

There are some studies that suggest that women are more susceptible to carcinogens in cigarettes and are, thus, more likely to develop lung cancer after fewer years of smoking compared to men, but the findings have been inconsistent and more research is needed.

Women over age 60 years have the highest mortality rates due to lung cancer. These women would have been adolescents at the peak of the U.S. smoking epidemic. Their early and frequent exposure to tobacco, as a smoker or via second-hand smoke, maybe a reason for the high rates.

There is evidence that female smokers are less able to repair damaged DNA caused by smoking when compared to male smokers, which may contribute to the fact that cigarette smoking seems to put women at greater risk for certain types of lung cancer.

Role of Estrogen

One of the most significant areas of research for women and lung cancer is the study of estrogen's influence on tumors. There is evidence that this hormone makes cancer cells grow or makes women more sensitive to carcinogens.

Among the data that's been collected, researchers have found a connection between early menopause (when estrogen levels drop) and a reduced risk of lung cancer.

Estrogen-progestin therapy is not linked to a higher risk of getting lung cancer, but it is linked to a higher risk of dying from the disease.

In some research, the use of oral contraceptives was associated with a reduced risk of NSCLC, but other findings have not shown the same results. More research is needed to better understand any connection between birth control pills and cancer risks.

Gene Mutations

Different cancer cells contain gene mutations that control how the cancer grows or spreads. Research is finding ways to target these mutations and treat cancer more effectively.

Among women, certain mutations are more common. Using genetic testing, doctors can identify them.

Two that have been specifically identified as important for women when it comes to lung cancer risk are:

  • Epidermal growth factor receptor (EGFR): This is a type of protein found on the surface of lung cancers. It is most common in women and nonsmokers. Researchers have found that lung cancer patients with mutations in EGFR tend to respond better to Iressa (gefitinib), a chemotherapy drug that blocks the EGFR proteins.
  • Kirsten rat sarcoma viral oncogene homologue gene (KRAS): This makes proteins that promote cell division and growth, which can make tumors more aggressive. One study showed that women might be three times more likely than men to carry the KRAS mutation. No medications have been shown to target this mutation, but by identifying it, doctors will be better able to guide your treatment.

Other Risk Factors

Other factors that may increase the likelihood of developing lung cancer include exposure to radon in the home, secondhand smoke, and environmental and occupational exposures.

In the 1980s, a theory was put forth connecting the human papillomavirus (HPV) with an increased risk of lung cancer, but subsequent research has found this not to be credible.

Treatment

Treatment plans are usually based on the stage of the disease and are the same regardless of one's sex. However, research shows that women consistently respond better to these treatments. The reason is unclear, but it may be due to hormonal differences.

The treatment plan you and your doctor choose will likely include a combination of therapies.

Surgery

For early-stage lung cancers (stage 1 to stage 3A), surgery may offer a chance for a cure or at least a low risk of recurrence. There are several different types of lung cancer surgery that may be chosen depending on the size of your tumor and its location.

Women who have lung cancer surgery tend to fare better than men with these procedures. In one study, the five-year survival rate post-surgery was 75.6% for women versus 57.9% for men.

Radiation Therapy

Radiation therapy may be done for several reasons. In early-stage lung cancers that are inoperable for some reason, a technique called stereotactic body radiotherapy (SBRT) can significantly improve survival rates and lower the risk that your cancer will return.

External beam radiation therapy is commonly done following surgery to clean up any remaining cancer cells. It may also be done prior to surgery along with chemotherapy in an attempt to decrease a tumor to a size that can be surgically removed.

Radiation therapy may also be done as a palliative treatment—that is, a treatment designed not to cure cancer, but to extend life or relieve the symptoms of the disease.

Chemotherapy

Chemotherapy may be used with surgery to help kill cancer cells, or it may be done alone, in which case it is usually more of a palliative treatment. It consists of a combination of drugs usually administered intravenously.

Women respond better to chemotherapy than men. In one study, the treatment resulted in a 42% survival rate for women versus 40% for men. These results referred specifically to treatment for adenocarcinoma.

Targeted Therapies

To fight certain types of NSCLC, doctors now use targeted therapies to zero in on specific types of cells. The drugs used to treat EGFR mutations are a type of targeted therapy. Other treatments are available for those who have ALK rearrangements, ROS1 rearrangements, RET mutations, and others. These are either used alone or with other treatments.

More treatments being explored in clinical trials. Tarceva (erlotinib) also appears to be an effective targeted therapy for women.

Immunotherapy

Immunotherapy is an exciting new approach to treating cancer that has effectively helped boost the immune system of those with NSCLC so they can fight cancer.

Research suggests that women respond differently to immunotherapy compared to men. Studies are looking for ways to combine antiestrogen drugs with immunotherapies to make them more effective for women.

Clinical Trials

The National Cancer Institute (NCI) recommends that people with lung cancer consider participating in clinical trials. These trials not only help advance lung cancer research but, at times, offer people life-extending treatments that are not otherwise available.

Among the clinical trials that apply to women, there have been ongoing studies regarding the effectiveness of estrogen-related cancer therapies.

You can search NCI's online database for trials that are enrolling participants.

Prognosis

While the survival rate for lung cancer in women is higher than for men at all stages of the disease, the overall five-year survival rate is still only 23% for women (vs. 16% for men).

The good news is that these rates have been increasing and are expected to continue to improve as treatment and diagnostics improve.

Support Resources

Unfortunately, until recently there was less support available for women with lung cancer than was available for some other cancers. But what the lung cancer community lacks in numbers it makes up in depth, and there is a very active and supportive lung cancer community out there.

If you are on social media, look for groups of others coping with similar challenges. #LCSM Chat is a Twitter-based community that "fosters social media collaboration among lung cancer patients" and others. They hold online chats on different cancer topics that provide an opportunity for lung cancer patients, their caregivers, advocates, lung cancer physicians, and researchers to communicate.

A Word From Verywell

Lung cancer is, in many ways, a different disease in women than in men. Fortunately, these differences are becoming more clear as experts learn more about the molecular variations between different cancers. With lung cancer in women now being nearly as common as in men, it's likely that researchers will discover further differences that can be used to guide treatment and personalize lung cancer care.

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