The increase in risk of death from lung cancer and chronic obstructive pulmonary disease (COPD) in female smokers is enough to completely offset improvements in longevity derived from medical advances that have reduced death rates in the rest of the population over the last 50 years. That and other troubling news about smoking and mortality in general and in women in particular were reported in a recent article in the New England Journal of Medicine.
Male smokers have always had higher lung cancer death rates, but women in the US have caught up in their risk of dying from smoking-related illnesses, according to the authors of a comprehensive evaluation of long-term trends in the effects of smoking over the past 50 years.
Thus, it includes the first generation of US women who started early in life and continued for decades -- long enough for health effects to show up. Lung cancer risk leveled off in the 1980s for men but is still rising for women. The study was conducted by a team of researchers led by epidemiologist Michael J. Thun, MD, recently retired vice president emeritus of the American Cancer Society.
In 2009, 205,974 people in the US were diagnosed with lung cancer, including 110,190 men and 95,784 women, according to the Centers for Disease Control and Prevention (CDC). That same year, 87,694 men and 70,387 women passed away from the disease. Said Thun:
It's a massive failure in prevention. The steep increase in risk among female smokers has continued for decades after the serious health risks from smoking were well established, and despite the fact that women predominantly smoked cigarette brands marketed as lower in 'tar' and nicotine.
So not only did the use of cigarette brands marketed as 'Light' and 'Mild' fail to prevent a large increase in risk in women, it also may have exacerbated the increase in deaths from COPD in male smokers, since the diluted smoke from these cigarettes is inhaled more deeply into the lungs of smokers to maintain the accustomed absorption of nicotine.
The risk of dying from lung cancer was 2.7 times higher for women who smoked in the 1960s than that of women who never smoked. The risk jumped to 25.7 times higher for women smokers from 2000 to 2010. Similarly, the risk of dying from COPD among female smokers was 4.0 times higher than that of never-smokers in the 1960s. By 2010, the risk had increased to 22.5 times higher.
Smoking mortality statistics are even worse for women in Europe, according to findings of a recent study published in the Annals of Oncology. The authors of that study predict that within the next decade, lung cancer will overtake breast cancer as the main cause of cancer deaths in European women. (It is already the main cause of cancer death among women in the UK and Poland.) According to investigators from King's College London, over the next 30 years, lung cancer among females will rise 30 times faster than among males.
There is at least some good news in the findings of the US study: Researchers confirmed that quitting smoking at any age dramatically lowers mortality from all major diseases caused by smoking, and that quitting smoking is far more effective than reducing the number of cigarettes smoked. Smokers who quit by age 40 avoided nearly all of the excess smoking-related mortality from lung cancer and COPD. That is especially reassuring to me: I quit smoking when I was 40.
- Thun MJ, Carter BD, Feskanich D, Freedman ND, Prentice R, et al. 50-year trends in smoking-related mortality in the United States. N Engl J Med. 2013 Jan 24;368(4):351-364. doi: 10.1056/NEJMsa1211127.
- Malvezzi M, Bertuccio P, Levi F, La Vecchia C, Negri E. European cancer mortality predictions for the year 2013. Ann Oncol. 2013 Mar;24(3):792-800. doi: 10.1093/annonc/mdt010. Epub 2013 Feb 12.