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Young women get lung cancer more often than young men. Wait, that can't be right.

Lung cancer is the leading cause of preventable cancer deaths in the United States. Cigarette smoking contributes to about 80% of those deaths. Historically, men were more likely than women to get lung cancer because they were more likely to smoke. They started smoking earlier in life, and they smoked more cigarettes per day. Oh, perhaps we think of cigarette smoking as a guy thing. You know, the Marlboro Man and the popular media and culture showing guys hanging around and smoking.

Lung Cancer is the Leading Cause of Cancer Deaths in Women

We think of lung cancer as being a guys' disease. However, lung cancer is the leading cause of cancer deaths in women. I'll say that again, the leading cause of cancer deaths in women, killing more women each year than breast cancer, uterine cancer, and ovarian cancer combined.

It's also the leading cancer that's most preventable, mostly preventable because while smoking is the number one cause, 20% of women who develop lung cancer have never touched a cigarette. Recently, a large study on the incidence of lung cancer in the U.S. revealed that the incidence of lung cancer is higher in young women than in young men.

Gender and Behavior Factors of Lung Cancer

Let's try to understand what the study is saying and what as women we should do about it. Smoking behaviors have become increasingly similar between men and women. And white women born in the 1960s and early '70s smoke on average about as much as men. This study published in the New England Journal of Medicine looked at the North American Association of Central Cancer Registries, a list of all the cancers that people reported, and looked at the cases of lung cancer diagnosed in the U.S. in people aged 30 to 54. So they're calling that young, 30 to 54, from 1995 to 2014.

They found that lung cancers are decreasing in each group. That's good. They're decreasing, but are decreasing faster in men. In particular, lung cancer rates for Hispanic women and non-Hispanic white women born since the mid-'60s are now greater than that of men. This is troublesome in so many ways. They also looked at the general reports of smoking habits by age and self-identified racial groups. Women who quit smoking were more likely to get lung cancer than men who quit smoking. Hispanic women who don't smoke as much as Hispanic men are more likely to get lung cancer. Researchers are puzzled because smoking behaviors in women don't explain the increase in lung cancers between men and women.

I mentioned that 20% of lung cancers in women are in women who've never smoked. The risks of lung cancer in non-smokers are higher in women than in men. Are the differences between men and women related to sex, meaning genetics, female hormones, and female biology? One kind of lung cancer is more common in women than men, and maybe that's due to women's biology. Or are the differences related to gender? Women have social behaviors that are different than men. For example, most miners are men, and men who work in coal mines and uranium mines are more likely to get lung cancer. Men who smoke and work in these mines are at even greater risk as the two risks add up. They may even multiply the total risk.

Now, working in a coal or uranium mine is a gender thing, not a sex thing. Now, there are very few coal miners and uranium miners of either sex, but that's an example of how behaviors can add extra risk for lung cancer.

Reducing the Risk of Lung Cancer

So what are some of the risks for lung cancer for women who don't smoke? High radon levels in the home are associated with an increased risk of lung cancers. And radon plus smoking makes the risk of lung cancers add up. Women may spend more time in the home. And therefore, if there's a radon problem, they may be more exposed to radon. Air pollution adds to the risk of lung cancer. Maybe women are spending more time in traffic with kids and doing errands, so that might increase their exposure.

In the developing world, the number one cause of lung cancer in women is cooking inside over a fire. Now, in the U.S. women don't necessarily cook over a fire with wood smoke, but burning material in the kitchen is bad for your lungs. Even when the food isn't exactly burned, smoke from broiling or frying goes into your lungs. Barbecuing is the poster child for lung-risky behavior in cooking in the U.S., but my media-informed view is that barbecuing is a guy thing, right? Men outside are surrounded by the smoke of burning meats. So that's a gender behavior.

We aren't sure what biology or behavior is adding to women's risk of lung cancer, so what should we be doing? Don't put smoke of any kind in your lungs if you can avoid it. Number one, two, and three is to stop smoking. Try to keep your kids from starting and get your friends and family to stop. Don't pollute your lungs in the house. Check your radon levels. Your local health department can help you with that and can help you fix it. Don't make smoke inside, no wood fires. Avoid smoke in the kitchen. Try to limit your exposure to bad air on bad air days. Be an advocate for clean air outside in your community.

Lung Cancer Symptoms in Women

Lastly, what are the symptoms of lung cancer in women? We've learned that the symptoms of heart attacks are different in men and women. And the same is true for lung cancer. Men who have lung cancer are more likely to have a persistent cough, cough up blood, or develop respiratory infections due to tumors blocking their airways. In contrast, the first symptoms of lung cancer in women are often a vague sense of shortness of breath, sometimes attributed to age or weight gain, being out of shape, and fatigue. Both of these sets of symptoms can happen in men and women. But the frequency of the symptoms, shortness of breath, or fatigue are more common in women. These differences and symptoms may be at least in part related to the different kinds of lung cancers between men and women.

So lung cancer isn't an older man's disease. It can happen to relatively young women in their 30s to 50s. Don't pollute yourself. If you have a persistent cough or fatigue, don't write it off as your allergies. Talk to your healthcare provider about your symptoms and your risks. And thanks for joining us on The Scope.

updated: September 8, 2023
originally published: June 21, 2018