GoKawiilWhen Narjust Florez’s mother told her physicans that she had problems with her vision, they dismissed them as being due to cataracts. They were wrong. Florez’s mother had lung cancer, which had spread to her eyes. Despite her repeated medical visits and being highly educated and fully insured, her cancer was repeatedly missed. “My mum is a lawyer and still being gaslighted,” says Florez. “Imagine what it must be like for a regular person.”
Florez, a physician-scientist at the Dana- Farber Institute in Boston, Massachusetts who specializes in lung cancer in young people and women, has collected many similar stories. Studies show not only that women are routinely being diagnosed too late, but also describe lung cancer in women as an epidemic in some populations1. Yet lung cancer is still generally considered a disease of men.
Nature Outlook: Lung cancer
“When we talk about lung cancer, we always think about it as a disease of men, but actually there are more women with lung cancer than men,” says Daniela Molena, who studies lung cancer in women at the Memorial Sloan Kettering Institute in New York City.
Molena and other researchers suggest that lung cancer in women should be seen as a distinct disease, one driven by a complex interplay of biological sex differences and gender-based factors that researchers and clinicians have mainly overlooked. This oversight has translated into clinical practice that fails women at every turn: screening guidelines that have historically marginalized women, clinical trials in which women are under-represented2, inappropriate drug dosages and treatment regimens, and diagnostic delays that cost lives. “It’s just, unfortunately, inequalities from diagnosis to the moment of death,” says Florez.
Indeed, although incidence and mortality rates in men have been declining over the past three decades, lung cancer is overtaking breast cancer to become the leading cause of cancer deaths in women in many countries.
The trends are particularly alarming among younger women. In 2018, researchers reported that the incidence of lung cancer in white and in Hispanic women aged 30–49 had outstripped that in young men in the United States3. Tobacco use alone can’t explain this trend; women are developing lung cancer despite smoking less than young men do.
Why women?
Owing to the different roles that societies ascribe to an individual’s sex, women and men are exposed to different sets of risk factors. In many parts of the world, women do most or all of the cooking, exposing them to carcinogens released when oils are heated or coal and wood are burnt in poorly ventilated spaces. And because traditional gender roles result in women spending more time indoors than do men, women who do not smoke are disproportionately exposed to second-hand tobacco smoke at home or in the workplace.
Moreover, physiological differences between women and men mean that women respond differently to tobacco smoke. “If a man smokes one pack of cigarettes every day for 30 years and develops lung cancer, a woman requires only 20 because we have different metabolism of the carcinogens of tobacco in the liver,” says Florez. Studies suggest that sex differences in DNA-repair capacity might make women more prone than men to tobacco-induced damage1. The nature of this damage differs too. Women are significantly more likely than men to have carcinogenic mutations in genes such as EGFR and KRAS.
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