Lung Cancer

Lung Cancer

A Woman's Risk Is Rising

If you still smoke, here's your best reason to stop: The American Cancer Society (ACS) estimates that 59,000 American women were killed by lung cancer in 1994, representing a whopping 500 percent increase in deaths from this disease among women over the past 30 years. That's four times the increase experienced by men. And it's not expected to peak until well into the next century.

The reason?

"Lung cancer in women is mostly caused by smoking," says researcher Ellen R. Gritz, Ph.D., chairman of the Department of Behavioral Sciences at the University of Texas M. D. Anderson Cancer Center in Houston and former director of the Division of Cancer Control at the Jonsson Comprehensive Cancer Center at the University of California at Los Angeles.

"There are other factors such as radon and occupational exposures," she adds. "But they pale in magnitude compared to deaths attributed to smoking."

"You've Come a Long Way, Baby!"

The facts of smoking bear evidence: As the rate of smoking rises in women, so do the rates of lung cancer. In 1935, about 18 percent of all American women were smokers, and by 1965 the percentage rose to a peak of 33 percent, says Dr. Gritz. About 1977, the proportion of women smokers began to decline until, by 1992, less than 25 percent of American women were smokers.

The number of deaths due to lung cancer also increased--approximately 20 to 40 years after the increase in smoking. Now that smoking rates have dropped among women, lung cancer rates will eventually begin to drop as well, says researcher Linda Sarna, D.N.Sc., professor of oncology nursing at the University of California at Los Angeles. But the decline won't begin until about 2020 because of the time lag between when a woman starts to smoke and when she develops cancer.

In addition to not smoking, you need to avoid other people's smoke. Several thousand U.S. nonsmokers develop lung cancer annually because smoking friends, lovers, spouses, co-workers and even complete strangers give it to them.

A study of 1,800 nonsmoking women from five urban areas across the United States indicates that nonsmoking women increase their lung cancer risk by 24 percent when they live with a smoker. Their risk is increased 39 percent when they work with people who smoke and an astounding 50 percent when they hang out with smokers in social settings such as bars and restaurants.

"The findings indicate that there is an increased risk in each setting," says Elizabeth Fontham, Dr.Ph., the Louisiana State University researcher who led the study.

The March of Cancer

Once tobacco smoke or some other carcinogen has damaged the DNA in lung cells or activated oncogenes that trigger growth of a tumor, most lung cancer evolves into one of two forms, either small-cell cancer, which is treated primarily with chemotherapy, or non-small-cell cancer, which is generally treated with surgery and radiation.

Women seem more likely to develop adenocarcinoma, a type of non-small-cell cancer, says Robert Ginsberg, M.D., head of thoracic surgery at Memorial Sloan-Kettering Cancer Center in New York City. No one knows why. But because there are rarely symptoms of cough, bloody sputum or chest pain until the disease's later stages, 60 percent of those who have any type of lung cancer don't get to a doctor until the disease has advanced too far to be cured by treatment. As a result, most people with lung cancer die within a year of diagnosis.

A study at the University of Texas at Houston indicates, however, that shrinking even an advanced tumor with chemotherapy before and after surgery will increase average survival time from one to five years. But the best way to make sure you won't die of the disease is to prevent it, says Dr. Sarna. Here's what experts suggest.

Stay smoke-free. Any woman who smokes should quit, experts agree.

That's easier said than done, of course. Statistics show that most people average around seven tries before they actually quit forever. So don't be discouraged if you've tried and failed. (For tips on the best ways to stop, see page 492.)

Avoid exposure. You may not smoke yourself, but you can be in a whole lot of danger from those around you who do, says Dr. Sarna. Ask friends and significant others not to smoke in your presence, she suggests. Avoid restaurants that don't have--or don't enforce--smoke-free areas. And find out what local and state laws govern smoking in your workplace.

Gorge on veggies and fruit. A study of approximately 3,000 women at the University of Minnesota in Minneapolis found that women who ate 31 or more servings a week of vegetables had a 50 percent lower risk of lung cancer, while women who ate 18 or more servings of fruit each week had a 25 percent lower risk.

"The most striking finding was that the more vegetables women ate, the less likely they were to get lung cancer," says nutritional epidemiologist Kristi Steinmetz, Ph.D., the researcher who led the study.

That's why you should integrate as many fruits and vegetables as possible into your diet, she adds, a suggestion that Demetrius Albanes, M.D., a researcher at the National Cancer Institute in Bethesda, Maryland, supports.

Eat internationally. One way to increase the fruits and vegetables in your diet may be to move away from the All-American, hamburger-and-french-fry diet toward a more international cuisine, suggests Dr. Steinmetz.

Other cultures tend to use more vegetables more often and in frequently innovative ways. Try vegetarian tacos or ratatouille as a start, then experiment as you find time.

You might want to schedule an occasional vegetarian meal, says Dr. Steinmetz. And whenever you serve a nonvegetarian meal, double your veggies and cut back on the meat on your plate.

Ditch the burgers and cheese. At least one study suggests that there may be a link between saturated fat and lung cancer. In a study of 1,400 nonsmoking women in Missouri, researchers at the National Cancer Institute found that the women who ate the most saturated fat--more than 15 percent of their total calories--had a sixfold increase in the risk of lung cancer. What's more, women who ate the most saturated fat were 11 times more likely to develop adenocarcinomas--the most common type of lung cancer among women.

Among the foods that can contribute a lot of saturated fat are hamburgers, cheeseburgers and meat loaf, followed by cheese, cheese spreads, hot dogs, ice cream and sausage. According to Michael Alavanja, Ph.D., the researcher who led the Missouri study, decreasing your fat intake to less than 30 percent of total calories and saturated fat to less than 10 to 12 percent of total calories can reduce your risk of cancer and heart disease.

Increase ventilation. If you live in a house that has high levels of radon, you could be putting yourself at increased risk for lung cancer. A radioactive gas emitted as the earth's rock formations age and decay, radon is prevalent in various areas throughout the United States. A study of more than 4,000 men and women at the Karolinska Institute in Stockholm found that lung cancer nearly doubled in those who lived in homes with elevated levels of radon emissions for 32.5 years.

Have your home tested for radon, recommends Clark Heath, M.D., vice-president for epidemiology of the ACS. Current government guidelines suggest that you increase ventilation in your home through special ventilating systems whenever your house air exceeds specific emission levels. You can call 1-800-SOS-RADON to find out where to get test kits and brochures on how to reduce radon in your home.