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There has been much media interest in the work of Thompson and Pearson1 2 who demonstrated, via a hospital based study of 1044 patients undergoing bronchoscopic examination, that women of all ages are more likely to present with small cell lung cancer than men, and that younger women are more likely to present with small cell cancer than older women. Increasingly, women who begin smoking at an early age seem to be more susceptible to small cell lung cancer (two year survival about 5%).
We can extend and complement these findings in a study of population based data held by the Northern and Yorkshire Cancer Registry and Information Service (NYCRIS). Table 1 shows data for 7485 patients diagnosed between 1992 and 1994, 4823 (64%) of whom were men. A lower proportion of men (11%) than women (17.5%) had a histological diagnosis of small cell lung cancer. Rates of histological confirmation increased over time but were lower for older patients. Of those confirmed, younger patients of both sexes were significantly more likely to present with small cell lung cancer than older patients (p<0.001, logistic regression). However, young women in particular were more likely to present with small cell cancer than men of similar age (p<0.001).
The reasons for these patterns are not understood. It is suggested that changes in smoking habit, particularly in younger women, could play a part. Initiation of smoking at an early age has been shown to increase the risk of small cell lung cancer in men,3 so it is reasonable to assume that a rise in young female smokers could be responsible. Should the incidence continue to rise, there are important future implications for both provision of care and the prognosis of younger patients with lung cancer. These data again emphasise the need for effective anti-smoking programmes, particularly targeting adolescents.
The authors are grateful to NYCRIS and members of The Yorkshire Cancer Management Study Group for making these data available.
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