▴ International Early Lung Cancer Action Program Investigators. Women’s susceptibility to tobacco carcinogens and survival after diagnosis of lung cancer. JAMA2006;296:180–4OpenUrlCrossRefPubMed

Lung cancer is on the rise, especially in women. Previous studies have suggested that women have a higher relative risk of developing lung cancer. This large follow up study from the International Early Lung Cancer Action Programme (ELCAP) investigators was designed to assess the risk of lung cancer related to smoking in women compared with men. Survival after diagnosis was also evaluated, using the data from the present study combined with those from the original ELCAP study.

An additional 6296 women and 8139 men (all asymptomatic) were screened with baseline CT scans. All patients with lung nodules underwent immediate biopsy or surgical resection. A panel of five expert lung pathologists reported the histological samples.

Lung cancer was diagnosed in 111/6296 women (1.7%) and 93/8139 men (1.1%). Combining the two series together, lung cancer was diagnosed in 156/7498 women (2.1%) and 113/9427 men (1.2%). This gave an odds ratio of cancer in women of 1.9 (95% CI 1.5 to 2.5) corrected for age and pack-year smoking history. It was also noted that survival was better in women, regardless of the stage of lung cancer and after matching for cell type and treatment. The hazard ratio for a fatal outcome in women was 0.48 (95% CI 0.25 to 0.89). This is an interesting result, but the authors could not find any specific reason for the difference in survival. It has been suggested that lung cancer in women may be less aggressive or relatively more curable than in men, and this needs to be evaluated further.