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Women Breathe better than Men

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NEW YORK, May 9 — Women with lung cancer are less than half as likely as men to have chronic obstructive pulmonary disease (COPD) at diagnosis, investigators here found.

The finding raises a red flag for clinicians not to dismiss possible diagnoses of lung cancer in women because of the absence of COPD, according to Raghu Loganathan, M.D., of the Lincoln Medical and Mental Health Center in The Bronx and colleagues at the Memorial Sloan-Kettering Cancer Center.

"Using the presence of COPD alone as a criterion to determine a patient's risk may miss women with lung cancer," they said in the May issue of Chest. The issue has growing importance because lung cancer mortality in American women rose 550% from 1950 to 1991. By 2003 lung cancer accounted for 25% of all cancer deaths among women, and is now the most common cause of cancer death among women.

The researchers conducted a retrospective study of men and women, newly diagnosed with lung cancer, who had pulmonary function tests before the diagnosis. Patients were considered to have COPD if the ratio of forced expiratory volume in one second over the forced vital capacity (FEV1/FVC) was lower than 70%. A ratio higher than 70% was considered to be normal.

The study, of 151 men and 143 women, found:

110 men (72.8%) and 75 women (52.5%) had COPD, which represented a significantly lower prevalence of COPD in women. The odds ratio was 0.41, with a 95% confidence interval from 0.25 to 0.67; the result was significant at P= 0.0003.

Even after the researchers adjusted for age and smoking status, women had less COPD. The odds ratio rose slightly to 0.44, with a 95% confidence interval from 0.26 to 0.74, significant at P=0.002.

Among the 256 smokers in the study, women still had a lower rate of COPD. The odds ratio was 0.45, with a 95% confidence interval from 0.27 to 0.77, significant at P=0.003).

Again, analysis adjusted to account for age and number of pack-years of smoking showed a sustained similar odds ratio for women of 0.48; with a 95% confidence interval from 0.28 to 0.83, significant at P=0.009.

The implication was that "the absence of COPD should not lower the risk in a female patient who is otherwise considered to be at increased likelihood for developing lung cancer," Dr. Loganathan said. "Physicians must consider additional (and well-established) risk factors, such as smoking history and age of the patient, when contemplating lung cancer screening."

Although there is currently no standard for lung cancer screening, many experts consider heavy smoking, age over 50, and COPD—among other things—Lung cancer accounts for 33% of all cancer deaths among women in the U. S. True or False? to be possible signals of the potential for disease.

"Understanding the role that gender has in the development of lung cancer may help identify more advanced screening methods and new approaches to preventive care," commented W. Michael Alberts, M.D., chief medical officer of the University of South Florida's H. Lee Moffitt Cancer Center & Research Institute in Tampa, and president of the American College of Chest Physicians.

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