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Article in the Local Seattle Papers as Well

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http://seattlepi.nwsource.com/national/ ... archdiff=1

Variance in lung-cancer survival

Gender affects life expectancy, response to drug treatment, researchers find



Women with lung cancer survive slightly longer than men with the disease, respond differently to at least one cancer drug and show higher levels of tobacco-induced genetic damage in their lungs, researchers are reporting today.

Some differences may stem from the effects of estrogen, whether naturally occurring or taken as a drug, and the scientists said more women should be included in studies of lung cancer to find out whether particular methods of treatment, prevention and detection are best suited to them.

The researchers also said clarifying differences in the disease between men and women might yield information that would ultimately help both sexes.

"It may help us unlock some secret about how lung cancer behaves," said Dr. Peter Bach, a pulmonologist at the Memorial Sloan-Kettering Cancer Center in New York who is an author of the report. The other authors are Dr. Mark Kris, also of Sloan-Kettering, and Dr. Jyoti Patel of Northwestern University.

Their report reflects a growing medical interest in understanding differences in the way major diseases affect men and women. Researchers have recognized, for instance, that women who have heart attacks may not suffer the crushing pain men experience and women are more prone than men to autoimmune diseases such as lupus and multiple sclerosis.

The article by Bach and his colleagues, being published tin The Journal of the American Medical Association, calls lung cancer "a contemporary epidemic" in women. Most cases, up to 80 percent in women, are from smoking. Last year, 80,100 new cases were diagnosed in American women, and 68,800 women died from the disease.

The report notes that although women's death rates from lung cancer have stabilized in the last five years, the rates may start increasing again as groups of women with the highest smoking rates reach the age when cancers begin to develop.

Lung cancer is among the deadliest cancers, because it often starts spreading before being detected. Among cases diagnosed from 1992 to 1999, only 12 percent overall survived five years, 10 percent of the men and 14 percent of the women.

The disease kills more women in the United States than any other cancer, as many as breast cancer and all gynecological cancers combined. Lung cancer bypassed breast cancer in 1987 as the leading cause of cancer deaths in women. From 1930 to 1997, as more and more women took up smoking, their death rate from lung cancer rose 600 percent.

Although smoking has been known for decades to cause most lung cancers, a quarter of adult women in the United States smoke. In 2000, 30 percent of high school girls surveyed said they had smoked in the last 30 days. Since the 1960s, smoking rates for American men have decreased nearly 50 percent. For women, the decrease is 25 percent.

Sharp increases in smoking among women in Africa, Japan and China portend epidemics in those places, the report says.

It is not known whether men and women who smoke are equally susceptible to lung cancer. Studies are divided, some finding a greater risk in women, some in men and others finding no difference.

Biological differences in the disease itself do exist between men and women, the researchers said. Women are more likely than men to develop a type of cancer called adenocarcinoma. The reason is not known, though it is the most common lung cancer among non-smokers, and women are less likely than men to smoke. But studies also have suggested that estrogen, either natural or as a drug, may stimulate adenocarcinomas.

Multiple studies have found higher rates of genetic damage caused by tobacco in lung tumors in female than in male smokers, even though the women had, overall, smoked less. Women also appear less able to repair genetic damage.

Compared with male smokers, women who smoke also have a more active version of a gene that makes chemicals in cigarette smoke more harmful to cells. Estrogen may make that gene more active.

Even though women appear more vulnerable to tissue damage from cancer-causing chemicals in cigarette smoke, those who develop lung cancer survive a bit longer than men with the disease. Researchers are not sure why, Bach said.

Studies of a lung cancer drug approved last year, Iressa, have found that it works better in women than in men. The reason is not known, but Bach said scientists are studying other drugs in the same class to find out whether men and women respond to them differently.

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