Lung cancer is one of the most common in both sexes, with a worldwide incidence of 2 million cases each year. The latest epidemiological data show that in Europe a patient dies from lung cancer every 83 seconds. In our country in 2021 there were 400,000 new cases of cancer, of which 41,000 lung (10%); as regards deaths, on the other hand, out of a total of 180,000 deaths from cancer, deaths from lung cancer were 34,000 (almost 1 out of 5). Although it is even more frequent in men, it is estimated that from 2015 to date lung cancer mortality has decreased by 15% in men and increased by 5% in women, with a proportional increase in the incidence of 3.4% in women. (Aiom data).
Cancers, the differences between women and men
by Elisa Manacorda
There are many characteristics that differentiate lung cancer in women from that affecting men: the age of onset is lower; women show increased sensitivity to carcinogens from cigarette smoke; women are in contact with a greater number of domestic environmental carcinogens (radon, asbestos, cooking oils); non-smokers have a higher incidence of lung cancer; lung cancer in women has a higher rate of chromosomal mutations. These differences lead to consider lung cancer in women as a distinct disease from that of men.
Lung cancer, immunotherapy has encouraging effects even in the most frail patients
by Mara Magistroni
Women 3 times more susceptible to smoking than men
Analyzing the impact of cigarette smoking, for example, we can say that the susceptibility of women is 3 times greater than that of men, the rate of mutations induced by inhaled carcinogens is considerably higher in women. At the base of these substantial gender differences, there seem to be hormonal factors (estrogens), genetic susceptibility (growth factors, gene polymorphism, oncogenes such as KRAS), pro-inflammatory state induced by some respiratory diseases. In addition, women undergoing radiotherapy for breast cancer have a higher incidence of lung cancer.
But better survival
However, in the face of these uncomfortable data on the risk of developing lung cancer, women show better short- and long-term survival than men. Females have better surgical outcomes, greater responses to new molecularly targeted drugs and immunotherapy, with longer survival than males for all stages and histologies of lung cancer. The 1-year survival for women is 50.2% (versus 42.5% of men) and 5-year survival 22.7% (versus 16.4% of men).
Lung cancer, it’s time for screening. Here because
by Mara Magistroni
Numerous studies are still needed to clarify the peculiar characteristics of lung cancer in women, a priority is to sensitize women to quit smoking and to participate in screening campaigns to arrive at the diagnosis and treatment of this disease as quickly as possible. And just from the screening comes another gender difference. The benefit in terms of mortality reduction obtained with screening is higher in women than in men: according to the recent NELSON study, the reduction in mortality is about 61% in women compared to 26% in men. Similar results, although with less striking differences between the sexes, were also observed in the North American (NLST) and Italian (ITALUNG) trials. Data that will be discussed at the national congress of the Italian Society of Thoracic Endoscopy which will be inaugurated on 29 September in Rome.
* Director of the Thoracic Surgery Unit of the San Camillo Forlanini Hospital in Rome