Lung cancer in women: Exploring sex differences in susceptibility, biology, and therapeutic response

Historically, lung cancer has been viewed as a male disease. With the increase in tobacco use by women over the past 50 years, there has been a dramatic increase in the incidence of lung cancer in women. Lung cancer is now the leading cause of cancer-related death for American women, accounting for more than one quarter of all cancer-related deaths in women. As the number of lung cancer cases in women has increased, significant sex differences in biology and natural history have been noted. There is evidence that women might be at increased risk from the carcinogenic effects of tobacco smoke. Women are, in general, younger at diagnosis, more likely to have adenocarcinoma histology, and are less likely to have a smoking history than men. Stage for stage, women with lung cancer have improved survival compared with men, regardless of treatment modality. There is evidence of significant molecular differences in the tumors of men and women and evidence that estrogen might play a role in the development of lung cancer. A better understanding of these differences is important for the treatment of lung cancer in all patients.