by Mark Wheeler

“You’ve come a long way, baby!”

With those words in 1968, cigarette-maker Philip Morris began marketing Virginia Slims cigarettes to women with an advertising strategy showing “canny insight into the importance of the emerging women’s movement,” according to a report from the United States surgeon general.

Sadly, that slogan and others convinced more and more women to smoke, which has led to more women with smoking-associated disease, said Frederic W. Grannis Jr., M.D., clinical associate professor in the Department of Surgery. “In the 1960s, lung cancer in women was uncommon,” he said. “Now it’s roughly 50-50 with men.”

Grannis recently reported more disturbing news for women. Grannis, radiologist Arnold Rotter, M.D., chief of the Department of Diagnostic Radiology’s Computed Tomography Section, and their colleagues in the International Early Lung Cancer Action Project, or I-ELCAP, reported in the July 12 issue of the Journal of the American Medical Association that smoking may wield even greater impact on women than men.

Findings from I-ELCAP, covering 6,300 women and 8,100 men, indicate that women who smoke have a greater risk of developing lung cancer than men of the same age who smoke the same amount. A bit of good news for women, though: They have a lower rate of dying from lung cancer compared to men.

Based on this, the I-ELCAP report states that antismoking efforts directed toward girls and women need to be “even more serious” than those directed at boys and men.

In 2006, the report estimates that lung cancer will kill more than 73,000 women (and more than 90,000 men) in the U.S. “There are two things women should take away from this study,” said Grannis. “One is that lung cancer is the number one killer of women. It accounts for more deaths in women than any other cancer, more than the second and third cancer killers — breast and colon — combined.”

The second point, he said, is that in the same way that yearly mammograms have reduced breast cancer deaths in woman, early screening using low-dose, noncontrast computerized tomograms can do the same for lung cancer.

“We could change the face of lung cancer in women in the same way as we did breast cancer by screening,” said Grannis, part of City of Hope’s Lung Cancer and Thoracic Oncology Program. The problem is that most health insurance doesn’t pay for early screening, he said. And while wealthier people can pay the $300 such a check-up typically costs, the poor cannot.

Why women have an increased susceptibility to tobacco carcinogens yet a lower rate of fatal outcome is unclear. “It’s a critical problem, exacerbated by the fact that lung cancer occurs in 25 percent of female nonsmokers compared to just five percent of men,” he said. Involuntary exposure to secondhand smoke plays a major role, while environmental factors, such as exposure to radon, is another, and estrogen — a female reproductive hormone with well-known links to breast cancer — might also contribute.

“It’s an important area of research,” said Grannis. “Clinicians and researchers need to put together a coordinated effort to understand the problem.”