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Why lung cancer is a growing risk for women

The death of singer-actress Dana Reeve, the widow of actor Christopher Reeve, of lung cancer underscores the risks women face from lung cancer, even those who don't smoke. NBC chief science correspondent Robert Bazell comments.
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The death of singer-actress Dana Reeve, the widow of actor Christopher Reeve, of lung cancer underscores the risks faced by women, even those who don't smoke.

While annual cancer deaths are declining in the United States, lung cancer remains stubbornly lethal, claiming over 158,000 American lives in 2004, according to the National Center for Health Statistics.

Lung cancer is seen as a disease of older, male smokers, but, at 44, Reeve was at least 20 years younger than the typical victim. In fact, lung cancer is becoming a big problem for women, experts say. NBC chief science correspondent Robert Bazell  discusses lung cancer's risks for women and non-smokers.

Q. Cigarette smoking causes most lung cancer, but experts estimate that 10 percent of cases happen to people who have never smoked, especially women. From what we understand Dana Reeve didn’t smoke. Is lung cancer different in women?
A. In men, 90 percent who get lung cancer are smokers or former smokers and in women, it’s 80 percent.

What’s interesting about lung cancer is there has been increasing research in recent years that cigarette smoke affects men and women differently, both in terms of how easily they get it from smoking and the severity of the disease. No one knows how to account for those differences. There have been several studies on things like brain [susceptibility to] nicotine and there are definitely different patterns in men and women. But it hasn’t been put together in some synthesis of understanding. There are clearly differences in the brains of men and women and there are differences in the response to cigarette smoking.

Smoking among men really shot up in the 1970s and 1980s and then leveled off and has really gone down in response to smoking campaigns. Women’s smoking rates have not gone down as much and neither have the lung cancer rates. The numbers of men and women who are getting lung cancer are getting very close.

Q. We hear about the risks of second-hand smoke. Is that a possibility?
Even when we have a situation like Dana Reeve where she didn’t smoke, the question is how much could have been second-hand smoke. She apparently one time worked as a singer in clubs where she was exposed to a lot of second-hand smoke. That may have been a factor, you never really know. You’ll never know for an individual case whether it was second-hand smoke or some genetic abnormality this person had.

Q. Does lung cancer run in families?
There are genetic cases where people are predisposed to lung cancer and don’t need to be exposed to cigarette smoke at all. Those cases are a small percentage of lung cancer.

Q. Dana Reeve was reportedly asymptomatic. People often get diagnosed even before they have symptoms. Does early diagnosis make a difference?
A. Lung cancer is usually diagnosed at a point where it’s far too late. The death rate from lung cancer is very high. In 2003, 91,000 men were diagnosed and 88,000 died. For women, 80,000 diagnosed and 68,000 died. Those are very high numbers for any cancer.

There’s the whole argument whether the fast CT scan should be given to people—especially if they’re at risk because they were smokers or maybe there is lung cancer in the family—and whether that’s going to save lives. There’s a huge study under way to determine that. [A CT scan, also called a spiral or helical CT scan, is a special X-ray that detects lung abnormalities and tumors at a very early stage. Some doctors argue that "false positives" from the test can lead to unnecessary biopsies and potentially risky surgeries.]

It's the argument you have with any cancer test — you find a lot of stuff and you cut it out, but does it really make any difference in the death rate?