A study out Tuesday is the most powerful evidence yet of women's higher vulnerability to cigarette smoke.
Dr. Claudia Henschke of Weill Cornell Medical College has been following almost 17,000 smokers and former smokers for eight years or more. She uses sophisticated scans to look for the earliest signs of lung cancer.
"If you match them age by age by pack-year, women get more cancers, twice as many," Henschke says.
The one small piece of good news that women more often survive.
"They are more likely to get it but less likely to die of it," Henschke says.
Still lung cancer will kill 73,000 American women this year — more than will die from breast and ovarian cancer combined. Those statistics are well known to Marie and Rose Anne Salvaggio, mother and daughter, who own the Via Oreto restaurant in New York.
Marie managed to quit smoking 15 years ago after she suffered a lung collapse that she thought was cancer.
"You have to get a good fright in you to quit smoking," Marie Salvaggio says.
Rose Anne still struggles to stop.
"It's such a lousy, horrible, horrendous habit," she says.
Scientists do not know why women are affected differently by cigarette smoke. It appears the cells in women's lungs respond differently to the toxins in cigarettes. But the public health message is clear.
"Young women need to understand that they are more likely to get lung cancer, so they really should not start smoking," Henschke says.
So they don't join the millions like Marie and Rose Anne Salvaggio who struggle to overcome the habit before it is too late.