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Women have hardly come a long way when it comes to cigarettes and lung cancer, despite efforts to educate Americans on the dangers of smoking over the past few decades.

According to a new analysis by the American Cancer Society (ACS), women’s relative risk for developing developing lung cancer from smoking is rising, while men's risk plateaued in the 1980s. Now, men and women are about equally likely to die from lung cancer.

"More women die from lung cancer than breast cancer," says Michael Thun, MD, vice president emeritus at the American Cancer Society and lead author of the analysis, which was published in The New England Journal of Medicine.

Dr. Thun and his colleagues looked at smoking habits as well as lung cancer and other smoking-related respiratory diseases for three periods over the past 50 years — 1959 to 1965, 1982 to 1988, and 2000 to 2010 – among U.S. men and women. They examined data on current, past, and non-smokers collected by ACS, as well as data from the National Institutes of Health.

For women smokers, the relative risk of dying from lung cancer was 2.73 in the 1960s —meaning there were 2.73 times as many lung cancer deaths among female smokers compared to female nonsmokers. By the 1980s, the relative risk had risen to 12.65 for women smokers, and by the end of the past decade, it had more than doubled, to 25.66.

For men who currently smoked versus those who had never smoked, the relative risks were 12.22, 23.81, and 24.97 for the same time periods.

“What we’re measuring is the average risk of men and women who are continuing to smoke since the age of 55,” he says “It really represents the effects of persistent lifetime smoking that begins in adolescents."

History's Impact on Women's Smoking Habits

American women didn't initially adopt the smoking habit — changing smoking habits among U.S. women are directly linked to social change over the last half century, according to Dr. Thun.

Historically, cigarettes became popular among men at the height of the first World War. “Their smoking moved rapidly to starting in adolescence and smoking heavily throughout their lives,” he says.

“Initially, there were social norms that discouraged women from smoking. It was considered improper,” he adds, noting that women largely picked up the cigarette habit during and after the second World War, when many first entered the workforce.

The number of female smokers in the country increased yet again in the 1970s during the rise of feminism, when the tobacco industry adopted themes of feminist optimism and independence embodied by the ad tagline for Virginia Slims: You've Come a Long Way, Baby.

Other Smoking-Related Health Risks: COPD and Heart Disease

Smoking hasn't just increased the number of lung cancer cases and deaths in women — it's also pushed up incidence of other diseases.

The ACS study found that men and women who currently smoke share a near-identical risk rate for chronic obstructive pulmonary disease, ischemic heart disease, or a combination of these conditions, including lung cancer. For men over the age of 55 and women over 60 years old, the death rate from all smoking-related conditions is now three times as high among current smokers as it is in those who don’t have a history of cigarette use.

“The central message from this study is it takes 50 years to see the impact [smoking has had] on mortality,” Thun says. “In China, India, and Indonesia, smoking in men is now very common, but they’re still in the very early stages of the epidemic of the diseases caused by smoking. In some sense we have been the guinea pigs in this experiment. The point of this is showing just how long the risks continue, in order to motivate governments in other countries to accelerate tobacco control.”

Silvia Novello, MD, an oncologist at the University of Turin in Italy, who is studying gender differences among lung cancer patients but is not associated with the study, says while several trials have shown a greater risk for lung cancer among women, possibly due to greater susceptibility to carcinogens, the research is inconclusive. "Some differences exist between men and women because diagnosis in women is done earlier," she says.

The High Costs of Smoking

The authors of the report say women smokers typically have more difficulty kicking the habit. Women may have more negative factors stacked against them, such as hormonal changes, anxiety, and cultural or social pressures, says Dr. Novello.

Thun says women may have difficulty quitting for several reasons, but a central issue may be fear of weight gain. To counter that common source of anxiety, medical professionals should encourage women to make exercise a part of their cessation plan, he says. Additionally, cessation campaigns geared specifically toward women may be more effective at cutting down on the number of female smokers.

Despite the fact that more women die from lung cancer than breast cancer, says Thun, "Tobacco control doesn't have the same sex appeal as finding a cure for breast cancer."

In recent years, the U.S. Food and Drug Administration (FDA) has taken measures to encourage quitting. For example, in 2009, the federal government raised taxes on cigarettes. In New York state, there's currently a $4.35 tax on cigarettes — the highest in the country — according to the U.S. Centers for Disease Control (CDC). The average price for a pack of cigarettes is now $5, according to the American Lung Association. But rising cigarette prices seem not to matter for some Americans. Recent study found some Americans spend up to 25 percent of their paycheck on cigarettes, found a report from the Research Triangle Institute, an international nonprofit.

But the FDA must take further measures to encourage quitting among both women and men, says Thun. The most effective thing that could be done would be for the FDA to reduce the concentration of nicotine in cigarettes," he says. "If you reduce the nicotine level it becomes pointless for someone to smoke."

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