Lung Cancer in Women Neglected Epidemic

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Dr. Joan Schiller

(WOMENSENEWS)–Dr. Joan Schiller says her patients constitute a “forgotten generation” of U.S. women–those who became addicted to smoking before its harmful effects were widely known in the United States. Other medical experts are worried about another ignored generation of women–those who could be prevented from beginning to smoke and those who wish to stop–but can not find the medical care they need to assist them.

“The women who come to my lung cancer clinicare anybody’s aunt or teacher, regular folks,” says Schiller, a cancer specialist at the University of Wisconsin Medical School in Madison. “They just got hooked at a time before anybody knew.”

Her patients have fewer treatment options than other cancer patients, she adds, because little research has been conducted to improve those options.

“There is hardly any research money to look at women’s lung cancer, in terms of lives lost,” says Schiller. “Breast cancer gets roughly ten-fold more funding per life lost than does lung cancer.”

While older women with lung cancer are getting short shrift when it comes to treatment, experts say women of every age are not being adequately helped to give up smoking.

A state-by-state report–issued in September by the National Women’s Law Center in Washington, D.C., and the Oregon Health and Science University in Portland–indicated that states are failing to help women stop smoking, despite reliable and cost-effective methods. The report described smoking as “a critical women’s health issue” and found that the country as a whole was falling far behind federally established health goals in preventing and stopping smoking in women and girls.

Patients Advised to ‘Go Home and Die’

Specializing in treating women for whom cigarettes have done their worst, Schiller says some of her patients told her their family doctors had advised them “to go home and die.”

As Schiller began to see more and more such women at her clinic over the past 15 years, she realized most belonged to the generation born in the 1940s, who started smoking in the late 1950s or early 1960s, before tobacco’s cancer-causing properties were widely known.

Even though she was becoming more aware of this cohort of patients, Schiller found that many doctors had no idea that lung cancer was increasing among women to the point that it had become the top cancer killer of women.

Two years ago, Schiller founded Women Against Lung Cancer, today a group of 150 physicians and researchers that meets during general cancer conferences. Last November, the group held its own national conference in Chicago, in partnership with the University of Wisconsin and Chicago’s Loyola University Medical Center.

For women who need lung-cancer treatment, Dr. Schiller offers some advice: Seek out an oncologist at a National Cancer Institute-designated cancer center.

Too many other doctors, she warns, have a “real feeling of pessimism, of nihilism about treatment.” Doctors at the 53 centers in 26 states offer more hope because they are experienced in the latest treatments, which, she says, are “slightly better than they were 10 years ago.”

Cessation Programs Aren’t Adequate

Dr. Michelle Berlin is co-author of the report, “Women and Smoking: A National and State-by-State Report Card,” which found a shortage of programs to help women give up smoking. “The most striking finding is that so many women are still smoking, more than 20 percent,” she says.

“Only a handful of states have passed the low-cost or no-cost programs that would turn this around,” says Judy Waxman, vice president for health at the National Women’s Law Center. “We were appalled to find how far behind the states were in meeting the goals.”

Smoking causes most lung cancer and leads to cardiovascular disease, which kills more women than any other illness.

“Smoking kills 178,000 women each year,” according to the report. “Smoking kills regardless of gender, but women smokers suffer menstrual irregularities, pregnancy problems and higher rates of smoking-related osteoporosis than do men.”

“Adding insult to injury, the tobacco companies continue to target women and girls through advertising and promotions. Moreover, many women who want to quit smoking are hampered by a lack of access to smoking cessation treatments,” the report said.

Social Support Helps Women

“We point out women prefer certain cessation methods,” says report co-author Neena Chaudhry, National Women’s Law Center’s senior counsel. “Social support makes women 50 percent more likely to quit smoking.” Social support includes individual and group counseling as well as the support of family and friends, she says.

The report indicated that 70 percent of female smokers want to quit and that the average smoker tries eight to 11 times before successfully quitting.

Berlin advises that smokers start by finding a “quitline” through the American Lung Association. These are toll-free phone numbers providing self-help guidance and directing patients to treatment options. The report called for creation of a national toll-free “quitline.”

Women tend to use a wider variety of quitting strategies than men, prefer a more gradual approach and are more likely than men to ask for help, including medication, the report found. Medications include over-the-counter nicotine-replacement drugs and the prescription drug buproprion SR.

The gold standard of cost-effective treatment is smoking cessation, says Chaudhry. The report detailed the low cost of helping smokers quit in comparison with the high cost of treating diseases smoking leads to, such as lung cancer, heart disease and emphysema.

State Cessation Programs Save Lives, Expense

California and Massachusetts have introduces successful smoking-cessation efforts, according to the report. In 1990, California used funds from an increased cigarette tax to launch public education, advertisements and community and school-based programs that, together, contributed to a 58-percent drop in smoking.

“For every dollar the state spent on tobacco control,” the report said, “it saved $3 in smoking-related health care costs.”

Massachusetts increased the cigarette excise tax to fund prevention and cessation and saw smoking decline by 36 percent from 1993 to 2000, saving $2 in healthcare costs for every dollar spent on tobacco control. Recent budget cutbacks, Chaudhry says, have reduced these programs by 34.3 percent in California and by 90 percent in Massachusetts.

The report recommended that states raise the cigarette tax to at least $1.50 per pack, “the most effective thing in getting cigarettes out of the hands of teens,” says Berlin.

“We need to reach young girls and women with the information and the help they need,” says Berlin. “With this report card, we have the route laid out for us.”

Suzanne Batchelor has written on health and medicine for Medscape, CBS Healthwatch and the Texas Medical Association’s “Healthline Texas,” and for the national science series “Earth and Sky.”

For more information:

National Women’s Law Center–Health
“Women and Smoking: A National and State-by-State Report Card, 2003 (September 2003)”
(Adobe PDF format):
http://www.nwlc.org/pdf/Women&SmokingReportCard2003.pdf

National Cancer Institute–designated Cancer Centers:
http://www3.cancer.gov/cancercenters/centerslist.html


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