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New research finds that women who smoke today have a much greater risk of dying from lung cancer than they did decades ago compared to those who never smoked.

, Associated Press

Women smokers now have the same risk of death as men who smoke

  • Article by: JANE E. BRODY
  • New York Times
  • March 3, 2013 - 2:19 PM

The title of a recent report on smoking and health might well have paraphrased the popular ad campaign for Virginia Slims, introduced in 1968 by Philip Morris and aimed at young professional women: “You’ve come a long way, baby.”

Today that slogan should include: “… toward a shorter life.”

Ten years shorter, in fact.

The new report is one of two analyses of the hazards of smoking — and the benefits of quitting — published last month in the New England Journal of Medicine. The data show that “women who smoke like men die like men who smoke,” Dr. Steven A. Schroe­der, a professor of health and health care at the University of California, San Francisco, wrote in an accompanying editorial.

That was not always the case.

Half a century ago, the risk of death from lung cancer among men who smoked was five times higher than that among women smokers. But by the first decade of this century, that risk had equalized: for both men and women who smoked, the risk of death from lung cancer was 25 times greater than for nonsmokers, Dr. Michael J. Thun of the American Cancer Society and his colleagues reported.

Today, women who smoke are even more likely than men who smoke to die of lung cancer. According to a second study in the same journal, women smokers face a 17.8 times greater risk of dying of lung cancer than women who do not smoke; men who smoke are at 14.6 times greater risk to die of lung cancer than men who don’t.

After controlling for age, body weight, education and alcohol use, the new analysis found something else: Men and women who continue to smoke die on average more than 10 years sooner than those who never smoked.

Down, but not out

Dramatic progress has been made in reducing the prevalence of smoking, which has fallen in the United States from 42 percent of adults in 1965 (the year after the first surgeon general’s report on smoking and health) to 19 percent in 2010.

Yet smoking still results in nearly 200,000 deaths a year among people 35 to 69 years old in this country. The risks are even greater among men 55 to 74 and women 60 to 74. More than two-thirds of all deaths among current smokers in these age groups are related to smoking. Overall, the death rate from all causes combined in these age groups “is now at least three times as high among current smokers as among those who have never smoked,” Thun’s team found.

While lung cancer is the most infamous hazard linked to smoking, the habit also raises the risk of death from heart disease, stroke, pulmonary disease and other cancers, including breast cancer.

Furthermore, changes in how cigarettes are manufactured may have increased the dangers of smoking. The use of perforated filters, tobacco blends that are less irritating, and paper that is more porous made it easier to inhale smoke and encouraged deeper inhalation to achieve satisfying blood levels of nicotine.

The result of deeper inhalation, Thun’s report suggests, has been an increased risk of chronic obstructive pulmonary disease, or COPD, and a shift in the kind of lung cancer associated with smoking.

But there is good news, too: It’s never too late to reap the benefits of quitting. The younger you are when you stop smoking, the greater your chances of living a long and healthy life, according to the findings of an international team led by Dr. Prabhat Jha of the Center for Global Health Research in Toronto.

The team analyzed smoking and smoking-cessation histories of 113,752 women and 88,496 men 25 and older and linked them to causes of deaths in these groups through 2006.

Those who quit smoking by age 34 lived 10 years longer on average than those who continued to smoke, giving them a life expectancy comparable to people who never smoked. Smokers who quit between ages 35 and 44 lived nine years longer, and those who quit between 45 and 54 lived six years longer. Even quitting smoking between ages 55 and 64 resulted in a four-year gain in life expectancy.

Reining in a killer

Schroeder said we can do a lot better to reduce the prevalence of smoking if government agencies, medical insurers and the public cooperate.

Unlike the races, ribbons and fund­raisers for breast cancer, “there’s no public face for lung cancer, even though it kills more women than breast cancer does,” Schroeder said. Lung cancer is stigmatized as a disease people bring on themselves, even though many older victims were hooked on nicotine in the 1940s and 1950s, when little was known about the hazards of smoking and doctors appeared in ads assuring the public it was safe to smoke.

Raising taxes on cigarettes can help. The states with the highest prevalence of smoking have the lowest tax rates on cigarettes, Schroeder said. Also helpful would be prohibiting smoking in more public places like parks and beaches. Some states have criminalized smoking in cars when children are present.

More “countermarketing” of cigarettes is needed, he said, including anti-smoking public service ads on television and dramatic health warnings on cigarette packs, as is now done in Australia. But two U.S. courts have ruled that the proposed label warnings infringed on the tobacco industry’s right to free speech.

Doctors “should do more to stimulate quit attempts,” Schroeder said. He also recommended that health insurers, both private and government, broaden their coverage of stop-smoking aids and do a better job of publicizing programs that help smokers quit.

As Nicola Roxon, a former Australian health minister, put it, “We are killing people by not acting.”

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