Women's Lung Cancer Program at Mount Sinai
The incidence of lung cancer in women has been rising since the 1930s. Approximately 71,000 women died of lung cancer in the United States each year, which is more than the number of lives lost to breast, ovarian, and uterine cancer combined. Although smoking is the primary cause of lung cancer, individuals who have never smoked (“never-smokers”) can also get lung cancer. Approximately 10 percent of men with lung cancer are never-smokers, but about 20 percent of women diagnosed with lung cancer have never smoked. Additionally, of the 3,400 people who die from lung cancer as a result of secondhand smoke, the majority (65 percent) are women.
Led by Andrea Wolf, MD, the team at Mount Sinai Women’s Lung Cancer Program recognizes lung cancer as a significant women’s health issue. A personalized approach to treatment and acknowledging gender-specific issues in lung cancer is paramount in order to achieve the best possible results of care. Some examples are:
1. Non-smokers: Lung cancer among never-smokers is twice as common in women compared to men. Genetic mutations associated with non-small cell lung cancer in non-smokers (EGFR TK domain) are more common among women than men. These particular mutations are associated with a more favorable prognosis and a better response to specific treatments for patients with lung cancer.
2. Tobacco use: Smoking is still the predominant risk factor responsible for most lung cancers. While smoking among women peaked at 33% in 1965, this number has only slowly started to decrease after 1980 to the current level of 18%. In contrast, more than 50% of men smoked in 1965 and this number decreased markedly throughout the 1970s and onward to the current level of 23%.
3. Smokers: Women appear to be at higher risk for smoking-related lung cancer than men. Genetic mutations associated with more aggressive lung cancers in smokers (KRAS G12C) occur in women at a younger age and who have smoked less than men.
4. Smoking cessation: Women face different barriers to smoking cessation than men. Fear of weight gain in particular is felt to be a more dominant issue among women. Moreover, data suggest that women rely more heavily on cigarette use to reduce stress and depression than do men. Hormone fluctuations related to ovulation, pregnancy, and menses have been correlated with cigarette craving. Finally, some placebo-controlled trials of nicotine-replacement therapy to facilitate smoking cessation have demonstrated decreased efficacy among women smokers compared to men.
5. Hormone replacement: The effects of female hormones (estrogen and progesterone) are being elucidated for various tumors, including lung cancer. Current data suggest that supplemental estrogen/progesterone may be associated with increased incidence of non-small cell lung cancer, while estrogen alone does not appear to have an effect. The roles of circulating estrogen, estrogen receptors, and anti-estrogen therapy are areas of active study.
6. Treatment response: Multiple institution and population-based studies have shown that women have improved survival compared to men with treatment for non-small cell lung cancer, regardless of age, stage, therapeutic modality, or histology (microscopic type of cancer). This survival advantage for women has been demonstrated with surgery for early stage disease as well as radiation and/or chemotherapy for advanced disease.
Diagnosis and Treatment of Lung Cancer at Mount Sinai
The diagnosis of lung cancer can be frightening and difficult for women and their loved ones. The Women’s Lung Cancer Program at Mount Sinai offers hope, diagnosis, treatment, community outreach, education, social support, and research in the area of lung cancer in women. All support groups, meetings, and educational conferences are for patients and their caregivers, family, and friends.
1. Non-smokers: We understand that there is a great deal of stigma associated with lung cancer and its relationship with smoking, but one in five women with lung cancer has never smoked. We offer support groups, education, genetic testing, and the latest therapy options for these and other patients with lung cancer.
2. Smokers: Many patients who do smoke consider smoking cessation more strongly once diagnosed with lung cancer. We offer medication and information regarding smoking cessation programs, nutrition, support groups, education, genetic testing, and latest therapy options for these and other patients with lung cancer.
3. Women’s Health: The Women’s Lung Cancer Program at Mount Sinai offers options to see female or male surgeons and oncologists specializing in lung cancer as well as access to Mount Sinai’s Women’s Health Services, including a variety of medical and social service programs dedicated to issues in women’s health.
Treatment at All Stages of Lung Cancer
Both early and some later stage lung cancers may be amenable to a minimally invasive surgery known as video assisted thoracic surgery (VATS). For this surgery, we make three one-inch incisions on the side of the chest. With these incisions we can perform the dissection necessary to remove the entire tumor, section of lung if needed, and associated lymph nodes. In addition to favorable cosmetic incisions, we feel VATS surgery results in decreased pain and a shorter hospital stay.