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Cited by 462Global Cancer Incidence and ScreeningSmoking Behavior and CessationLung Cancer Diagnosis and Treatment

Higher Lung Cancer Incidence in Young Women Than Young Men in the United States

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Jemal, Ahmedin, Miller, Kimberly D., Ma, Jiemin, Siegel, Rebecca L., Fedewa, Stacey A., Islami, Farhad, Devesa, Susan S., Thun, Michael J.·2018·New England Journal of Medicine
DOI 10.1056/nejmoa1715907PMC PMC7717174
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Abstract

BACKGROUND: Previous studies showed a higher incidence of lung cancer among young women than among young men in the United States. Whether this pattern has continued in contemporary birth cohorts and, if so, whether it can be fully explained by sex differences in smoking behaviors are unknown. METHODS: We examined the nationwide population-based incidence of lung cancer according to sex, race or ethnic group, age group (30 to 34, 35 to 39, 40 to 44, 45 to 49, and 50 to 54 years), year of birth (1945 to 1980), and calendar period of diagnosis (1995-1999, 2000-2004, 2005-2009, and 2010-2014), and we calculated female-to-male incidence rate ratios. We also examined the prevalence of cigarette smoking, using data from the National Health Interview Survey from 1970 to 2016. RESULTS: Over the past two decades, the age-specific incidence of lung cancer has generally decreased among both men and women 30 to 54 years of age in all races and ethnic groups, but the declines among men have been steeper. Consequently, among non-Hispanic whites, the female-to-male incidence rate ratios increased, exceeding 1.0 in the age groups of 30 to 34, 35 to 39, 40 to 44, and 45 to 49 years. For example, the female-to-male incidence rate ratio among whites 40 to 44 years of age increased from 0.88 (95% confidence interval [CI], 0.84 to 0.92) during the 1995-1999 period to 1.17 (95% CI, 1.11 to 1.23) during the 2010-2014 period. The crossover in sex-specific rates occurred among non-Hispanic whites born since 1965. Sex-specific incidence rates converged among non-Hispanic blacks, Hispanics, and non-Hispanic Asians and Pacific Islanders but crossed over from a higher incidence among men to a higher incidence among women only among Hispanics. The prevalence of cigarette smoking among women born since 1965 has approached, but generally not exceeded, the prevalence among men. CONCLUSIONS: The patterns of historically higher incidence rates of lung cancer among men than among women have reversed among non-Hispanic whites and Hispanics born since the mid-1960s, and they are not fully explained by sex differences in smoking behaviors. Future studies are needed to identify reasons for the higher incidence of lung cancer among young women. (Funded by the American Cancer Society.).

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  • Incidence rates in women are approaching or surpassing those in men in several countries at younger or middle ages and in recent generations in Europe and Northern America.

    “The net result is that incidence rates in women are approaching or surpassing those in men in several countries at younger or middle ages and in recent generations in Europe and Northern America, 18,20,21 forewarning of a relatively higher overall lung cancer burden among women in future decades.”

    From Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. (2024) · cites this paper as [21]

    The Results (page not available in our copy) show that lung-cancer incidence among younger women approached or surpassed that among men in recent U.S. birth cohorts. The paper's analysis is of the United States; it does not establish the claim about several countries in Europe and Northern America. (LLM, conf=0.86)

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  • The high lung cancer rates among Chinese women are postulated in part to reflect increased outdoor ambient air pollution and exposures to household burning of solid fuels for heating and cooking.

    “For example, the high lung cancer rates among Chinese women are postulated in part to reflect increased outdoor ambient air pollution and exposures to household burning of solid fuels for heating and cooking.21,27,28”

    From Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. (2024) · cites this paper as [21]

    The Discussion mentions outdoor air pollution only in relation to sex differences in U.S. lung cancer trends; it does not discuss Chinese women. Searches for Chinese women and household solid-fuel burning found no passage addressing the proposed explanation for their lung cancer rates. (LLM, conf=0.76)

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Authors
Jemal, A., Miller, K. D., Ma, J., Siegel, R. L., Fedewa, S. A., Islami, F., Devesa, S. S., & Thun, M. J.
Affiliations
American Cancer Society (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2018-05-24
Volume
378
Issue
21
Pages
1999-2009
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1715907
PMC
PMC7717174
OpenAlex
W2804784400
Cited by
462
References
36
Citations by year
2026: 38 · 2025: 58 · 2024: 70 · 2023: 58 · 2022: 67 · 2021: 67 · 2020: 52 · 2019: 33 · 2018: 17
FWCI
15.85
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Cancer Institute (Z01CP010183)
Topics
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
Keywords
lung cancer, sex differences, young women, smoking prevalence, birth cohort trends, age-specific incidence, racial and ethnic disparities, non-Hispanic whites, Hispanic women, lung cancer risk factors, National Health Interview Survey
MeSH terms
Adult, Ethnicity, Female, Humans, Lung Neoplasms, Male, Middle Aged, Smoking, United States, Incidence, Prevalence, Age Distribution, Sex Distribution

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