Lung Cancer in Women: Analysis of the National Surveillance, Epidemiology, and End Results Database

doi:10.1378/chest.127.3.768

Chest

Volume 127, Issue 3, March 2005, Pages 768-777

https://doi.org/10.1378/chest.127.3.768 Get rights and content

Objectives

In order to further characterize the effect of gender on the clinicopathologic features and survival of patients with lung cancer, and to determine gender-associated differences in temporal trends, we analyzed data that had been entered into a population-based cancer database

Patients and methods

Data on demographics, stage at diagnosis, histology, initial therapy, and survival were obtained on all patients with primary bronchogenic carcinoma registered in the national Surveillance, Epidemiology, and End Results database from 1975 to 1999

Results

Of the 228,572 eligible patients, 35.8% were female. The median age at diagnosis was 66 years for both men and women. However, women accounted for 40.9% of patients who were < 50 years of age and for 35.4% of older patients. The incidence of lung cancer in men peaked at 72.5 per 100,000 person-years in 1984 and then declined to 47 per 100,000 person-years by 1999. In women, the incidence continued to rise to a peak of 33.1 per 100,000 person-years in 1991 before reaching a plateau at 30.2 to 32.3 per 100,000 person-years from 1992 to 1999. These changes have resulted in a marked narrowing of the male/female incidence ratio from 3.56 in 1975 to 1.56 in 1999. As initial treatment, women with local disease underwent surgery more frequently than did men. Stage-specific survival rates were better for women at all stages of disease (p < 0.0001). In a multivariate analysis, male gender was an independent negative prognostic factor (p < 0.0001)

Conclusion

The incidence rate of lung cancer in women in the United States has reached a plateau. However, women are relatively overrepresented among younger patients, raising the question of gender-specific differences in the susceptibility to lung carcinogens. At each stage of the disease, the relative survival of women is better than that of men, with the largest difference noted in patients with local disease

Section snippets

Patients

The SEER program is a National Cancer Institute-funded initiative that has collected demographic and clinicopathologic data on newly diagnosed cancer patients in the United States since 1973. During the study period, the SEER system collected data from 9 to 11 selected geographic regions covering approximately 10 to 14% of the US population. The national SEER database collects information on all incident cases of cancer from hospitals, physicians’ offices, clinics, radiation therapy facilities,

Patient Characteristics

The clinicopathologic characteristics of 228,572 patients with primary bronchogenic carcinoma who received diagnoses from 1975 to 1999 and were registered in the national SEER database are listed in Table 1. Overall, 81,843 patients (35.8%) were female. The median age at diagnosis was 66 years for both men and women. However, 8.6% of women and only 6.9% of men were < 50 years of age at the time of diagnosis (p < 0.0001). Women accounted for 40.9% of patients who were < 50 years of age, but for

Discussion

The majority of epidemiologic studies evaluating the effects of gender in lung cancer have been conducted in Europe, Japan, and Canada, raising questions as to the applicability of their results to women in the United States. Most prior studies in the United States were either geographically or temporally limited or were performed at academic centers with potentially biased referral populations. Wingo et al²² previously published data from the SEER database on gender-specific and race-specific

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Presented in part at the Fourth International Lung Cancer Congress, Maui, HI, June 25–28, 2003, and the Tenth World Conference on Lung Cancer, Vancouver, BC, Canada, August 10–14, 2003

This research was supported in part by Surveillance, Epidemiology, and End Results contract No. N01-CN-65064 and NO1-PC-35145 from the National Cancer Institute, Bethesda, MD

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Chest

Clinical Investigations: TumorsLung Cancer in Women: Analysis of the National Surveillance, Epidemiology, and End Results Database

Objectives

Patients and methods

Results

Conclusion

Section snippets

Patients

Patient Characteristics

Discussion

Ann Oncol

Lung Cancer

Chest

Surgery

Lung Cancer

Mol Cell Endocrinol

Biochem Biophys Res Commun

Cancer statistics, 2003

CA Cancer J Clin

Sex-associated differences in presentation and survival in patients with lung cancer

J Clin Oncol

Lung cancer and cigarette smoking in women: a multi-center case control study in Europe

Int J Cancer

Female-male differences in patients with primary lung cancer

Cancer

Gender differences in lung cancer risk by smoking: a multicentre case-control study in Germany and Italy

Br J Cancer

Differences in lung cancer risk between men and women: examination of the evidence

J Natl Cancer Inst

Lung cancer in young females

Eur Respir J

Sex differences in presentation, management and prognosis of patients with non-small cell lung carcinoma

J Thorac Cardiovasc Surg

Clinical Investigations: Tumors
Lung Cancer in Women: Analysis of the National Surveillance, Epidemiology, and End Results Database