Lung cancer in women: Why gender-sensitive medicine can save lives
On the occasion of World Lung Cancer Day on 1 August, the Austrian Society of Pneumology (ÖGP) highlights the growing importance of gender-sensitive medicine in lung cancer care. While lung cancer incidence has been declining among men, it has continued to rise among women since the late 1990s. Worldwide, lung cancer is now the second most common cancer affecting women after breast cancer. Increasing scientific evidence also shows that women differ from men in risk factors, tumour biology, diagnosis and treatment response, yet many of these differences are still insufficiently considered in routine medical care.
Lung cancer remains the leading cause of cancer-related deaths worldwide. Although changing smoking patterns have contributed to the increasing burden among women, they do not fully explain the observed trends.
Smoking remains the main risk factor – but not the only one
According to OA Dr. Maximilian Hochmair, Head of the ÖGP Expert Group for Pulmonary Oncology, around 80 to 90 percent of all lung cancer cases remain linked to tobacco use. However, an increasing number of women develop lung cancer despite never having smoked or having smoked only minimally. In these cases, adenocarcinoma is the most common subtype.
Additional risk factors include passive smoking, air pollution and long-term exposure to smoke from wood, coal or biomass fuels used indoors. Fumes generated by overheating cooking oils are also being discussed as a possible risk factor. These environmental exposures affect women disproportionately in many parts of the world due to traditional household roles.
Biological differences also play a role
Research increasingly shows that lung cancer develops differently at the molecular level in women than in men. Women are more likely to carry EGFR mutations, which promote tumour growth but also enable targeted treatment with modern tyrosine kinase inhibitors. Comprehensive molecular diagnostics therefore play a key role in selecting the most appropriate therapy.
Scientists are also investigating differences in the immune system, drug metabolism and gene regulation. Although many lung tumours express oestrogen receptors, current evidence regarding the influence of female hormones, hormonal contraception or hormone replacement therapy on lung cancer risk remains inconclusive.
Delayed diagnosis remains a major challenge
Early-stage lung cancer often causes only non-specific symptoms such as persistent cough, shortness of breath, back pain, fatigue or weight loss. Especially in younger women, these symptoms are frequently not immediately associated with lung disease. Studies suggest that women are diagnosed later than men and often require several medical consultations before lung cancer is identified.
Women remain underrepresented in clinical studies
Women have historically been underrepresented in clinical lung cancer trials. As a result, much of the evidence on treatment dosing, side effects and efficacy is still primarily based on male patient populations. Current research indicates that women may experience certain treatment-related adverse effects more frequently, including nausea, neurological symptoms and some immune-related side effects. Potential sex-specific dosing strategies are still under investigation.
Differences in responses to immunotherapy have also been observed, although these appear to be influenced mainly by differing tumour mutation profiles rather than biological sex alone.
Gender-sensitive medicine improves care
The ÖGP emphasises that there is no distinct form of "female lung cancer". Instead, biological and gender-related differences should be considered more consistently in prevention, diagnosis and treatment. This includes considering lung cancer earlier in non-smoking women, ensuring equal participation of women in clinical studies, performing molecular tumour analyses whenever appropriate, taking environmental and passive smoking exposure into account and adapting future screening programmes to individual risk profiles.
The society concludes that gender-sensitive medicine does not mean fundamentally different treatment for women and men, but rather evidence-based, individualised care that recognises biological differences where they are clinically relevant. Such an approach could contribute to earlier diagnosis and improved treatment outcomes.
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