Women's smoking patterns have been similar to men's for a while now, and a new study shows the result -- higher death rates. Women smokers in the 2000s died of lung cancer almost 26 times as often as women who never smoked. That's about the same as the gap between men who do and don't smoke. And it's a big jump compared with women smokers in the 1980s. They died of lung cancer at 13 times the rate of nonsmoking women. In the 1960s, the risk for women smokers was only 3 times as high. The reason for the change, researchers said, is that women have been starting smoking earlier and smoking more cigarettes. And they've been doing that long enough for health effects to occur. Women smokers also have nearly caught up with men in their increased risk of emphysema and other smoking-related diseases. The study was based on statistics from the American Cancer Society. Smoking costs people about 10 years of life, another new study found. But quitting before 40 can gain back nearly all of those years. The New England Journal of Medicine published both studies. HealthDay News and the New York Times wrote about them January 23.
By Robert H. Shmerling, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Have you noticed that smoking is becoming less popular?
According to the latest estimates, smoking rates in the United States have dropped dramatically. In 1960, 42% of U.S. adults smoked. By 2010, that number was down to about 20%. As a result, smoking-related deaths have been falling as well.
That's why news about the rising risk of smoking-related deaths among women is so surprising -- and disappointing.
A new review published in the New England Journal of Medicine tracked deaths linked to smoking over 50 years. It included more than 2 million people who were at least 55 years old. This study compared women and men who smoked to those who never smoked. It found a huge increase in women smokers' risk of dying.
- Women who smoked in the 1960s had a 2.7 times higher risk of dying from lung cancer than women who never smoked. By the 2000s, the risk was nearly 26 times higher.
- Women who smoked in the 1960s had a 4 times higher risk of dying from smoking-related lung disease (such as emphysema). By the 2000s, the risk was 22.5 times higher.
- The increased risk of lung cancer for male smokers leveled out during the 1980s. This trend occurred as men's smoking rates fell.
- By the 2000s, men and women who smoked had similar rates of smoking-related diseases. They included:
- Lung cancer
- Emphysema and related lung disease
- Heart disease and other heart and artery problems
Fortunately, there were also hopeful findings. For all age groups, the risk of death from a smoking-related disease fell dramatically after people quit.
What accounts for the increased risk of smoking for women? One reason is that rates of smoking among women have only recently leveled off. Smoking for a longer time probably accounts for some of the increase, too. Most women smokers of the '60s started after age 30. Later generations were more likely to begin as teenagers.
Another possible contributor is that women choose "light" or "low-tar and nicotine" brands more often than men. Smokers tend to inhale these cigarettes more deeply into their lungs to satisfy the craving for nicotine. So these cigarettes, which were supposed to be less harmful, may have actually increased the risk of disease.
This study's messages should be heard loud and clear: There is no safe type of cigarette. And when smoking becomes widespread in a population, smoking-related deaths and disease may rise over decades. Fortunately, the health risks linked to smoking are at least somewhat reversible if you quit -- the earlier, the better.
What Changes Can I Make Now?
Regardless of whether you're a man or a woman, smoking is a terrible idea. The trends among female smokers make this point well.
Smoking is a powerful addiction. Resist the temptation to start. Do what you can to discourage your children from taking up the habit.
If you currently smoke, commit to quit. Although some can quit on their own, many need help. Here are some options to consider:
- Use a nicotine-replacement system. These include nicotine-containing skin patches, nasal sprays, inhalers, chewing gum and lozenges. They may reduce nicotine-withdrawal symptoms as you quit.
- Consider a complementary or alternative approach. Hypnosis and acupuncture are among the most popular.
- Involve your family and friends in your plans to quit. They can be a source of support and encouragement.
- Ask a friend who smokes to quit with you.
- Contact your local chapter of the American Cancer Society to learn about smoking cessation programs and support groups in your area.
A combination of two or more of these approaches may help more than any one of them alone. And if you've tried quitting before, try again. Most people who quit try more than once before they are successful.
What Can I Expect Looking to the Future?
Recent medical advances have reduced the rates of death for some common conditions, such as many types of cancer and heart disease. Yet, for women, these advances have largely been wiped out by the impact of smoking.
The suffering and early death related to smoking can be prevented. In the future, you can expect to hear much more about ways to discourage people from taking up the habit and ways to quit once they're hooked. Methods may include new medicines, vaccines and genetic testing to find out which smoking cessation approach is most likely to work. We may also see new public health campaigns and legislation that discourage smoking in the future. I am hopeful that the popularity of smoking will continue to decline as dramatically among women as it has for men.
