Canadian women have the highest rate of lung-cancer mortality in the developed world; at 47 per 100,000 population, that is almost double the average of other Western countries.
That stat jumped out in a recent report from the Organization for Economic Co-operation and Development, which examined 72 different measures of health-system performance in 34 OECD countries. But what does it mean? What does it actually say about the performance of the health system?
In fact, it says very little about the quality of care for cancer patients. The prognosis after a diagnosis of lung cancer is dismal, regardless of where you live in the world.
In Canada, the five-year survival rate is only 17 per cent (compared to 63 per cent of all cancers) – and it is slightly better for women than men.
What the statistic does, however, is remind us yet again of the devastation wrought by smoking and the toll that it will continue to take for years to come.
Lung cancer is the biggest cancer killer in Canada. This year, it will claim the lives of 10,800 men and 9,400 women, according to the Canadian Cancer Society.
The mortality rate is significantly higher for Canadian men than women, 72 per 100,000. It is also much closer to the OECD average of 66.3 per 100,000.
What we are seeing, more than anything else, is a narrowing of the gap between men and women, with lung-cancer mortality falling much more quickly in men than in women.
There is actually a simple explanation for that – the history of smoking patterns.
In 1965, a whopping 55 per cent of adult males smoked, and that number has been declining steadily since. The smoking rate among women never reached 40 per cent, but it didn’t begin to decline until the end of the 1970s.
That’s because the marketing of cigarettes to women was even more sophisticated and relentless than for men. “Light” and “slim” cigarettes, promoted as being less harmful than regular cigarettes (which was never true), enticed women, as did the heavily promoted myth that smoking is the best form of weight control.
Smoking was promoted as a way of creating bonds of friendship, and as a symbol of freedom and independence. Manufacturers rode on the coattails of the women’s liberation movement. This approach was embodied by the legendary ad campaign for Virginia Slims, with its catchphrase: “You’ve come a long way, baby.” There are numerous carcinogens in cigarettes and other tobacco products but the lag between exposure (and the cellular damage) and development of cancer is often 20 to 30 years.
Today’s mortality rates are a reflection of smoking patterns a generation (or two) ago.
So why are lung-cancer deaths so much higher for women in Canada than in other Western countries? Because, essentially, we didn’t do a very good job of promoting smoking cessation back then and we’re paying the price for laggardness now.
The good news is that there has been a marked improvement in how Canada regulates the marketing and sale of tobacco, though many other countries are far more aggressive.
Today about 17 per cent of men and 14 per cent of women are daily smokers. (Another 4 per cent of the population are occasional smokers.)
A lot more can be done but different approaches are required. We tend to be preachy and moralistic in our efforts to get people to quit smoking. Everybody knows smoking is bad for their health, but the remaining hard core of smokers are addicts. They need a lot more support and a lot less hectoring.
Beyond the obvious role of tobacco, lung cancer is one of the cancers about which we know the least. That’s because it doesn’t attract the research dollars of more high-profile (and less deadly) cancers like breast and prostate.
A lung-cancer diagnosis tends to carry a lot of stigma with it too. We blame people for their illness – damned smokers! – something we rarely do with other conditions.
We shouldn’t forget either that there are other causes of lung cancer. Because so many men smoke, their partners are exposed to second-hand smoke, as are workers in the service industry, which is dominated by women.
There are also other carcinogens that can cause lung cancer, including exposure to radon (a radioactive gas found in rocks and soil), asbestos and chemicals like polycyclic aromatic hydrocarbons (PAHs).
Roughly 8 per cent of men and 20 per cent of women diagnosed with lung cancer are never-smokers.
Regardless of the underlying cause, there is much work to be done to improve the treatments for lung-cancer patients. Survival rates haven’t improved markedly for decades.
Finally, there is a lingering perception that lung cancer is a man’s disease. In fact, it kills more women than all six women’s cancers (breast, ovarian, cervical, uterine, vaginal and vulvar) combined.
When it comes to lung cancer, women have indeed come a long way. And a long, deadly road still lies ahead.
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