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Elderly women in the early stages of lung cancer live longer than elderly men, regardless of the type of treatment they receive

Elderly women with early lung cancer live longer than elderly men, regardless of the type of treatment they receive, concludes a national population-based study of Medicare patients. Whether this is due to women's better response to treatment, different tumor biology, or longer life expectancy is not well understood. However, this study found that women's longer survival was independent of sex differences in life expectancy between men and women due to unrelated causes of death. It also showed improved survival advantages even among untreated women. This suggests that lung cancer in women has a different natural history and, potentially, a different tumor biology, note Juan P. Wisnivesky, M.D., M.P.H., and Ethan A. Halm, M.D., of Mount Sinai School of Medicine.

The researchers examined sex differences in the natural history of lung cancer, after controlling for unrelated causes of death and type of treatment among 18,967 elderly Medicare patients with stage I and II non-small-cell lung cancer.

The patients were diagnosed between 1991 and 1999. The researchers grouped patients into three treatment categories: surgery, radiation or chemotherapy but no surgery, and untreated.

Adenocarcinomas were more common among women, who were also more likely to be diagnosed with stage IA disease than men. Women had a 22 to 26 percent lower risk of dying from lung cancer regardless of type of treatment received. They also had a 22 to 27 percent decreased risk of dying from all causes. Even potential sex differences in smoking did not explain the findings. Median cancer-specific survival for women was 51 months compared with 37 months for men. Also, the 5-year survival rates were significantly higher in women than men (46 vs. 38 percent). The survival advantage of women was specific to adenocarcinoma and large-cell carcinoma cases. There were no gender differences in survival from squamous cell carcinoma.

The study was supported by the Agency for Healthcare Research and Quality (HS13312).

More details are in "Sex differences in lung cancer survival: Do tumors behave differently in elderly women?" by Drs. Wisnivesky and Halm, in the May 2007 Journal of Clinical Oncology 25(13), pp. 1705-1712.

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