Tobacco's Deadly Legacy

For almost a century, Big Tobacco told women that smoking would make them
sophisticated, smart, stylish and sexy. Instead, smoking triggered a lung cancer
epidemic that kills more American women every year than breast cancer.
How can you protect yourself?

By Lisa James

May 2005

Remember “You’ve come a long way, baby”? This ubiquitous slogan in television and print advertising for Virginia Slims cigarettes began in the mid-’60s, just about the time the women’s liberation movement was showing American females how to climb out of the box male-dominated society had shoved them into. The campaign was so successful that many people believe Big Tobacco only started making its play for the female market during feminism’s heyday. It’s an erroneous perception; cigarette companies actually began advertising to women during the Roaring Twenties, another era of female emancipation.

As a result of the tobacco industry’s come-ons, women started smoking in prodigious numbers, from 5% of all cigarettes sold in 1923 to a peak of 34% in 1965. But because women’s smoking rates lagged behind men’s, lung cancer among women also ran behind male malignancy rates. This led to another misperception, namely that women didn’t have to worry about this very common—and very deadly—cancer.

Nothing could be further from the truth. Women might have started smoking (for the most part) after men did, but by now their lung cancer rates have, sadly, caught up. “Today when you look at high school students, girls are almost as likely to smoke as boys,” says Dr. Jyoti Patel, a thoracic (chest) oncologist at Northwestern Memorial Hospital in Chicago. “It’s ironic when you think of it. They were told ‘you’ve come a long way, baby’ and actually, they’ve come the wrong way.”

That wrong way represents a long smoke trail. During the silver screen’s golden age in the 1930s and ’40s, the sight of such strong-willed women as Bette Davis and Joan Crawford puffing away left an indelible impression on young female minds, an influence reinforced by cigarettes’ omnipresence on TV in the ’50s and ’60s. Over the past 40 years, as the public has gradually become more aware of tobacco’s dangers, the industry’s pitch to women has become more ingenious (and insidious): A female sporting event sponsorship here, funding for a nonprofit women’s group there.

The only bright spot in Big Tobacco’s war on women’s lungs has been the large amounts of money these companies have had to cough up in lawsuit settlements, such as the $16 million payout upheld by the Supreme Court in March to a Glendale, California woman who started smoking before the industry was forced to acknowledge tobacco’s dangers by placing warnings on each pack. “This is a good day for the children,” Patricia Henley said at the time, since she plans to donate most of the money to a foundation dedicated to teaching kids about the evils of smoking. “This is punishment money from the tobacco industry.”

Such legal setbacks aside, cigarette advertising has been grimly effective: Six years after a confident, stylish model first strode through a Virginia Slims ad, the number of teenage girls who started smoking grew by more than 50%. And the increase in female smokers has, in turn, helped foster a lung-cancer death rate among these women 12 times greater than that for those who have never lit up.

Lives Up in Smoke

Nowadays, lung cancer is an equal-opportunity threat. “Although there has been a discrepancy in risk between men and women in past studies, the actual risk is probably the same,” says Dr. Patel. “The problem is that men have cut their smoking by about half since the ‘60s while women have only cut by a quarter, so men and women smoke at much more equal levels. Teenage girls start smoking to express their independence and because they think it’ll keep them thin.” A similar pattern holds for lung cancer death rates, which have declined among men since 1991 but have only leveled off recently among women after increasing for years.

One gender-based difference lies in the specific types of cancer that can develop. Women are more likely to get adenocarcinoma (ADn-o-KAR-si-NO-ma), which arises in glandular cells lining the lung’s inner surfaces. One reason is that the female sex hormone estrogen might play a role in development of adenocarcinoma, just as it does in breast cancer. (Pollution and workplace exposure to such contaminants as asbestos can also trigger lung cancer.) Another form is called small (or oat) cell; it accounts for 15% of all lung malignancies and is more tightly linked to smoking than other types. Small cell cancer is particularly dangerous because it tends to spread early and aggressively.

A further difference lies in the fact that women who have never smoked seem to be a lot more sensitive than their male counterparts to second-hand smoke (the stuff you breathe in from someone else’s cigarette). “People think, ‘If I never smoked I can never have lung cancer,’ but it’s actually not so infrequent,” Patel explains. “The probability is that 20,000 Americans who never smoked will develop lung cancer this year.” Living with a smoker is thought to increase a nonsmoker’s risk by 10 to 15%, but reliable studies are lacking.

Women who quit smoking might think they are in the clear; unfortunately, they’re wrong. “The problem is that many women have done the right thing—they’ve stopped smoking,” says Patel. “Their risk improves, but it never goes back to that of a never-smoker.”

Lung cancer poses such a hazard to both genders because, unlike mammograms for breast cancer or PSA testing for prostate cancer, there is no good screening test for malignancies in the lung. This means most people don’t know they have lung cancer until symptoms like bloody cough and chest pain develop. By that point it’s often too late; only 16% of all lung malignancies are caught early enough to be successfully treated. According to Patel, women do hold one advantage when cancer does strike—they have a better survival rate than men.

What’s more, lung cancer isn’t the only smoking-related malignancy. Researchers have linked lighting up with cancers of the head and neck, esophagus, pancreas, kidney, bladder and stomach. And the news from Tobaccoland is getting even worse: Recent studies have uncovered a connection between smoking and breast cancer, especially when a woman takes up the habit as a teenager.

Protection on a Plate

Just because not smoking is the single best way to avoid lung cancer doesn’t mean it is the only way. “Tobacco smoke is estimated to cause 80% to 90% of all lung cancers; that still leaves the door open for other cases,” says Registered Dietitian Karen Collins, nutrition writer and consultant with the American Institute for Cancer Research (AICR). “Eating well has a balancing effect.”

A cancer-fighting diet is especially helpful to someone who has been exposed to other folks’ fumes. “Second-hand smoke causes damage to the genes by producing free radicals, molecules that damage cells,” explains Collins. “So looking at how the foods we eat supply antioxidants [free-radical quenchers] becomes a key factor—it seems getting a variety of antioxidants seems to be important. By far the largest source of antioxidants is the number of phytochemicals that occur naturally in fruits, vegetables, whole grains, beans and other plant foods.” Studies done with one supplemental antioxidant, beta carotene, found that it may increase the risk of lung cancer in smokers, a finding that has been disputed by some practitioners. Present and former smokers should consult a qualified health practitioner before embarking on a supplementation program.

Some of the most powerful anti-cancer nutrients, substances called indoles, are found in a vegetable family called the crucifers, the most notable of which is broccoli. Not only do indoles serve as antioxidants, but they change the makeup of bodily enzymes that activate and deactivate cancer-causing substances. So it’s no surprise that large studies have linked a reduced risk of lung cancer with dining on cruciferous veggies.

Unfortunately, a lot of people just don’t like broccoli and its many cousins. “When people have to choose between good nutrition and good taste, good nutrition doesn’t win out very often,” Collins says. “Frankly I didn’t like the way my mom fixed broccoli either, but these foods are so loaded with health-protective substances that it’s worth our while to find ways to make them something we can enjoy.” Other foods that may help forestall lung cancer include garlic and such dark leafy greens as spinach. (For ways to turn broccoli, spinach and other anti-cancer superheroes into gourmet delights, visit the AICR website at www.aicr.org or call 800-843-8114.)

Eating right, actively advocating for smoke-free public spaces, saying no to Big Tobacco’s false promises: Now that’s the smart way for today’s woman to get where she wants to go.