{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:16:46Z","timestamp":1790882206337,"version":"4.1.0"},"reference-count":76,"publisher":"European Respiratory Society (ERS)","issue":"163","license":[{"start":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T00:00:00Z","timestamp":1641945600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir Rev"],"accepted":{"date-parts":[[2021,8,16]]},"published-print":{"date-parts":[[2022,3,31]]},"abstract":"<jats:p>In stark contrast to a few decades ago when lung cancer was predominantly a disease of men who smoke, incidence rates of lung cancer in women are now comparable to or higher than those in men and are rising alarmingly in many parts of the world. Women face a unique set of risk factors for lung cancer compared to men. These include exogenous exposures including radon, prior radiation, and fumes from indoor cooking materials such as coal, in addition to endogenous exposures such as oestrogen and distinct genetic polymorphisms. Current screening guidelines only address tobacco use and likely underrepresent lung cancer risk in women. Women were also not well represented in some of the landmark prospective studies that led to the development of current screening guidelines. Women diagnosed with lung cancer have a clear mortality benefit compared to men even when other clinical and demographic characteristics are accounted for. However, there may be sex-based differences in outcomes and side effects of systemic therapy, particularly with chemotherapy and immunotherapy. Ongoing research is needed to better investigate these differences to address the rapidly changing demographics of lung cancer worldwide.<\/jats:p>","DOI":"10.1183\/16000617.0100-2021","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T09:35:24Z","timestamp":1641980124000},"page":"210100","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":78,"title":["The evolving landscape of sex-based differences in lung cancer: a distinct disease in women"],"prefix":"10.1183","volume":"31","author":[{"given":"Meera","family":"Ragavan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manali I.","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2022,1,12]]},"reference":[{"key":"2024102404001305000_31.163.210100.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1715907"},{"key":"2024102404001305000_31.163.210100.2","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1002\/ijc.32809","article-title":"Lung cancer incidence in young women vs. young men: A systematic analysis in 40 countries","volume":"147","author":"Fidler-Benaoudia","year":"2020","journal-title":"Int J Cancer"},{"key":"2024102404001305000_31.163.210100.3","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.10.5412"},{"key":"2024102404001305000_31.163.210100.4","doi-asserted-by":"crossref","first-page":"79","DOI":"10.2147\/LCTT.S37319","article-title":"Lung cancer in women","volume":"3","author":"Barrera-Rodriguez","year":"2012","journal-title":"Lung Cancer Targets Ther"},{"key":"2024102404001305000_31.163.210100.5","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.30084"},{"key":"2024102404001305000_31.163.210100.6","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1001\/jamasurg.2021.0242","article-title":"New USPSTF guidelines for lung cancer screening: better but not enough","volume":"156","author":"Colson","year":"2021","journal-title":"JAMA Surg"},{"key":"2024102404001305000_31.163.210100.7","doi-asserted-by":"crossref","first-page":"e13572","DOI":"10.1200\/JCO.2020.38.15_suppl.e13572","article-title":"Assessing risk-based LDCT screening strategies versus the current USPSTF lung cancer screening recommendations at an institutional setting","volume":"38","author":"Velez Martinez","year":"2020","journal-title":"J Clin Oncol"},{"key":"2024102404001305000_31.163.210100.8","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2010.151621"},{"key":"2024102404001305000_31.163.210100.9","unstructured":"US Cancer Statistics . Data visualizations https:\/\/gis.cdc.gov\/Cancer\/USCS\/#\/AtAGlance\/."},{"key":"2024102404001305000_31.163.210100.10","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.lungcan.2014.08.001","article-title":"Patterns in lung cancer incidence rates and trends by histologic type in the United States, 2004\u20132009","volume":"86","author":"Houston","year":"2014","journal-title":"Lung Cancer Amst Neth"},{"key":"2024102404001305000_31.163.210100.11","doi-asserted-by":"crossref","first-page":"8","DOI":"10.5334\/aogh.2419","article-title":"Global epidemiology of lung cancer","volume":"85","author":"Barta","year":"2019","journal-title":"Ann Glob Health"},{"key":"2024102404001305000_31.163.210100.12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0050185"},{"key":"2024102404001305000_31.163.210100.13","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/30.4.787"},{"key":"2024102404001305000_31.163.210100.14","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/00001648-199801000-00016","article-title":"Gender and smoking-related risk of lung cancer. The Copenhagen Center for Prospective Population Studies","volume":"9","author":"Prescott","year":"1998","journal-title":"Epidemiol Camb Mass"},{"key":"2024102404001305000_31.163.210100.15","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djh143"},{"key":"2024102404001305000_31.163.210100.16","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.3390\/cancers3021861","article-title":"Molecular epidemiology of female lung cancer","volume":"3","author":"Yim","year":"2011","journal-title":"Cancers"},{"key":"2024102404001305000_31.163.210100.17","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.critrevonc.2008.06.008","article-title":"Women and lung cancer: clinical and molecular profiling as a determinate for treatment decisions: a literature review","volume":"69","author":"Berardi","year":"2009","journal-title":"Crit Rev Oncol Hematol"},{"key":"2024102404001305000_31.163.210100.18","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7114.980"},{"key":"2024102404001305000_31.163.210100.19","unstructured":"US Environmental Protection Agency . Health Risk of Radon www.epa.gov\/radon\/health-risk-radon"},{"key":"2024102404001305000_31.163.210100.20","first-page":"715","article-title":"Lung Cancer and Exposure to Radon in Women \u2013 New Jersey","volume":"38","year":"1989","journal-title":"MMWR"},{"key":"2024102404001305000_31.163.210100.21","doi-asserted-by":"publisher","DOI":"10.1080\/15287390500260945"},{"key":"2024102404001305000_31.163.210100.22","doi-asserted-by":"crossref","unstructured":"Kwak K , Kang D , Paek D . Environmental exposure to asbestos and the risk of lung cancer: a systematic review and meta-analysis. Occup Environ Med 2021; in press [https:\/\/doi.org\/10.1136\/oemed-2020-107222].","DOI":"10.1136\/oemed-2020-107222"},{"key":"2024102404001305000_31.163.210100.23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/LCTT.S186843","article-title":"The current understanding of asbestos-induced epigenetic changes associated with lung cancer","volume":"11","author":"Cheng","year":"2020","journal-title":"Lung Cancer Targets Ther"},{"key":"2024102404001305000_31.163.210100.24","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198801143180203"},{"key":"2024102404001305000_31.163.210100.25","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.13.3033"},{"key":"2024102404001305000_31.163.210100.26","doi-asserted-by":"crossref","first-page":"427","DOI":"10.3389\/fonc.2018.00427","article-title":"Second primary lung cancer after breast cancer: a population-based study of 6,269 women","volume":"8","author":"Wang","year":"2018","journal-title":"Front Oncol"},{"key":"2024102404001305000_31.163.210100.27","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.1002217"},{"key":"2024102404001305000_31.163.210100.28","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2013.05.002"},{"key":"2024102404001305000_31.163.210100.29","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ccm.2019.10.005","article-title":"Lung cancer in women: a modern epidemic","volume":"41","author":"MacRosty","year":"2020","journal-title":"Clin Chest Med"},{"key":"2024102404001305000_31.163.210100.30","doi-asserted-by":"publisher","DOI":"10.21037\/tlcr.2018.05.06"},{"key":"2024102404001305000_31.163.210100.31","first-page":"2799","article-title":"The association of human papillomavirus 16\/18 infection with lung cancer among nonsmoking Taiwanese women","volume":"61","author":"Cheng","year":"2001","journal-title":"Cancer Res"},{"key":"2024102404001305000_31.163.210100.32","doi-asserted-by":"crossref","first-page":"e2015052","DOI":"10.4178\/epih\/e2015052","article-title":"Human papillomavirus infection and risk of lung cancer in never-smokers and women: an \u2018adaptive\u2019 meta-analysis","volume":"37","author":"Bae","year":"2015","journal-title":"Epidemiol Health"},{"key":"2024102404001305000_31.163.210100.33","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0017479"},{"key":"2024102404001305000_31.163.210100.34","doi-asserted-by":"crossref","first-page":"20","DOI":"10.2174\/1874306401610010020","article-title":"Relationship between lung cancer and Mycobacterium avium complex isolated using bronchoscopy","volume":"10","author":"Tamura","year":"2016","journal-title":"Open Respir Med J"},{"key":"2024102404001305000_31.163.210100.35","first-page":"527","article-title":"A consensus statement on the gender perspective in lung cancer","volume":"19","author":"Isla","year":"2017","journal-title":"Clin Transl Oncol Off Publ Fed Span Oncol Soc Natl Cancer Inst Mex"},{"key":"2024102404001305000_31.163.210100.36","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(03)01024-5"},{"key":"2024102404001305000_31.163.210100.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2009.11.027"},{"key":"2024102404001305000_31.163.210100.38","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28326"},{"key":"2024102404001305000_31.163.210100.39","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1056\/NEJMoa1911793","article-title":"Reduced lung-cancer mortality with volume CT screening in a randomized trial","volume":"382","author":"de Koning","year":"2020","journal-title":"N Engl J Med"},{"key":"2024102404001305000_31.163.210100.40","first-page":"67","article-title":"China national lung cancer screening guideline with low-dose computed tomography (2018 version)","volume":"21","author":"Zhou","year":"2018","journal-title":"Zhongguo Fei Ai Za Zhi Chin J Lung Cancer"},{"key":"2024102404001305000_31.163.210100.41","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1093\/jnci\/djaa013","article-title":"Disparities of national lung cancer screening guidelines in the US population","volume":"112","author":"Han","year":"2020","journal-title":"JNCI J Natl Cancer Inst"},{"key":"2024102404001305000_31.163.210100.42","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1093\/jnci\/djaa170","article-title":"State variation in low-dose computed tomography scanning for lung cancer screening in the United States","volume":"113","author":"Fedewa","year":"2021","journal-title":"JNCI J Natl Cancer Inst"},{"key":"2024102404001305000_31.163.210100.43","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1001\/jamaoncol.2020.6362","article-title":"Proportion of never smokers among men and women with lung cancer in 7 US States","volume":"7","author":"Siegel","year":"2021","journal-title":"JAMA Oncol"},{"key":"2024102404001305000_31.163.210100.44","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.ypmed.2019.05.001","article-title":"Race and sex differences in patient provider communication and awareness of lung cancer screening in the health information National Trends Survey, 2013\u20132017","volume":"124","author":"Warner","year":"2019","journal-title":"Prev Med"},{"key":"2024102404001305000_31.163.210100.45","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.32486"},{"key":"2024102404001305000_31.163.210100.46","unstructured":"Duan F , Chysanthopoulou S , De Mello S . Lung nodule consistency and relative risk of future lung cancer diagnosis: does sex matter? Radiological Society of North America Annual Meeting, Abstract SSA 04 02."},{"key":"2024102404001305000_31.163.210100.47","doi-asserted-by":"crossref","first-page":"A407","DOI":"10.1016\/j.chest.2019.08.444","article-title":"Gender gaps in care: lung cancer screening criteria in women","volume":"156","author":"Vu","year":"2019","journal-title":"Chest"},{"key":"2024102404001305000_31.163.210100.48","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s12885-020-07750-z","article-title":"Current lung cancer screening guidelines may miss high-risk population: a real-world study","volume":"21","author":"Ji","year":"2021","journal-title":"BMC Cancer"},{"key":"2024102404001305000_31.163.210100.49","doi-asserted-by":"crossref","first-page":"e2033769","DOI":"10.1001\/jamanetworkopen.2020.33769","article-title":"Evaluation of revised US preventive services task force lung cancer screening guideline among women and racial\/ethnic minority populations","volume":"4","author":"Reese","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2024102404001305000_31.163.210100.50","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.lungcan.2012.11.014","article-title":"Lung cancer and pregnancy","volume":"79","author":"Sar\u0131man","year":"2013","journal-title":"Lung Cancer"},{"key":"2024102404001305000_31.163.210100.51","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2312030880"},{"key":"2024102404001305000_31.163.210100.52","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/88.3-4.183"},{"key":"2024102404001305000_31.163.210100.53","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.2.180"},{"key":"2024102404001305000_31.163.210100.54","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jtcvs.2014.03.012","article-title":"Sex differences in early outcomes after lung cancer resection: analysis of the Society of Thoracic Surgeons\u2019 general thoracic database","volume":"148","author":"Tong","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024102404001305000_31.163.210100.55","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2003.11.021"},{"key":"2024102404001305000_31.163.210100.56","doi-asserted-by":"crossref","first-page":"543","DOI":"10.21037\/tlcr.2019.04.06","article-title":"Sex disparities in lung cancer incidence: validation of a long-observed trend","volume":"8","author":"Hellyer","year":"2019","journal-title":"Transl Lung Cancer Res"},{"key":"2024102404001305000_31.163.210100.57","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.08.1455"},{"key":"2024102404001305000_31.163.210100.58","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1016\/j.amsu.2020.11.081","article-title":"Gender disparities in lung cancer survival from an enriched Florida population-based cancer registry","volume":"60","author":"Elkbuli","year":"2020","journal-title":"Ann Med Surg"},{"key":"2024102404001305000_31.163.210100.59","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e3181f1923b"},{"key":"2024102404001305000_31.163.210100.60","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1093\/icvts\/ivab006","article-title":"Women have a higher resection rate for lung cancer and improved survival after surgery","volume":"32","author":"Lautam\u00e4ki","year":"2021","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"2024102404001305000_31.163.210100.61","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezs002"},{"key":"2024102404001305000_31.163.210100.62","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1016\/j.tranon.2019.04.015","article-title":"Comparison of the efficacy of stereotactic body radiotherapy versus surgical treatment for early-stage non-small cell lung cancer after propensity score matching","volume":"12","author":"Dong","year":"2019","journal-title":"Transl Oncol"},{"key":"2024102404001305000_31.163.210100.63","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1186\/s12890-019-0858-y","article-title":"Outcomes of stereotactic body radiotherapy versus lobectomy for stage I non-small cell lung cancer: a propensity score matching analysis","volume":"19","author":"Lin","year":"2019","journal-title":"BMC Pulm Med"},{"key":"2024102404001305000_31.163.210100.64","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29640"},{"key":"2024102404001305000_31.163.210100.65","doi-asserted-by":"crossref","first-page":"2023","DOI":"10.1093\/annonc\/mdq067","article-title":"The influence of sex and histology on outcomes in non-small-cell lung cancer: a pooled analysis of five randomized trials","volume":"21","author":"Wheatley-Price","year":"2010","journal-title":"Ann Oncol Off J Eur Soc Med Oncol"},{"key":"2024102404001305000_31.163.210100.66","doi-asserted-by":"publisher","DOI":"10.1136\/esmoopen-2018-000344"},{"key":"2024102404001305000_31.163.210100.67","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djz094"},{"key":"2024102404001305000_31.163.210100.68","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1093\/jnci\/djz096","article-title":"Sex-related effect on immunotherapy response: implications and opportunities","volume":"111","author":"Colli","year":"2019","journal-title":"JNCI J Natl Cancer Inst"},{"key":"2024102404001305000_31.163.210100.69","doi-asserted-by":"crossref","first-page":"4023","DOI":"10.1002\/cam4.2280","article-title":"Effect of sex on the efficacy of patients receiving immune checkpoint inhibitors in advanced non-small cell lung cancer","volume":"8","author":"Wang","year":"2019","journal-title":"Cancer Med"},{"key":"2024102404001305000_31.163.210100.70","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2019-0094"},{"key":"2024102404001305000_31.163.210100.71","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1038\/nri.2018.4","article-title":"The breakthrough of the microbiota","volume":"18","author":"Kroemer","year":"2018","journal-title":"Nat Rev Immunol"},{"key":"2024102404001305000_31.163.210100.72","doi-asserted-by":"publisher","DOI":"10.1016\/j.clim.2015.04.016"},{"key":"2024102404001305000_31.163.210100.73","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1713137"},{"key":"2024102404001305000_31.163.210100.74","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1056\/NEJMoa1704795","article-title":"Alectinib versus crizotinib in untreated ALK-positive non-small-cell lung cancer","volume":"377","author":"Peters","year":"2017","journal-title":"N Engl J Med"},{"key":"2024102404001305000_31.163.210100.75","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1200\/JCO.1990.8.9.1563","article-title":"Determinants of improved outcome in small-cell lung cancer: an analysis of the 2,580-patient Southwest Oncology Group data base","volume":"8","author":"Albain","year":"1990","journal-title":"J Clin Oncol Off J Am Soc Clin Oncol"},{"key":"2024102404001305000_31.163.210100.76","doi-asserted-by":"crossref","first-page":"e20077","DOI":"10.1200\/JCO.2019.37.15_suppl.e20077","article-title":"Exploring sex differences in small cell lung cancer: Is this a hormonal issue?","volume":"37","author":"Duma","year":"2019","journal-title":"J Clin Oncol"}],"container-title":["European Respiratory Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/16000617.0100-2021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T05:04:40Z","timestamp":1740373480000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/16000617.0100-2021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,12]]},"references-count":76,"journal-issue":{"issue":"163","published-online":{"date-parts":[[2022,1,12]]},"published-print":{"date-parts":[[2022,3,31]]}},"alternative-id":["10.1183\/16000617.0100-2021"],"URL":"https:\/\/doi.org\/10.1183\/16000617.0100-2021","relation":{},"ISSN":["0905-9180","1600-0617"],"issn-type":[{"value":"0905-9180","type":"print"},{"value":"1600-0617","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,12]]}}}