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TheView HealthGina Hollenbeck said sHe did “everytHinG riGHt.”
The Tennessee nurse and mother of two avoided cigarettes
all her life. She ate organic food. She ran half marathons
and played competitive tennis. But in 2015, she developed
a persistent cough and rapidly lost weight. She didn’t have a
primary- care doctor, so she consulted several specialists. For
months, none could identify what was wrong. Finally, she
paid out of pocket for chest X-rays and took them to an emer-
gency room, where she was referred to a pulmonologist who
diagnosed her with advanced lung cancer.
“I was like, ‘This is a cruel joke,’ ” says Hollenbeck, who is
now 42 and still not in remission. “Everybody kept saying,
‘There’s no way that you could possibly have lung cancer.’ ”
Hollenbeck represents a worrying caveat to what is other-
wise a great success for the U.S. medical system. Overall lung-
cancer rates have fallen significantly in recent decades—but
women, who have traditionally smoked less than men and
thus developed and died from lung cancer less often, now
account for a disproportionately high number of diagnoses.
Lung cancer is the deadliest form of cancer in the U.S. But
mortality rates have been falling for decades, driven by medi-
cal advances and historic decreases in cigarette smoking. The
benefits, however, have not been shared equally. What was
historically a men’s disease is now disproportionately affect-
ing women. A 2018 study in the New England Journal of Medi-
cine showed that rates of lung- cancer incidence actually rose
over the past 20 years among women born around either 1950
or 1960; in younger women, diagnoses fell, but not as much
as among men.
Perhaps more puzzling, Dr. Ahmedin Jemal, co-author of
the study, says smoking habits cannot totally explain the de-
mographic shift in lung cancer. But for a few historical blips,
U.S. smoking rates have been higher among men than women,
continuing to the present day, Jemal says. As of 2017, almost
16% of adult men smoked, compared with about 12% of
women, according to federal data. What’s more, though non-
smokers account for about 15% of all lung-cancer diagnoses,
24% of the U.S. women diagnosed in 2016 were non smokers
like Hollenbeck. That means other factors are contributing
to the troubling trend. “It’s completely unknown right now,”
says Alice Berger, who researches genetics and cancer at
Seattle’s Fred Hutchinson Cancer Research Center.ScientiStS are beginning to zero in on some clues.
Research shows that the type of lung cancer most common
among non smokers disproportionately affects women, and
young women are more likely to have a gene mutation often
found in the tumors of non smokers. (A silver lining, Berger
says, is that the mutation responds well to newer targeted
cancer therapies.) Quirks of female sex hormones or wom-
en’s immune systems could be responsible, Berger says. But
research is ongoing, so for now those ideas remain theories.
Other hypotheses focus on how cigarettes affect womenThe puzzle of lungcancer in women
By Jamie Ducharmewho do smoke. Jemal says something
about female biology could make
women more susceptible than men to
genetic mutations caused by carcino-
gens in cigarettes. If so, a higher per-
centage of women who pick up the
habit could develop cancer, relative to
men. But that, too, remains a theory re-
quiring deeper investigation.
Without firm answers about the risks
women face, doctors, patients and advo-
cates are spreading the word about lung
cancer among women and non smokers.
About 1,400 people have joined a
Facebook support group Hollenbeck
helped start, and she’s working to push
through a federal bill that would further
research into women and lung cancer.
“Our society believes that lung cancer
is a smoking disease,” she says. But for
young women like Hollenbeck, that’s
increasingly untrue. She hopes her story
teaches women that lung cancer doesn’t
discriminate and that they shouldn’t
hesitate to get help. “If you feel like
something might be wrong,” she says,
ILLUSTRATION BY LON TWEETEN FOR TIME “always go with that intuition.” □
15%
Share of total
number of Americans
diagnosed with
lung cancer who are
non smokers24%
Share of U.S. women
diagnosed with
lung cancer who are
non smokers110,00
Approximate number
of new lung-cancer
diagnoses among
U.S. women in 2019