Lung Cancer Still Rising in British Women

Women now pay the price for smoking in the Mad Men era as number of lung cancer cases rises, a United Kingdom charity says.

“You’ve come a long way, baby.” That’s the slogan cigarette maker Altria Group, formerly Phillip Morris Companies, used to sell its Virginia Slims when it first introduced the brand in 1968. Some media watch groups interviewed by the Centers for Disease Control and Prevention decades later blame this campaign for the rapid increase in smoking among teenage girls in that era.

A report by the United States Surgeon General — famous for being the first in the U.S. to say bravely, in 1964, that smoking caused cancer — interpreted this marketing slogan, as well as later ones, as an attempt to lure women into taking up smoking by linking it “to women’s freedom, emancipation, and empowerment.”

In the same report, the U.S. Surgeon General also tied the increase of smoking among teenage girls to rises in sales of Virginia Slims and other “niche” brands marketed directly to women.

Now, four decades after that slogan first saw print, women in the United Kingdom are paying the price. Lung cancer rates among British women continue to rise as decades of smoking take their toll, a leading charity reports on April 13.

New figures published by Cancer Research UK show that:
• Compared with fewer than 8,000 in 1975, more than 18,000 women in the UK were diagnosed with lung cancer in 2009.
• Compared with 22 per 100,000 in 1975, there were 39 cases of lung cancer for every 100,000 women in the UK In 2009.

The number of cases reflects smoking patterns from around two to three decades ago. Smoking among women was most prevalent in the 1960s — the period described by Cancer Research UK as the “the ‘Mad Men era,’” after the popular British television show. It was a time when the first wave of Women’s Liberation Movement was underway — and around 45 percent of women smoked.

Today, the numbers of smoking women have fallen to 20 percent of all UK women, following growing awareness of the hazards of smoking. But the effects of habits in earlier days are still being felt.

“The continuing rise of lung cancer in women reflects the high number of female smokers several decades ago when attitudes were different,” says Jean King, director of tobacco control at Cancer Research UK. These figures highlight the “deadly impact” of tobacco, she says.

But even if the numbers of women smokers are going down, King warns that, “Tobacco advertising hasn’t appeared on UK television since 1965, but that didn’t stop the marketing of cigarettes. New, more sophisticated marketing techniques have lured many hundreds of thousands into starting an addiction that will kill half of all long term smokers.”

Lung cancer rates in men going down
But unlike women, rates of lung cancer among men in the UK have been falling steeply. In 1975 the rate of lung cancer among men in the UK was 110 per 100,000, whereas now it is 58.8.

Nearly 35,000 people — 19,410 men and 15,449 women — died from lung cancer in the UK in 2010, according to the new figures.

But while lung cancer rates are rising in British women, these have been falling among U.K. men — the number of cases now stands at 58.8 per 100,000, compared with 110 in 1975.

Cancer Research UK puts this down to smoking rates having peaked earlier among men than women.
More than 65 percent of men smoked during World War II and the rest of the 1940s, leading to lung cancer rates reaching their highest around 30 years later, in 1979, the charity says. The disease is still more common among men in the UK, as the figures show.

Partly funded by Cancer Research UK, the British Doctors’ Study, which ran from 1951 to 2001, was the first to show that smoking increases the risk of lung cancer. It also went on to show clearly the benefits of quitting.

In 1962 — ahead of the U.S. Surgeon General — the UK’s Royal College of Physicians’ report, “Smoking and Health,” raised awareness of smoking-related diseases, helping change the perception of smoking. One of the key recommendations on how to reduce smoking rates found in this report included removing tobacco advertising from TV — a tobacco control measure that’s been adopted by most countries today.

Until the mid-1990s, lung cancer was the most common cancer in the UK. It’s since been overtaken by breast cancer, but it still accounts for 11 percent of all new cancer cases among women, and 14 percent among men.

Anti-smoking measures
Banning tobacco advertising and smoking in public places, raising taxes and other tobacco control measures recommended by the World Health Organization and implemented in the UK has reduced the number of British smokers. Recently, new measures have been introduced, including banning large shops and supermarkets from displaying tobacco products, and in 2015, smaller shops will also be banned from displaying cigarettes and other forms of tobacco.

Another measure being considered by the UK government is replacing colorful cigarette packaging and unique company branding with plain packaging that is uniform in color, size and shape. The European Union, is also mulling over introducing what is called graphic warnings — large picture warnings on both sides of the pack. The U.S. Food and Drug Administration has been pushing for placing such graphic warnings on cigarette packs, but the measure is being contested in American courts.

Cancer Research UK says these measures will reduce one of the remaining ways that tobacco is marketed to children.

“It’s vital that the UK closes one of the last remaining loopholes that portrays smoking as something glamorous and normal, rather than the lethal product it truly is,” King says.

Meanwhile in Canada — which counts among the most advanced countries where tobacco control measures are concerned — CBC News reports that lung cancer patients are judged harshly by friends, family and even healthcare workers, even when while 10 to 20 percent of them never smoked.

Canadians with lung cancer face a barrage of negative attitudes from caregivers, friends and relatives that interfere with caring behavior, Michelle Lobchuk, author of a report card on cancer in Canada that was released April 11 by the Cancer Advocacy Coalition, says.

The cancer patient advocacy group says that nicotine-stained skin, fingers and teeth, foul-smelling clothes, a smoker’s cough and premature aging tend to provoke “repulsion” against smokers, but pointed out that the reality is that 10 to 20 percent of lung cancer patients never smoked.

Lobchuck, a nursing professor at the University of Manitoba and Manitoba Research Chair in Caregiver Communication, and her colleagues studied 304 pairs of lung cancer patients and their family caregivers.
Following the findings of their research, the cancer patient advocates called for a de-stigmatization of smoking.

“The evidence on quitting smoking says social support is vital to offset feelings of guilt when trying to quit smoking,” Lobchuk notes.

“One thing that we can do now to de-stigmatize the lung cancer experience is to ask yourself, ‘Why do I need to know whether the patient with lung cancer smoked?’ If it comes from a desire to blame, you may be doing more harm than good.”

As a nurse, Lobchuk said she’s concerned about the lack of medical guidelines that focus on supportive care for patients and families trying to cope with lung cancer stigma.

Across the globe, in Wales, Dr. Jonathan Richards, a general practitioner in the poor county of Merthyr Tydfil agrees that de-stigmatization is important if doctors want women to seek prompt treatment for smoking.

According to him, “some research suggests that women are likely to get types of lung cancer that are not linked to smoking and the other is that at the moment we are finding that proportionately more women are continuing to smoke, whereas men are giving up smoking.

“I think it’s harder for women to give up smoking in some ways,” he tells BBC. “We know from surveys and research that smoking does actually help people — particularly in deprived areas like Merthyr Tydfil, cope with anxiety and depression — cope with the stresses of day to day life.

“It’s easy for people who perhaps don’t experience deprivation, and who don’t appreciate just how addictive nicotine and other chemicals in cigarettes are, to make judgments,” he points out.

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