Why Lung Cancer Is On The Rise In Women Who’ve Never Smoked
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It’s easy to assume that if you’ve never smoked, lung cancer is just not a risk for you, unless you got very unlucky with an asbestos-laden environment or such.
And yes, smoking is indeed the most overwhelmingly strong risk factor:
❝It is estimated that cigarette smoking explains almost 90% of lung cancer risk in men and 70 to 80% in women❞
Which is a lot (and we’ll address that discrepancy by sex shortly), but meanwhile first let’s mention:
❝Compared with non-smokers, smokers have as much as a 30-fold increased risk of developing cancer.
31% and 26% of all cancer deaths in men and women, respectively, result from lung cancer in the United States.
Overall 5-year survival is only 15%, and 1-year survival is approximately 42%.
In total, lung cancer is responsible for more deaths than prostate, colon, pancreas, and breast cancers combined❞
Source: Smoking and Lung Cancer
Sobering statistics for any smoker, certainly.
But, “smoking is bad for the health” is not the breaking news of the century, so we’ll look now at the other risk factors.
Before we do though, let’s just drop this previous main feature of ours for anyone who does smoke or perhaps who has a loved one who smokes:
Which Addiction-Quitting Methods Work Best? ← it’s not specific just to smoking, but it does cover such also
So, Why the extra risk for women, even if we don’t smoke?
Let’s reframe that first statistic we gave, now presenting the same information differently:
Women who do not smoke are 2–3x more likely to get lung cancer than men who do not smoke.
So… why?
There are three main reasons:
Genetic risks
Cancer often arises from genetic mutations. In the case of lung cancer, genes such as ALK, ROS1, TP53, KRAS, and EGFR are implicated, and some of those are much more likely to mutate in women than in men.
In some cases, it’s because if you have XX chromosomes (as most women do), there are genes you have redundant copies of that people with XY chromosomes don’t. Other less common karyotypes, such as XXY, probably carry higher risks, but that’s just a hypothesis we’re making based on “more copies of a gene = more chances for it to mutate”.
See also: Frequency and Distinctive Spectrum of KRAS Mutations in Never Smokers with Lung Adenocarcinoma
In other cases, it’s because estrogen interacts with the gene mutations, making lung cancer more likely to develop in women over time:
Hormonal risks (but not what you might think)
When something affects women more, it’s easy to blame hormones, but, as researchers have concluded…
❝A reduced lung cancer risk was found for OC and HRT ever users. Both oestrogen only and oestrogen+progestin HRT were associated with decreased risk. No dose-response relationship was observed with years of OC/HRT use. The greatest risk reduction was seen for squamous cell carcinoma in OC users and in both adenocarcinoma and small cell carcinoma in HRT users.❞
OC = oral contraceptive
HRT = hormone replacement therapy
Note: we snipped out the statistical calculations for readability and brevity, so if you are interested in those, check out the paper below:
Meanwhile, another research review of 22 studies with nearly a million participants found:
❝Current or ever HRT use is partly correlated with the decreased incidence of lung cancer in women.
Concerns about the incidence of lung cancer can be reduced when perimenopausal and postmenopausal women use current HRT to reduce menopausal symptoms.❞
So, the problem seems to at least a lot of the time be not estrogen (notwithstanding what we mentioned previously about mutations—sometimes a thing can have both pros and cons), but rather, untreated menopause being the higher risk factor.
This is very reminiscent of what we talked about in one of our main features about Alzheimer’s disease:
Alzheimer’s Sex Differences May Not Be What They Appear ← Women get Alzheimer’s at nearly 2x the rate than men do, and deteriorate more rapidly after onset, too.
Chronic inflammation
For reasons that have not been tied to genetics or hormones*, women suffer from autoimmune diseases at much higher rates than men.
*presumably it is at least one or the other, because there aren’t a lot of other options that seem plausible, but (as with many “this thing mainly affects women” maladies), science hasn’t yet determined the cause.
Because cancer is in part a disease of immune dysfunction (cells fail to kill cells they should be killing), having an autoimmune disease, or indeed chronic inflammation in general, will result in a higher risk of cancer.
For general theory, see: Cancer and Autoimmune Diseases: A Tale of Two Immunological Opposites?
For specifics, see: Non–Small Cell Lung Cancer: Role of the Immune System and Potential for Immunotherapy
And this one is the most likely explanation of why lung cancer in women who’ve never smoked is on the rise—it’s because chronic inflammation in women is on the rise. While people regardless of gender are getting chronic inflammation at increased rates nowadays (probably due in large part to the rise of ultra-processed food, as well as the higher stress of modern life, but again, we’re hypothesizing), if all other factors are equal, women will still get it more than men.
However!
Like the consideration of HRT’s protective effects (and unlike the genetic factors), this is one we can do something about.
For how, check out: How to Prevent (or Reduce) Inflammation
Want to know more?
For lung health in general, see:
Seven Things To Do For Good Lung Health!
Take care!
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PFAS Exposure & Cancer: The Numbers Are High
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PFAS & Cancer Risk: The Numbers Are High
Image Credits Mount Sinai This is Dr. Maaike van Gerwen. Is that an MD or a PhD, you wonder? It’s both.
She’s also Director of Research in the Department of Otolaryngology at Mount Sinai Hospital in New York, Scientific Director of the Program of Personalized Management of Thyroid Disease, and Member of the Institute for Translational Epidemiology and the Transdisciplinary Center on Early Environmental Exposures.
What does she want us to know?
She’d love for us to know about her latest research published literally today, about the risks associated with PFAS, such as the kind widely found in non-stick cookware:
Per- and polyfluoroalkyl substances (PFAS) exposure and thyroid cancer risk
Dr. van Gerwen and her team tested this several ways, and the very short and simple version of the findings is that per doubling of exposure, there was a 56% increased rate of thyroid cancer diagnosis.
(The rate of exposure was not just guessed based on self-reports; it was measured directly from PFAS levels in the blood of participants)
- PFAS exposure can come from many sources, not just non-stick cookware, but that’s a “biggie” since it transfers directly into food that we consume.
- Same goes for widely-available microwaveable plastic food containers.
- Relatively less dangerous exposures include waterproofed clothing.
To keep it simple and look at the non-stick pans and microwavable plastic containers, doubling exposure might mean using such things every day vs every second day.
Practical take-away: PFAS may be impossible to avoid completely, but even just cutting down on the use of such products is already reducing your cancer risk.
Isn’t it too late, by this point in life? Aren’t they “forever chemicals”?
They’re not truly “forever”, but they do have long half-lives, yes.
See: Can we take the “forever” out of forever chemicals?
The half-lives of PFOS and PFOA in water are 41 years and 92 years, respectively.
In the body, however, because our body is constantly trying to repair itself and eliminate toxins, it’s more like 3–7 years.
That might seem like a long time, and perhaps it is, but the time will pass anyway, so might as well get started now, rather than in 3–7 years time!
Read more: National Academies Report Calls for Testing People With High Exposure to “Forever Chemicals”
What should we use instead?
In place of non-stick cookware, cast iron is fantastic. It’s not everyone’s preference, though, so you might also like to know that ceramic cookware is a fine option that’s functionally non-stick but without needing a non-stick coating. Check for PFAS-free status; they should advertise this.
In place of plastic microwaveable containers, Pyrex (or equivalent) glass dishes (you can get them with lids) are a top-tier option. Ceramic containers (without metallic bits!) are also safely microwaveable.
See also:
Here’s a List of Products with PFAS (& How to Avoid Them)
Take care!
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Here’s how to help protect babies and kids from RSV
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What you need to know
- RSV is a respiratory virus that is especially dangerous for babies and young children.
- There are two ways to help protect babies from RSV: vaccination during pregnancy and giving babies nirsevimab, an RSV antibody shot.
- If someone in your household has RSV, watch for signs of severe illness and take steps to help prevent it from spreading.
Respiratory syncytial virus, or RSV, is a very contagious seasonal respiratory illness that is especially dangerous for infants and young children. Cases rose dramatically last month, and an increasing number of kids and older adults with RSV are being hospitalized across the United States.
Fortunately, pregnant people can get vaccinated during pregnancy or get their infants and young children an RSV antibody shot to help them stay healthy.
Read on to learn about symptoms of RSV, how to help prevent infants and children from getting very sick, and what families should do if someone in their household is sick with the virus.
What are the symptoms of RSV in babies and young children?
RSV symptoms in young children may include a runny nose, decreased eating and drinking, and coughing, which may lead to wheezing and difficulty breathing.
Infants with RSV may show symptoms like irritability, decreased activity and appetite, and life-threatening pauses in breathing (apnea) that last for more than 10 seconds. Most infants with RSV will not develop a fever, but babies who are born prematurely, have weakened immune systems, or have chronic lung disease are more likely to become very sick.
Who is eligible for an RSV antibody shot?
The Centers for Disease Control and Prevention recommends that babies younger than 8 months whose gestational parent did not receive an RSV vaccine during pregnancy receive nirsevimab between October and March, when RSV typically peaks. This antibody shot delivers proteins that can help protect them against RSV.
Nirsevimab is also recommended for children between 8 and 19 months who are at increased risk of severe RSV, including children who are born prematurely, have chronic lung disease or severe cystic fibrosis, are immunocompromised, or are American Indians or Alaska Natives.
Nirsevimab is typically covered by insurance or costs $495 out of pocket. Children who are eligible for the CDC’s Vaccines for Children Program can receive nirsevimab at no cost.
How can families help prevent RSV from spreading?
It’s recommended that children and adults who are sick with RSV stay home and away from others. If your infant or child has difficulty breathing or develops blue or gray skin, take them to an emergency room right away.
People who are infected with RSV can spread the disease when they cough or sneeze; have close contact with others; or touch, cough, or sneeze on shared surfaces. Help protect your family from catching and spreading RSV at home and in public places by ensuring that everyone covers their mouths during coughing and sneezing, washes their hands often, and wears a high-quality, well-fitting mask.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Better Than BMI
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BMI is a very flawed system, and there are several more useful ways of measuring our bodies. Let’s take a look at them!
What’s wrong with BMI?
Oof, what isn’t wrong with BMI?
In short, it was developed as a demographic-based tool to specifically chart the weight-related health of working-age European white men a little under 200 years ago.
This means that if you are, perchance, not a working-age European white man in 1830 or so, then it’s not so useful. It’d be like first establishing height norms based on NBA basketball players, and then applying it to the general population, and thus coming to the conclusion that someone who is 6’2″ is very short.
In long, we did a deep-dive into it here, and in particular what things go dangerously wrong when it’s applied to women, non-white people, athletic people, pregnant people, people under 16 or over 65 and more:
When BMI Doesn’t Quite Measure Up
What we usually recommend instead
For heart disease risk and diabetes risk both, waist circumference is a much more universally reliable indicator. And since those two things tend to affect a lot of other health risks, it becomes an excellent starting point for being aware of many aspects of health.
Pregnancy will still throw off waist circumference a little (measure below the bump, not around it!), but it will nevertheless be more helpful than BMI even then, as it becomes necessary to just increase the numbers a little, according to gestational month and any confounding factors e.g. twins, triplets, etc. Ask your obstetrician about this, as it’s beyond the scope of our article today!
As to what’s considered a risk:
- Waist circumference of more than 35 inches for women
- Waist circumference of more than 40 inches for men
These numbers are considered applicable across demographics of age, ethnicity, and lifestyle.
Bonus extra measurement based on the above
Important also is waist to hip ratio.
How to calculate it:
- measure your waist circumference
- measure your hip circumference
- divide the first measurement by the second one
Because it’s a ratio, it doesn’t matter what units you use (e.g. inches, cm, etc) so long as you use the same units for both measurements.
The World Health Organization offers the following chart:
Health risk Women Men Low 0.80 or lower 0.95 or lower Moderate 0.81–0.85 0.96–1.0 High 0.86 or higher 1.1 or higher Source: Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation
This is especially relevant for cardiovascular disease risk:
…and also holds true for all-cause mortality:
Waist-Hip-Ratio as a Predictor of All-Cause Mortality in High-Functioning Older Adults
An ancient contender that’s still more useful than BMI
Remember Archimedes? The (perhaps apocryphal) story of his “Eureka” moment in the bathtub when he realized that water displacement could be used to measure the volume of an irregular shape?
Just like Archimedes (who, the story goes, had been hired to determine the composition of a crown that might or might not have been pure gold), we can use this method to determine body composition, because we have references for how much a given volume of a given substance will weigh, so combing what we know about a body’s weight and volume will tell us about its composition in ways that neither metric could give us alone.
Indeed, it’s one of the commonly-mentioned flaws of BMI that muscle weighs more than fat, and Archimedes’ method not only avoids that problem, but also, actually turns that knowledge (muscle weighs more than fat) to our advantage.
It’s called “hydrostatic weighing” now:
You may be wondering: what about bones? Or internal organs?
The fact is that those are slightly confounding factors that do get in the way of a truly accurate analysis, but the variation in how much one person’s skeleton weighs vs another’s, or one person’s set of organs weigh than another’s, is too small to make an important difference to the health implications.
Lastly…
Hydrostatic weighing isn’t the only way to work out how much of our body is made of fat; if you have for example a smart scale at home (like this one) that tells you your body fat percentage, that is an estimate based on bioelectrical impedance analysis.
It’s less accurate than the hydrostatic method, but easier to do at home!
As to what percentages are “best”, healthy body fat percentages are (assuming normal hormones) generally considered to be in the range of 20–25% for women and 15–20% for men.
You can read more about this here:
Is A Visible Six-Pack Obtainable Regardless Of Genetic Predisposition?
Take care!
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The BAT-pause!
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When Cold Weather & The Menopause Battle It Out
You may know that (moderate, safe) exposure to the cold allows our body to convert our white and yellow fat into the much healthier brown fat—also called brown adipose tissue, or “BAT” to its friends.
If you didn’t already know that, then well, neither did scientists until about 15 years ago:
The Changed Metabolic World with Human Brown Adipose Tissue: Therapeutic Visions
You can read more about it here:
Cool Temperature Alters Human Fat and Metabolism
This is important, especially because the white fat that gets converted is the kind that makes up most visceral fat—the kind most associated with all-cause mortality:
Visceral Belly Fat & How To Lose It ← this is not the same as your subcutaneous fat, the kind that sits directly under your skin and keeps you warm; this is the fat that goes between your organs and of which we should only have a small amount!
The BAT-pause
It’s been known (since before the above discovery) that BAT production slows considerably as we get older. Not too shocking—after all, many metabolic functions slow as we get older, so why should fat regulation be any different?
But! Rodent studies found that this was tied less to age, but to ovarian function: rats who underwent ovariectomies suffered reduced BAT production, regardless of their age.
Naturally, it’s been difficult to recreate such studies in humans, because it’s difficult to find a large sample of young adults willing to have their ovaries whipped out (or even suppressed chemically) to see how badly their metabolism suffers as a result.
Nor can an observational study (for example, of people who incidentally have ovaries removed due to ovarian cancer) usefully be undertaken, because then the cancer itself and any additional cancer treatments would be confounding factors.
Perimenopausal study to the rescue!
A recent (published last month, at time of writing!) study looked at women around the age of menopause, but specifically in cohorts before and after, measuring BAT metabolism.
By dividing the participants into groups based on age and menopausal status, and dividing the post-menopausal group into “takes HRT” and “no HRT” groups, and dividing the pre-menopausal group into “normal ovarian function” and “ovarian production of estrogen suppressed to mimic slightly early menopause” groups (there’s a drug for that), and then having groups exposed to warm and cold temperatures, and measuring BAT metabolism in all cases, they were able to find…
It is about estrogen, not age!
You can read more about the study here:
“Good” fat metabolism changes tied to estrogen loss, not necessarily to aging, shows study
…and the study itself, here:
Brown adipose tissue metabolism in women is dependent on ovarian status
What does this mean for men?
This means nothing directly for (cis) men, sorry.
But to satisfy your likely curiosity: yes, testosterone does at least moderately suppress BAT metabolism—based on rodent studies, anyway, because again it’s difficult to find enough human volunteers willing to have their testicles removed for science (without there being other confounding variables in play, anyway):
Testosterone reduces metabolic brown fat activity in male mice
So, that’s bad per se, but there isn’t much to be done about it, since the rest of your (addressing our male readers here) metabolism runs on testosterone, as do many of your bodily functions, and you would suffer many unwanted effects without it.
However, as men do typically have notably less body fat in general than women (this is regulated by hormones), the effects of changes in BAT metabolism are rather less pronounced in men (per testosterone level changes) than in women (per estrogen level changes), because there’s less overall fat to convert.
In summary…
While menopausal HRT is not necessarily a silver bullet to all metabolic problems, its BAT-maintaining ability is certainly one more thing in its favor.
See also:
Dr. Jen Gunter | What You Should Have Been Told About The Menopause Beforehand
Take care!
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Steps vs Cardio | Which is Best for Fat Loss, Health, & Performance?
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“Move more”, they say; but does it matter how quickly?
Use it or lose it
For general performance:
- More steps per day do offer slight aerobic benefits but do not significantly improve endurance.
- Higher-intensity cardio (ideally, HIIT) is essential for improving aerobic fitness.
- Training should match endurance goals (e.g. long-distance running vs team sports vs whatever it is that you care about for you).
For general health:
- Both cardio and step tracking reduce mortality risk and improve longevity.
- 2–3 hours of cardio per week provides most health benefits, with diminishing returns after 8 hours per week.
- 10,000+ steps/day is optimal, but 5,000+ steps/day still benefits health. And, not mentioned in this video, but really (per science) there seem to be diminishing returns after about 8,000 steps per day.
Fun fact: the reason it’s 10,000 steps per day that everyone talks about as the default goal, is just because the Japanese person who popularized it noted that the kanji for 10,000 looks a bit like a walking person: 万
For fat loss:
- Both step tracking and cardio do help.
- Step tracking better reflects total daily movement, while cardio burns calories in sessions—but if it’s not HIIT, there is likely to be a compensatory metabolic slump afterwards.
- High-intensity cardio increases fatigue, which may impact resistance training and diet adherence.
- Excessive endurance training can slightly inhibit muscle growth, but low-intensity steps have minimal interference.
So for fat loss, it’s best to get those steps in, and throw in a few HIIT sessions per week, with adequate recovery time between them.
For more on all of these things, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
How To Do HIIT (Without Wrecking Your Body)
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Reduce Your Stroke Risk
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❝Each year in the U.S., over half a million people have a first stroke; however, up to 80% of strokes may be preventable.❞
~ American Stroke Association
Source: New guideline: Preventing a first stroke may be possible with screening, lifestyle changes
So, what should we do?
Some of the risk factors are unavoidable or not usefully avoidable, like genetic predispositions and old age, respectively (i.e. it is possible to avoid old age—by dying young, which is not a good approach).
Some of the risk factors are avoidable. Let’s look at the most obvious first:
You cannot drink to your good health
While overall, the World Health Organization has declared that “the only safe amount of alcohol is zero”, when it comes to stroke risk specifically, it seems that low consumption is not associated with stroke, while moderate to high consumption is associated with a commensurately increased risk of stroke:
Alcohol Intake as a Risk Factor for Acute Stroke
Note: there are some studies out there that say that a low to moderate consumption may decrease the risk compared to zero consumption. However, any such study that this writer has seen has had the methodological flaw of not addressing why those who do not drink alcohol, do not drink it. In many cases, someone who drinks no alcohol at all does so because either a) it would cause problems with some medication(s) they are taking, or b) they used to drink heavily, and quit. In either case, their reasons for not drinking alcohol may themselves be reasons for an increased stroke risk—not the lack of alcohol itself.
Smoke now = stroke later
This one is straightforward; smoking is bad for pretty much everything, and that includes stroke risk, as it’s bad for your heart and brain both, increasing stroke risk by 200–400%:
Smoking and stroke: the more you smoke the more you stroke
So, the advice here of course is: don’t smoke
Diet matters
The American Stroke Association’s guidelines recommend, just for a change, the Mediterranean Diet. This does not mean just whatever is eaten in the Mediterranean region though, and there are specifically foods that are included and excluded, and the ratios matter, so here’s a run-down of what the Mediterranean Diet does and doesn’t include:
The Mediterranean Diet: What Is It Good For? ← what isn’t it good for?!
You can outrun stroke
Or out-walk it; that’s fine too. Most important here is frequency of exercise, more than intensity. So basically, getting those 150 minutes moderate exercise per week as a minimum.
See also: The Doctor Who Wants Us To Exercise Less & Move More
Which is good, because it means we can get a lot of exercise in that doesn’t feel like “having to do” exercise, for example:
Do You Love To Go To The Gym? No? Enjoy These “No-Exercise Exercises”!
Your brain needs downtime too
Your brain (and your heart) both need you to get good regular sleep:
Sleep Disorders in Stroke: An Update on Management
We sometimes say that “what’s good for your heart is good for your brain” (because the heart feeds the brain, and also ultimately clears away detritus), and that’s true here too, so we might also want to prioritize sleep regularity over other factors, even over duration:
How Regularity Of Sleep Can Be Even More Important Than Duration ← this is about adverse cardiovascular events, including ischemic stroke
Keep on top of your blood pressure
High blood pressure is a very modifiable risk factor for stroke. Taking care of the above things will generally take care of this, especially the DASH variation of the Mediterranean diet:
Hypertension: Factors Far More Relevant Than Salt
However, it’s still important to actually check your blood pressure regularly, because sometimes an unexpected extra factor can pop up for no obvious reason. As a bonus, you can do this improved version of the usual blood pressure test, still using just a blood pressure cuff:
Try This At Home: ABI Test For Clogged Arteries
Consider GLP-1 receptor agonists (or…)
GLP-1 receptor agonists (like Ozempic et al.) seem to have cardioprotective and neuroprotective (thus: anti-stroke) activity independent of their weight loss benefits:
Of course, GLP-1 RAs aren’t everyone’s cup of tea, and they do have their downsides (including availability, cost, and the fact benefits reverse themselves if you stop taking them), so if you want a similar effect from a natural approach, there are some foods that work on the body’s incretin responses in the same way as GLP-1 RAs do:
5 Foods That Naturally Mimic The “Ozempic Effect”
Better to know sooner rather than too late
Rather than waiting until one half of our face is drooping to know that there was a stroke risk, here are things to watch out for to know about it before it’s too late:
6 Signs Of Stroke (One Month In Advance)
Take care!
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