"You've come a long way baby!"
That slogan from decades ago now returns with a new meaning and a new vengeance, according to a study released today in the New England Journal of Medicine.
The report, co-authored by Michael Thun, the recently retired vice president emeritus of the American Cancer Society along with colleagues from several outstanding institutions in the United States, shows clearly and unfortunately that women who are smokers are now neck and neck with men smokers when it comes to the relative risk of dying compared to non-smokers, whether it is from all causes, lung cancer, chronic obstructive lung disease (emphysema), and cardiovascular diseases including heart disease and stroke. (See below for an explanation of relative risk)
In a somewhat unvarnished tone, the authors write, "This finding is new and confirms the prediction that, in relative terms, 'women who smoke like men die like men.'"
It wasn't always that way. In the past, women who smoked were more likely to die than women who did not, but the increased risk was not as high as it was for men. But changes in how women smoke has changed that statistic over the last fifty years-and especially over the past 20 years-- as shown by this research.
Before we delve deeper into that, there is actually some very interesting information in this report for non-smokers: Death rates from all causes for non-smokers have dropped in half since 1959-1965 to the present time For cardiovascular diseases during that time period, the death rates for non-smoking men have declined an astonishing 79% and in non-smoking women 74%.
However, for women who are current smokers, the death rate from all causes hasn't budged over that time just as women began to smoke in larger numbers. The report notes that the relative risk of lung cancer death for a smoking man dying today is almost 25 times that of a non-smoking man. And now the real meat of the study: For a smoking woman, the increased relative risk of dying from lung cancer is now 25.66 times greater than that of a non-smoking woman; essentially the same increased relative risk men face. For chronic lung disease, the risk of dying from the disease in male smokers is 25.61 times greater, while in smoking women compared to never smokers that risk is 22.35 times greater. For current smokers, the death rates from ischemic heart disease (think "heart attack") was 2.86 times greater for smoking women compared to non-smokers and 2.5 times greater for smoking men compared to non-smokers.
It's enough to make you ill, just reading the numbers. But these aren't just numbers-they are real people who have families, go to church, participate in community activities, have a job and live life. According to another study that appears in the same issue of the New England Journal, it means that the typical smoker loses 10 years of life compared to never smokers, and those who die prematurely lose about 20 years of life.
But not all of the information in the research is grim. The investigators found that quitting smoking by age 40 reduced almost all of the excess risk of dying from these diseases. They also discovered that folks who stopped smoking at age 60 had a lower relative risk of dying than others who kept smoking, even if those people cut their cigarette consumption to 10 cigarettes a day or fewer.
So the advice you have been hearing for some time remains valid: not smoking in the first place is the best option, stopping smoking at any age is a good idea, but especially done before age 40, and just smoking fewer cigarettes doesn't get the job done.
How did all this happen?
Although we have been successful in reducing the number of smokers in this country we haven't seen a real improvement in those numbers for some time. State and community laws help, but smoking is very addictive and the manufacturers very clever in making and marketing their product. And recent attempts to make the warning labels on cigarette packages more graphic have met resistance recently in the courts.
The manufacturers for some time wanted to make think people think they were smoking less harmful cigarettes. So they put on filters and made the cigarette paper more porous, diluting the impact of the noxious chemicals in the smoke. But we humans are great at compensating: we just inhale longer and inhale deeper. The net result: more emphysema from damage to more lung tissue, and lung cancers in the outer portions of the lungs compared to what used to be the situation when I was a young doctor and we saw lung cancers in the more central lung tissue. And now we have people engaging in "social smoking": a couple cigs now and then won't make a difference. But this research suggests that such is not the case.
As we reflect on social progress in this country, there is a lot to be proud of (and still a ways to go). But the equality of making women equivalent to men when it comes to smoking behavior-as shown in this excellent and very important study-equality has produced one heck of a disaster for women when it comes to cancer, emphysema, heart disease and stroke.
I don't think this is what the feminist movement had in mind years ago when they set out to make us more conscious of the sexism in our society. And dying like men when women smoke is one element of equality that none of us really wanted to happen.
*One of the possibly confusing parts of this study is an understanding of the term "relative risk." Relative risk means higher (or lower, but for this example we will stick to higher) than a certain observed number. So three times the relative risk would mean 100 is the baseline and 300 is the observed number. Similarly, if 200 were the baseline then 600 would be the number. In this study, it is the relative risk that is being discussed. The baseline death rates for certain diseases and men and women may be different, but in both sexes the relative risk increase is what they are measuring-not the actual increase in the number of deaths from a particular disease.