Lung Cancer in Women: A Silent Emergency

For the first time in Spain, in the year 2024, the number of deaths from lung cancer in women has surpassed those from breast cancer. According to the National Institute of Statistics (INE), in 2024, 6,679 women died from lung cancer, compared to 6,578 from breast cancer. This reversal in the pattern of female cancer mortality is not an isolated event, but the result of a trend that has been developing over years.

The steady increase in the number of new cases and deaths from lung cancer in women is closely linked to the introduction of tobacco into the lives of many Spanish women from the 70s and 80s. Lung cancer has a prolonged latency period: it can take decades from the start of tobacco exposure until the tumor appears. The peak of tobacco consumption experienced by women in past decades is now beginning to translate into a continuous growth of new diagnoses (incidence) and deaths (mortality).

According to estimates from the Spanish Network of Cancer Registries (REDECAN), in 2025, 11,064 new cases of lung cancer in women will be diagnosed in Spain. This figure multiplies by 2.4 the cases from just 20 years ago. The incidence continues to rise, while in men, although the absolute numbers remain higher, the trend is downward. This divergent evolution reflects the differential impact of smoking between the sexes and the historical absence of specific prevention strategies for women.

Additionally, the use of electronic cigarettes and vaporizers is gaining ground, especially among adolescents and young women, posing new challenges. Although often perceived as less harmful alternatives, the scientific evidence warns about their role as a gateway to nicotine and lung damage. Numerous studies indicate that these products are not harmless and can facilitate the initiation, persistence, and relapse of tobacco use.

In contrast to this scenario, lung cancer remains an underrepresented disease in public health policies aimed at women. Unlike breast cancer, there is no systematic screening program in Spain for its early detection. Although several European countries have begun to implement pilot programs with low-dose computed tomography (LDCT) in high-risk individuals (smokers and ex-smokers over 50 years old), in Spain, the diagnosis of lung cancer often comes in advanced stages, when therapeutic options are more limited and survival is low. Currently, the five-year survival rate for lung cancer is around 15–20%, compared to over 80% for breast cancer.

The European Commission, within the framework of its European Cancer Plan, recommended in 2022 assisting member states in exploring the implementation of lung cancer screening programs in high-risk populations using low-dose CT. These recommendations are based on solid scientific evidence that shows a significant reduction in mortality, especially when screening is combined with smoking cessation programs. The European project SOLACE, co-funded by the EU4Health program, is developing guidelines and tools for the implementation of these programs with criteria of equity, quality, and economic efficiency.

In the scientific field, recent studies have documented the sustained increase in lung cancer mortality among women in Europe and Latin America. A 2022 study on trends in 31 European countries showed that while male mortality from this tumor was decreasing due to anti-tobacco policies implemented since the 80s, female mortality continued to increase in more than two-thirds of the countries, with an annual increase of 4.1% in Spain between 2000 and 2017. Another study indicated that the most common subtypes of lung cancer in women (such as adenocarcinoma) have distinct biological and molecular characteristics compared to those in men, underscoring the need to apply a gender perspective also in research and clinical practice.

Additionally, between 15% and 20% of women diagnosed with lung cancer in Spain have never smoked, pointing to other risk factors, such as passive exposure to tobacco smoke, air pollution, hormonal factors, or genetic predisposition.

The current situation demands a clear institutional response, with a gender focus, based on the best available scientific evidence. We can no longer treat lung cancer as a "male" disease nor continue designing preventive strategies without considering the patterns of exposure, diagnosis, and survival in women.

Therefore, it is essential to strengthen specific research on lung cancer in women. We need to better understand the biological pathways involved, develop specific diagnostic and therapeutic biomarkers, promote equitable participation in clinical trials, and ensure that research outcomes are broken down by sex. Only then can we design prevention, detection, and treatment strategies that are truly effective and fair.

Lung cancer in women is no longer an emerging problem: it is a silent urgency that demands attention, resources, and immediate intervention.