Kick Butts Now!

It may not be so easy for women smokers.

WebMD Feature

June 5, 2000 -- When she was 16, Jill McCain (not her real name) started smoking as a way to tarnish her good-girl image. By the time she graduated from college, she was a pack-a-day smoker. Like 22.5 million other American women, she was hooked.

McCain has lost track of the number of times she tried to quit over the years. A succession of half-hearted attempts -- everything from using the nicotine patch, to going cold turkey, to phasing out the number of cigarettes she smoked each day -- slowly wore her down. Last spring, however, the Conshohocken, Penn., dancer suddenly had a new incentive: Her boyfriend, a nonsmoker, popped the question. She accepted -- and resolved, once and for all, to be smoke-free by their wedding date.

Her vow couldn't have come at a better time. The United States is on the verge of breaking an unflattering record: It will soon be the first country where women and men smoke in equal numbers, says the American Lung Association (ALA). This dubious distinction comes on the heels of studies indicating that women who smoke face greater cancer risks than previously thought -- and that it's even harder for them to quit than expected.

Women at Increased Risk

It's long been known that women are more likely to die of lung cancer than men. In 1999 alone, an estimated 68,000 women died of the disease, according to the ALA. Now scientists at the University of Pittsburgh have begun to figure out why.

Researchers knew that a gene responsible for spurring the development of cancerous tumors resides on the X chromosome, meaning that women -- who have two X chromosomes -- have two copies, or "doses," of the potentially deadly gene. Nicotine, which enters the body when a person smokes a cigarette, awakens this normally inactive gene. The study -- published in the January 2000 issue of the Journal of the National Cancer Institute -- reveals that, independent of other factors, the gene activates earlier and wreaks more havoc in women than in men.

These findings offer the first biological clue as to why women are more susceptible to lung cancer than men, says Sharon Persinger Shriver, PhD, lead author of the study. "We hope the results will be a wake-up call for smokers," she says.

Another new study, published in the journal Obstetrics & Gynecology in February 2000, links smoking to yet another aggressive and difficult-to-diagnose disease -- ovarian cancer. After scrutinizing surveys from more than 400 women with this condition, researchers at the Centers for Disease Control and Prevention found that smokers were three times more likely to develop the deadly cancer than nonsmokers. "Ovarian cancer is very difficult to diagnose because there are no early warning signs. The five-year survival rate is just 46%," says Polly Marchbanks, PhD, the study's lead author. "This study provides yet another reason for women to quit smoking."

Why Can't Women Quit?

Combine the information from these two studies with what is already known about the health risks of smoking, and it seems obvious that every woman should try to overcome the habit. McCain, for one, had tried to quit more times than she could count. When friends and family reminded her about the damage she was causing to her body, she largely ignored them. "Excuses are easy to make for an addiction you enjoy. It was always 'not me.' Even when my own mom had cancer, I smoked right through her disease," she says.

Her experience is common for both men and women. Studies show that 70% of smokers want to quit. But only 34% actually try to quit each year and of this number, a scant 3% succeed, according to a January/April 1996 review article in the Journal of the American Medical Women's Association.

Though there's long been anecdotal evidence that women may have an even tougher time quitting than men, new research backs this up. A study published in the December 1999 issue of the journal Nicotine & Tobacco Research looked at the effects of gender on smoking and smoking behavior. Researchers had men and women smoke two cigarettes and measured nicotine's effects on their bodies. Physical aspects, such as increased heart rate and blood pressure, were identical across gender lines.

The psychological effects of smoking, however, varied significantly: While men were driven to smoke primarily by nicotine, women took away greater emotional rewards. For instance, women craved cigarettes in response to such social cues as going out with friends or seeing someone else light up. "Our work suggests that women who are trying to quit smoking may need to take care to avoid smoking-related situations," says Thomas Eissenberg, PhD, lead author of the study.

Eventually, Eissenberg hopes such information will lead to cessation programs tailored specifically to the needs of women smokers. Meanwhile, there are steps a woman can take on her own to increase her chances of quitting successfully (see Quit Tips for Women).

With the help of nicotine gum and fierce determination, Jill McCain finally quit smoking this April -- well before her wedding date later this year. "It's a total lifestyle change, but I'm at a point in my life where I was really ready to do it," she says. For McCain, the quitting process was 80% psychological. "I finally realized that it is all or nothing with nicotine. It stripped me of energy and may have contributed to a sickness I have yet to see. I had enough, and I stopped."

Catherine Guthrie is a freelance writer based in San Francisco. Her work has appeared in Health magazine.

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