Sex-Related Differences in Bronchial Epithelial Changes Associated With Tobacco Smoking

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Lung cancer is the most common cause of cancer death in North Americanwomen. Because smoking-related changes in the bronchial epithelium and in lung function havenot been studied in detail in women, we used fluorescence bronchoscopy-directed biopsy todetermine the prevalence of high-grade preinvasive lesions in former and current smokers of bothsexes.


Spirometry, white-light bronchoscopy, and fluorescence bronchoscopy wereperformed in 189 women and 212 men older than 40 years of age who had smoked 20 pack-yearsor more (pack-years=number of packs of cigarettes smoked per day × number ofyears of smoking).


Carcinoma in situ was found in 1.8% of thesubjects, severe dysplasia was found in 6.5%, and moderate dysplasia was found in14% (all preinvasive lesions). Compared with men, women had a lower prevalence ofhigh-grade preinvasive lesions in the observed airways (14% versus 31%; oddsratio=0.18; 95% confidence interval=0.04-0.88), and women withpreinvasive lesions had fewer such lesions (two-sided P=.048). The prevalenceof preinvasive lesions did not change substantially for more than 10 years after cessation ofsmoking. Lung function was associated with the prevalence of preinvasive lesions, but theassociation was weaker in women than in men. If the presence of airflow obstruction was definedby an FEV1/FVC (forced expiratory volume in 1 second/forced vital capacity) valueof 70% or less, only 56% of the men and 44% of the women withpreinvasive lesions had abnormal lung function.


In developing strategies forchemoprevention or early detection of lung cancer in high-risk populations, it is important toconsider the effect of sex and arbitrarily chosen lung function values on the prevalence ofpreinvasive airway lesions.

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