*May 2025* by Dr. Narjust Florez
Lung cancer remains one of the deadliest cancers worldwide.1 Among women, it is the second most diagnosed cancer2 and in the United States is the number one cause of cancer-related death,2,3 making it an increasing issue in women’s health. Despite being traditionally associated with older men and tobacco use, lung cancer rates are rising among women—particularly younger women.4
In 2021, lung cancer diagnoses were higher in women under 65 years old than in men, and by 2025, women under 50 are more likely than men to receive a lung cancer diagnosis.5 Women, particularly those who are younger and do not use tobacco, are more likely to be diagnosed with adenocarcinoma-type non-small cell lung cancer and to harbor EGFR and KRAS mutations.6,7,8
General environmental exposures, such as secondhand smoke and occupational hazards, also contribute to lung cancer risk.9,10 However, women face additional gender-specific exposures, particularly from indoor air pollution caused by wood-burning stoves or biomass fuels used for cooking and heating, due to gendered roles related to cooking. Despite having marginally higher survival rates than men, lung cancer in women remains under recognized, and research lags behind the unique needs of these patients. It is crucial for the medical community to understand the distinct challenges of lung cancer in women to raise awareness and address health disparities.
Issue 1: Delays in Diagnosis and Barriers to Screening
Given the rising incidence of lung cancer in women, it is essential to address the barriers that prevent eligible women from being screened and diagnosed early. Diagnostic delays can occur throughout one’s lung cancer care11; however, women face particular obstacles that can hinder a timely lung cancer diagnosis. This includes lower rates of help-seeking for early symptoms, reduced referral to definitive care, and stigma surrounding the disease.12
A retrospective study examining factors contributing to care delays for suspicious lung nodules found that female patients were more likely to experience prolonged referral and biopsy times.13 The longest delays were observed between the initial consultation and biopsy, and from diagnosis to the start of treatment.13 These prolonged waiting periods are concerning, as they can defer the start of treatment, enable progression of disease, and limit potential care options.
Screening limitations and eligibility also remain persistent barriers to diagnosis. While some barriers affect all individuals, such as limited access to care and screening, socioeconomic constraints, stigma, and physician mistrust,14 many disproportionately impact women due to gender bias within the healthcare system.
For example, a study by Warner et al. examining race and sex differences in conversations relating to lung cancer screening found that women were less likely than men to have these discussions with their primary care provider or be aware of screening options.15 As a result, women may miss critical opportunities for early detection. Furthermore, screening-eligible women of color are six times less likely than their male counterparts to be offered screening options, thereby limiting their access to early detection.16
Beyond provider bias, many women are structurally excluded from screening due to stringent eligibility criteria, especially relating to age and tobacco use history. A retrospective cohort study of patients with lung cancer from 2005-2015 found that 80.6% of women with a confirmed diagnosis did not meet the eligibility criteria, with 27.4% excluded due to age and 75.1% due to insufficient tobacco use—less than 30 pack-years.
In 2021, the U.S. Preventive Services Task Force (USPSTF) guidelines for screening expanded their eligibility criteria to include individuals 50 and older and reduced their tobacco use history requirement to 20 pack-years.17 Even with the expanded age range and lower tobacco use requirement for the 2021 guidelines, a retrospective analysis addressing sex disparities in lung cancer screening eligibility found that women are still more likely than men to fall below the USPSTF’s 20 pack-year smoking threshold and therefore be deemed ineligible for lung cancer screening.18
These findings underscore how current screening frameworks, even after revision, continue to overlook a substantial portion of at-risk women, particularly those with minimal or no tobacco exposure. This is especially concerning given there are increased rates of women being diagnosed with lung cancer at younger ages.19 further highlighting how disproportionate screening eligibility negatively impacts lung cancer care for women.
Issue 2: Overlooked Psychosocial and Sexual Health Burdens
Psychosocial and sexual health issues in women with lung cancer are under researched, despite evidence that these women face high rates of depression, anxiety, and diminished functional well-being. A 2022 analysis of over 700,000 individuals revealed that women with lung cancer had significantly higher rates of psychological disorders and reported more feelings of depression and anxiety compared to men.20 This mental health burden may be exacerbated by stigma or self-blame, as many women report receiving accusatory remarks surrounding tobacco use status upon diagnosis, regardless of their tobacco use history.21,22
Preliminary data from our own Young Lung Cancer Psychosocial Needs Assessment, which was composed of 69% women, revealed that more than one-third of participants reported a new mental health diagnosis since their lung cancer diagnosis.23 Emotional and functional well-being were among the most affected, with patients reporting sadness, anxiety, fatigue, and fear of premature death.23
Sexuality and sexual health are often overlooked in lung cancer care for women, despite their significant roles in identity, emotional well-being, and relationships.24 Although sexual health studies in oncology often focus narrowly on breast and gynecological cancers, evidence suggests that sexual concerns are common for women across many cancer types such as colorectal, head, and neck cancers.25,26
Sexual dysfunction remains a major issue for women diagnosed with lung cancer. Our own Sexual Health Assessment in Women with Lung Cancer (SHAWL) Study, the largest study of its kind, evaluated the sexual health of 249 female participants with lung cancer. Of these, 77% reported moderate to severe sexual dysfunction, with many citing vaginal dryness, discomfort, and pain during intercourse.27 Experiences unique to women with lung cancer, and related to their sexual dysfunction, included fatigue, shortness of breath, and body image changes.28 The responses from this study highlight the urgent need for increased awareness and conversations about sexual health, as addressing these issues can improve overall well-being, pain management, and relationships.28
Issue 3: Lack of Women’s Representation in Clinical Trials
A long-standing issue in women’s health is the lack of representation in clinical trials. As of 2019, women made up only 40% of clinical trial participants focused on diseases that disproportionately affected them, such as cancer, psychological disorders, and cardiovascular disease.29 Further research on non-small cell lung cancer-specific trial enrollment between 2003-2016 and 2010-2020 showed that women represented 38.7% and 39% of participants, respectively, indicating little progress over time.30,31
Barriers to trial participation have included travel distances and expenses, distrust of the medical community, and limited awareness of available trials.22,32 On top of these challenges, women face additional gender-specific barriers. As primary caregivers, women face additional time constraints that can affect their willingness to participate in research.22 Further, gendered assumptions such as women being difficult to work with or less interested in participating influence whether they are offered the opportunity to participate, further diminishing their enrollment into clinical trials.33
These limitations hinder our ability to understand and generalize the impact of treatments on both men and women as we fail to capture sex-specific differences in efficacy, side effects, and outcomes of cancer treatments. A meta-analysis of over 3,500 patients undergoing immunotherapy, targeted therapy, or chemotherapy in a cancer trial from 1980 to 2019 showed that women were 25% more likely to experience more severe adverse events.34 However, another study examining the prevalence of adverse event reporting among patients receiving oral targeted cancer treatments found that women were less likely to report those events.35 Further, our own analysis of 476 women with metastatic melanoma and non-small cell lung cancer found that pre-menopausal women were at the highest risk for immune-related toxicities.36 These findings highlight the need to increase female representation in clinical trials to improve care and outcomes for all, ensure equity, and develop safer, more effective medicines based on sex-specific responses.
Solutions and Next Steps
Women’s health is complex, influenced by a combination of biological, social, and systemic factors that warrant deeper exploration. While the challenges they face are multifaceted, we must start by amplifying awareness and investing in research that centers women’s experiences. Read more.
