Perioperative outcome of lung cancer surgery in women: results from a Spanish nationwide prospective cohort study

The epidemiology of lung cancer is changing in many areas or the world in terms of incidence differences by gender (1). Tobacco smoking is the major cause, accounting for 80% of the worldwide lung cancer burden in males and at least 50% in females (2). However, in the last three decades, lung cancer incidence rates have decreased or leveled off among men, but have risen among women (1,3-5). This increase in women (by 600% in the last 50 years) has been defined as a ‘contemporary epidemic’ (6). Other factors rather than smoking and linked to sex may increase women’s susceptibility to lung cancer, including genetic predisposition, exposure to sex hormones, tumor histology and molecular profile (7,8). In addition, several lifestyle and behavioral factors related to smoking habits or environmental and occupational exposures could account for some sex-specific differences (9)