Editor of US Surgeon General's report on women and smoking will speak at UCSF Women's Health Conference

Virginia Ernster, PhD, associate director at the UCSF Comprehensive Cancer Center and senior scientific editor of the just- released U.S. Surgeon General's report on women and smoking, will speak about the tobacco industry's impact on women's health at the upcoming UCSF Women's Health 2020 Conference, Saturday, March 31.

The report, released Tuesday (March 27) is a comprehensive compilation of hundreds of studies published on women and smoking. Several years in the making, it examines patterns of tobacco use among women and girls, factors influencing women and girls to smoke and efforts to reduce tobacco use among women.

The report also outlines the devastating consequences smoking has had on women's health, one of the most significant being the dramatic increase in lung cancer deaths. Lung cancer mortality rates among U.S. women have mushroomed 600 percent since 1950, reflecting increases in smoking rates among women beginning in the 1920s. Last year, 67,600 women died from lung cancer.

"What drives this point home is that in 1987 lung cancer surpassed breast cancer as the leading cause of cancer death in women," Ernster said. "Last year, 27,000 more women in the United States died of lung cancer than of breast cancer."

This is information that isn't widely known among women. Women should mobilize to raise awareness about lung cancer just as they have done so successfully with breast cancer, Ernster said.

"We need to learn from breast cancer advocates and call attention to lung cancer as a women's disease," she said. "The leading cause of lung cancer is smoking and if women didn't smoke, we could eliminate between 85 to 90 percent of all lung cancer cases in women. Lung cancer was a very rare disease among women during the first part of the 20th century because few women smoked."

In addition to being a major risk factor for lung cancer, smoking also can increase the risk for women developing a host of other cancers, including cancers of the mouth, bladder, pancreas, kidney and cervix. Smoking is also a major contributor to heart disease, the number one cause of death in American women. It also can lead to emphysema and bronchitis. Since 1980, about three million women have died prematurely from a smoking related disease in the U.S.

"Anything that kills as many women from as many diseases as smoking does is clearly a women's issue," Ernster said. "The tobacco industry has targeted women. We need to create a strong advocacy community among women. We know the enemy. The enemy is smoking and the tobacco industry. We shouldn't tolerate the targeting of women by the tobacco industry any longer."

While men and women share many of the same smoking related disease risks, tobacco also causes health problems unique to women. For example, women who smoke have more difficulty becoming pregnant. Other studies show that women who smoke go through menopause at a younger age than non-smokers. In addition, tobacco use causes a modest increase in risk for ectopic pregnancy and miscarriages.

Smoking can also increase the risk of osteoporosis, peptic ulcers, arthritis, eye disease, facial wrinkling and is associated with depression in women. In nonsmokers, exposure to environmental tobacco smoke also increases the risk of lung cancer and heart disease.

The report also discusses trends of smoking among women. One of the most alarming facts is that smoking prevalence has jumped among teenage girls in the 1990s, despite smoking prevention and educational efforts to make the damaging health effects of smoking well known. Last year, nearly 30 percent of high school senior girls reported having smoked within the past 30 days. "Most smokers begin in their early adolescence," Ernster said. "It's fairly uncommon for people to start smoking after the age of 18."

Overall, about 22 percent of women smoke in the U.S., while about 26 percent of men smoke. These numbers represent a significant narrowing of the gender gap between male and female smokers. In 1965, about 52 percent of men were smokers, compared with 33 percent of women.

Cigarette smoking hasn't always been prevalent among American women, according to the report. While cigarette smoking had increased substantially among men around the time of World War I, it was then still considered socially taboo for women to smoke. But the tobacco industry recognized a huge market for its products in women and started creating advertisements targeted toward this demographic group. One of the first ads during the 1920s featured an attractive man and woman in a romantic moonlit setting. The man is smoking and the woman is looking longingly at the cigarette smoke with a caption that read: "Blow some my way."

Other ads promoted the message that smoking would make women thin and glamorous. For example, a slogan for Lucky Strikes cigarettes was: "When tempted, reach for a Lucky instead of a sweet." The tobacco industry has also has long tried to champion the themes of women's liberation and independence as evidenced by Virginia Slim's slogans: "You've Come a Long Way, Baby!" and "It's a Woman's Thing."

"Cigarette ads depict women smokers as free-spirited, attractive, glamorous and athletic," Ernster said. "In reality, many women who smoke are victims of smoking related diseases that are often painful and fatal."

Despite some of the grim statistics about women and smoking, there is hope on the anti-tobacco front, Ernster said. While just over 20 percent of American women smoke, close to 80 percent have chosen not to. Smoking prevalence peaked in the 1960s among women and since than has slowly declined. In adult women, the decision to not smoke in is closely tied to higher educational levels.

Moreover, in contrast to the rest of the nation, lung cancer death rates are now decreasing in women in California, Ernster said. Much of California's smoking prevention success is attributed to the passage of legislation that put a tax on tobacco products and banned smoking in public places, such as restaurants and bars. But the tobacco industry has found other venues for selling its products, Ernster said.

"As we become more successful in preventing smoking in this country, the tobacco industry is going abroad to developing countries and to Eastern Europe in particular, where smoking prevalence among women traditionally has been lower," she said. "The industry is now trying to recruit those women to smoking. The writing is on the wall. It will be a tragedy if the smoking related epidemic now seen among women in developed countries is repeated elsewhere throughout the world. But it would be a great public health victory if we can prevent that from happening."

Among the 60 contributing authors were the following UCSF faculty: Neal Benowitz, MD, professor of medicine at San Francisco General Hospital Medical Center; Deborah Grady, MD, professor and vice-chair in department of epidemiology and biostatistics; Sharon Hall, PhD, professor in residence and vice-chair in the department of psychiatry; Ruth Malone RN, PhD, assistant professor of physiological nursing; John Wiencke, PhD, assistant professor of epidemiology and biostatistics.

For media interested in interviewing Virginia Ernster or covering her talk at UCSF Women's Health 2020, contact Leslie Harris in the UCSF News Service office, 415-885-7277.

UCSF Women's Health 2020 will feature 30 sessions that will examine a wide range of women's physical and emotional health issues. Topics include hormone replacement therapy, lesbian health, heart disease, financial planning for fiscal fitness, feeling at home in your body, depression, child bearing and sexuality. The all-day program will take place from 8:30 a.m. to 4:30 p.m., Saturday, March 31, at the University of California, San Francisco, Cole Hall, 513 Parnassus Avenue.

The UCSF National Center of Excellence in Women's Health (COE) and the UCSF Obstetrics and Gynecology Research and Education Foundation are sponsoring the event. For more information or to register, call 415-820-8565 or visit http://itsa.ucsf.edu/~ucsfcoe