Hurricane Maria, Bloodstream Infections, Lung Cancer in Women

Women’s Health

Lung Cancer and Steroid Hormones: An Evolving Paradigm

Lung cancer remains to be the second most common cancer and the leading cause of cancer-related mortality in women. The risk for developing lung cancer in women is 1/17 and increases with age and smoking history. Women with stage I NSLC have better prognosis after surgical treatment compared with men (Graham et al. South Med J. 2013;106[10]:582); however. they are less likely to have undergone a low dose screening CT scan, even after meeting high risk criteria (Lamb et al. Chest. 2017;152[suppl]A623). The prognosis in advanced stage lung cancer at diagnosis does not differ among the genders or age groups (Santoro et al. J Bras Pneumol. 2017;43[6]:431).

There is increasing interest in the role of steroid hormones in lung biology in health and disease with estrogen and progesterone receptors identified in both healthy and malignant tissue. The role of hormone receptors as a prognostication tool and a therapeutic target is being actively investigated.

Estrogen receptor Beta (ER-Beta) is the predominantly expressed estrogen receptor in lung cancer cells (Raso et al. Clin Cancer Res. 2009;15[17]:5359). Increased cytoplasmic ER-alpha and ER-beta is associated with tobacco smoking and likely indicates a hormonal-smoking interaction (Siegfried. Mol Cancer Res. 2014;12[1]:24). A higher nuclear expression ER-beta in women may be protective against hormone-related lung cancer (Schwartz et al. J Clin Oncol. 2007; 25[36]:5785), whereas higher cytoplasmic expression of ER-alpha and ER-beta was associated with worse lung cancer survival (Cheng. J Natl Cancer Inst. 2018; Jan 13). Therapies targeting ER-beta1 and its downregulation resulted in sensitizing the cells to epidermal growth factor receptor-tyrosine kinase inhibitors and may result in reversing EGFR-TK resistance (Fu et al. Oncol Rep. 2018;39[3]:1313).