Diane Stover is the chief of pulmonary medicine at Memorial Sloan- Kettering Cancer Center in New York. Eighty percent of the diseases she treats are related to smoking. And she's got a special warning for women: Smoking hurts you more than it hurts men,

In March, Surgeon General David Satcher released a report on women and smoking that backs her up. It showed that smoking was about the worst thing a woman could do for her own health, the health of a fetus, or the health of any small children exposed to her secondary smoke. About five years ago, when her daughter started middle school, Stover was shocked to see children standing outside the school, smoking. She also was embarrassed that she didn't know then that 6,000 kids start smoking every day, and 3,000 of them become chronic smokers. The upshot was the formation of an American College of Chest Physicians task force to look for ways of getting women and girls off the weed. The most dreaded disease among women is breast cancer, and for good reason. But statistics tell us that lung cancer kills more women than breast, uterine and ovarian cancer combined. The task force set about underscoring the specific health hazards to women and girls who smoke, with an emphasis on preventing children from starting to smoke in the first place. "There's data that shows girls may be more susceptible to the effects of tobacco when they are adolescents, as opposed to boys whose lung growth span is much longer," Stover says. "During the fertile years, if a woman wants to become pregnant, it takes, on average, a year longer if she smokes. The saddest part for the passive smoker is the fetus. There are 4,000 chemicals in cigarettes, 50 of which are cancer-causing." Women who smoke have more miscarriages, and their babies have higher rates of upper-respiratory disease. Now evidence shows a higher incidence of sudden infant death syndrome among babies whose mothers smoke. Children exposed to secondhand smoke, Stover says, are more prone to middle-ear infections, upper- and lower-chest infections and asthma. "The effects on children are really devastating," she says. Despite our feminist utopian ideals about parenthood, mothers spend more time with young children than fathers, in most cases, and exposure to mothers' secondhand smoke is more of a health problem than exposure to fathers' smoke. As female smokers age, "menopause happens earlier, and there is an acceleration of osteoporosis," Stover says. "Then lung cancer comes into play. Women seem to be at increased risk of developing lung cancer as compared to men." Studies suggest that men handle the cancer-causing products in smoke differently from women, she says. They excrete these products more easily in urine. "In women they tend to stay around and are transformed into more cancer-causing products in the body." The reasons are unclear, Stover says. "There is good data that, cigarette for cigarette, women seem to be at least 1.5 to 1.7 times at risk of developing lung cancer as compared to men," she said. Women also tend to develop lung cancer with less time smoking than men, Stover says. "Years ago, we didn't know all of this," she says. "Now we know." Smoking has increased among adolescent girls, she says, even though they have been exposed to smoking-prevention programs in school. "One of the biggest problems is the effects of tobacco do not happen immediately. Heart disease, emphysema, cancer are things that take 20 to 30 years to develop. When I talk to kids, they say, I'm going to stop before bad things happen. But once addicted to nicotine, it's very difficult to stop. If someone doesn't start smoking before they are 18 or 20, the likelihood is they will not become lifelong smokers. That's why advertising hones in on kids. If you don't hook them early, they won't be hooked. Our kids are replacement smokers for" the half-million people who die each year from smoking-related illnesses, she says. "One out of every three people who smoke are going to die of a smoking-related illness," she says, and they die prematurely. Stover cautions women on birth control pills not to smoke. They are at higher risk of strokes and heart attacks. Perhaps her most sobering warning to those of us who ever smoked is that half of the people pulmonary physicians see with lung cancer stopped smoking 20 years ago. On the plus side, she says, damage to the vascular system among people who smoke "is totally reversible" if they quit. Women who quit smoking avoid damaging their fetuses and young children. These are some of the points she plans to make at a briefing today for the Congressional Caucus on Women's Issues. Rep. Judy Biggert (R-Ill.), co-chair of the caucus, says the purpose of the briefing is to decide whether the issue of women and smoking is one that the caucus will identify for special attention. All 63 females in the House are members of the caucus, and the caucus picks bipartisan issues "that we can agree on," she says. The surgeon general's office has had an enormous impact on smoking. It now has all the research necessary to do a public education campaign showing that smoking has particularly dreadful effects on women. Lung cancer, just to cite one example, is a bipartisan disease. The caucus and the surgeon general, who also will brief the caucus, ought to come up with a plan to make American women and girls as aware of the terrible effects of smoking on them as they are aware of the terrible effects of AIDS. They are both silent killers, and both can be avoided.

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