BETHESDA, Maryland-A working group of the National Cancer Institute (NCI) has released a series of recommendations aimed at stimulating scientific research into tobacco-related cancers in women and translating discoveries into evidencebased interventions to prevent the cancers worldwide. The report, "Women, Tobacco, and Cancer: An Agenda for the 21st Century," noted that the incidence and mortality rates of smoking-related cancers in US women soared during the second half of the 20th century. Lung cancer mortality in women increased 600% between 1950 and 1997, making it the leading cause of cancer death in females. The NCI working group comprised experts from the institute, other federal agencies, nongovernment research institutions, and advocacy groups. Members drew in part on information contained in several recent reports, including the 2001 Surgeon General's report, "Women and Smoking," which highlighted the importance of gender-specific research into tobacco use and effects. The panel set several key goals for future research into tobacco-related cancers in women:

• Increase our understanding of sex differences across the broad range of research on women, tobacco, and cancer.
• Develop new and more effective interventions to prevent and treat tobacco use and environmental tobacco smoke exposure among women and girls, especially in populations at greatest risk; expand partnerships, networks, and innovative research platforms to ensure the widespread delivery of these interventions.
• Improve national and global evaluation and surveillance of the health hazards related to tobacco use and ETS exposure, specifically, of women's and girls' knowledge, attitudes, and behaviors related to tobacco use and associated risks. The working group emphasized that there is a critical need to better understand sex differences as they relate to all phases of tobacco addiction and tobacco-related diseases. "This includes genetic, molecular, cellular, neurobiological, biobehavioral, and hormonal factors that play a critical role in tobacco addiction and in the etiology of cancers and other diseases caused by tobacco," the working group stated. Researchers also need to decipher the etiologic role of gene-hormoneenvironment interactions in the cancers, and discover new methods for prevention and treatment of tobacco addiction. In addition, the NCI panel said that development of better treatment and prevention techniques requires identifying the behavioral, psychosocial, sociocultural, and environmental factors that influence tobacco use, exposure to second-hand smoke, and disease risk.

Translating basic and applied research into effective interventions will depend on advances in four areas:

• Using evidence from animal studies, pilot projects, and small clinical and community studies to develop new interventions for prevention, cessation, and treatment.
• Finding ways to use or modify existing infrastructures to rapidly evaluate the efficacy of promising treatments and the effectiveness and costefficiency of proven small-scale programs and policies.
• Exploring and strengthening the positive health effects of tobacco-control policies on women and girls.
• Monitoring the harmful effects of tobacco marketing on females.

Delivering the proven results of research and development efforts will depend on finding ways to increase the appeal, access, affordability, and use of effective interventions, the working group said. This, in turn, will require identifying and targeting messages and strategies that successfully involve individuals and organizations in evidence-based tobacco-control policies. Data from research-including surveillance, policy, economic, and cultural studies-need to be more available to health care workers, policy makers, and the public, the panel added. The NCI report also stressed the importance of partnerships between government agencies, nongovernment organizations, private foundations, corporations, academic institutions, and community groups in accelerating progress in tobacco-related interventions aimed at women and girls. Finally, the panel cited the importance of local, national, and worldwide evaluation and surveillance in determining the progress of efforts to reduce tobacco use, ETS exposure, and tobacco-related cancers among women and girls, and to make changes in programs when needed.