Dr. Kevin Most: Lung cancer

Dr. Kevin Most

How many of you remember the Marlboro Man, the iconic figure who convinced many Americans that smoking was cool. This was an advertising hall of fame effort, and it did have a huge impact on the health of Americans and still does to this day. Although denied by tobacco companies the impact on young children was huge, studies showed that more than 90 % of school children knew who the Marlboro man and Joe Camel were 10 years before they could legally smoke. Ironically 4 of the actors hired to play the Marlboro Man in commercials and print ads died from lung related illnesses.

Although Richard Nixon stopped tobacco ads on TV and Radio in 1970 the impact of tobacco on the health of Americans continues to be felt. Lung cancer continues to be the number one cause of cancer death in the US with close to 200,000 deaths attributed to lung and bronchial cancers each year. Tobacco is highly addictive. Its addictive properties were really noted when soldiers returning from WW I came back to the states. They had been supplied cigarettes in their rations and upon return they continued to smoke. At that time it was thought to be cool to smoke.

So why are we talking about this now? Awareness, On March 5th Dave Eanet and the WGN team will be participating in the “Fight for Air” run up the Presidential Towers to support the American Lung Association. You can go on line and donate to Dave and his team. I know Steve is probably asking why would anyone run up a bunch of flights of stairs when there is a perfectly good elevator 10 feet away. I think Steve may be waiting for the “Elevator for air “ event where we all take the elevator and raise money.

So lets talk a little bit about lung cancer, we all know there has been an identified link between lung cancer and cigarette use, this was actually identified in 1955. It took 10 years before mandatory labeling of packs was required and another 25 years before it was banned on airlines. Five years later President Nixon signed the law banning advertising on TV and Radio. It is ironic that President Ronald Reagan at one time did advertising for Chesterfield cigarettes.

So we know it is dangerous and has a major impact on our health yet we still have high rates of cigarette smoking in many areas of the country. Overall we continue to have a 15% smoking rate in the US, this is down from 21% 10 years ago. We do have states where the rates are still over 25% (WV, KY, AR)

Smoking not only increases your chance of lung cancer but also impacts your day to day life. Your chance of bronchitis goes up many hundred times higher than a non smoker, you chance of pneumonia is increased dramatically as well. More importantly your chance of heart disease and high blood pressure is greatly elevated.

On a simple note, your chance of missing work due to illness is elevated to a point that many companies are now looking at hiring non smokers. Many companies give insurance discounts to those employees who don’t smoke.

So how much smoking is dangerous, the simple answer is any smoking at all is not good for you. A single cigarette can elevate your heart rate and your blood pressure almost immediately. Obviously we are concerned with the individual who smokes at a more chronic pace. For individuals we look at risk based on pack years of smoking. Simple math, an individual who smokes one pack a day for a year has a one pack year history. The individual who smokes 2 packs a day for 20 years has a 40 pack year history. The math is not that simple as it seems as age plays a role as does other variables. That being said we are concerned when an individual hits the 30-40 pack year amount.

So we do want individuals to quit for their health and the health of those around them. There are many strategies for quitting smoking. It really comes down to the individual , their motivation and the strategies they want to try. Hypnosis, Cold Turkey, Medication, slow taper are all ways to quit. Often showing the individual the impact it is making on the health of their family and the financial impact on the family is often great motivation.

We need to understand that smoking also has second patients. The impact of second hand smoke cannot be minimized. This is why we no longer allow smoking in bars and restaurants as the workers were being exposed to close to 2-3 packs a day as they worked. So now that we have protected them do we have second patients? Absolutely, parents who smoke are exposing their children to second hand smoke, be it in the house or in the car. To a child smoke is an irritant which causes inflammation. We know the trigger for asthma is inflammation. So we see higher rates of asthmatic children in the homes that have smokers. It is not good enough to just go in the garage to smoke. Parents should be 50 yards from the home and wait a few minutes after finishing the cigarette before entering the home again. This is another great reason to stop smoking, think of your children. Also no smokers should be anywhere near a new born as they are developing their lungs and have a developing immune system so they could have a tough time fighting off a pneumonia.

One of the sad things about lung cancer is the diagnosis is made too late, it is made after a surgical cure could occur. Often the cancer has spread and there is not much to do besides extend life as much as we can with Chemo, radiation and some surgery. You have probably seen the TV commercial that is out now touting a drug that extends the life of a lung cancer patient by 3 months. These drugs are not talking about cures they are talking about life extension. We have not seen great advancements in the treatment of this terrible disease. We do need funding to continue to do research and look into other treatment options. One of the advances has been around genetic testing, not so much in the identification of those who may get lung cancer but more in the identification of which medications will work best.

So if we need to identify the cancer early what tools do we have. One difficult thing is that the symptoms to look for are the same symptoms the chronic smoker has had for a long time in many cases. Shortness of breath, chronic cough, weight loss to name a few. Also we really did not have a good screening tool as a Chest X ray is not good for early screening. We now however have a low dose CT scan that can identify lung cancer early. It is actually approved as a screening tool just like colonoscopy for colon cancer screening. So if you are a smoker, or one that has quit in the last 15 years, are between 55-74 yrs old, have a smoking history of 30 pack years and are healthy enough to undergo treatment, you are eligible to get the screening CT scan done. The sad thing is that there are estimated to be 6.8 million individuals who fit this criteria yet less than 4 % are taking advantage of this. This may be people are not aware or they don’t want to know.

Probably the biggest message is, it is never to late to quit. The impact of quitting can be noted immediately. 20 minutes after quitting your HR and blood pressure drop ( this is the immediate effect of each cigarette) 12 hours after quitting, Carbon Monoxide levels go back to normal, 1 month later your lung function improves, 6 months after quitting your lung defense system is back to working properly. Probably most importantly 1 year after quitting your risk of heart disease has improved dramatically.

A few good things have occurred in the past few years, the banning of cigarettes in public enclosed areas is key as a deterrent as well as a protective measure for the non smokers exposed to their smoke. Many pharmacy’s have decided to no longer carry cigarettes, which may impact their bottom line. We also continue to tax cigarettes, one thing Chicago should be proud of is that they have the highest tax of cigarettes in the country at close to $7 a pack.