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Anatomy of nicotine addiction
Source Mayo Clinic
November 15, 2012 is the
Great American Smokeout
Quitting now is the best cure despite recent medical advances
Kim McNeill didn’t realize that her habit of smoking just a few cigarettes a day could result in lung cancer. A few years ago she was diagnosed and treated for Stage 3B — a very advanced — lung cancer at Boston Medical Center. (Yawu Miller photo)
Kim McNeill was 21 years old when she tried her first cigarette and learned to blow smoke rings. “I was trying to be cute,” she remembered.
After a while, McNeill said she would find any excuse to light up — after meals, talking on the phone, waiting for a bus — and thought her habit of four or five cigarettes a day was relatively harmless.
It wasn’t. Those “excuses” began to take a toll. McNeill got a persistent cough that didn’t go away. “I thought I had a cold,” she said. But the cough got worse and the chest pains intensified.
When tightness in her chest crept in, she knew something was wrong. “I thought I had pneumonia,” she said.
A series of tests in the emergency room at Boston Medical Center produced a different diagnosis — cancer. “It sounded like death to me,” McNeill remembered. “I went home and I cried. It was the worst sensation in the world.”
Given the nature of lung cancer, McNeill’s fears were real. The American Cancer Society (ACS) estimates that in 2012 lung cancer will account for more than 160,000 — or 28 percent — of all cancer deaths, making it the most deadly of all cancers. The disease is more lethal than cancers of the breast, colon, prostate and liver combined. At more than 226,000 new cases each year it is second only to prostate cancer in men and breast cancer in women.
The tragedy is that lung cancer is largely preventable. The ACS estimates that almost 90 percent of all lung cancer deaths are attributed to smoking and exposure to second-hand smoke. The longer a person smokes and the more cigarettes smoked, the greater the risk.
According to the National Cancer Institute, tobacco smoke contains more than 7,000 chemicals, including substances that are toxic to the body and carcinogens, or cancer-causing elements.
Lung cancer takes a long period of time to develop. Dr. Michael Ebright, assistant professor of cardiothoracic surgery and co-director of the Lung Cancer CyberKnife Program at Boston Medical Center, explained that the time lapse gives some smokers the feeling that they have beaten the odds.
“Most people start [smoking] in their teens,” Ebright said, “but don’t develop cancer until their 50’s or 60’s.There’s a latency period before you develop cancer.”
But Ebright is quick to point out that there are some lung cancers that are extremely aggressive and develop quickly.
The signs and symptoms of the disease are many — a persistent cough, coughing up blood, chest pains, shortness of breath, wheezing or hoarseness. But these can indicate a myriad of other illnesses as well. “A new cough that has been persistent is cause for concern,” he explained. “Any time you cough up blood requires a trip to the doctor.”
But often, according to Ebright, by the time the symptoms emerge, the disease has advanced. “Only 20-25 percent are discovered early,” he said.
And that is not good. The National Cancer Institute (NCI) has determined that the 5-year survival rate for cases that have metastasized or spread beyond the lungs drops to under 4 percent.
Though lung cancer remains the most deadly cancer and the second most common cancer in both men and women, improvements are beginning to emerge. New cases of the disease are dropping in this country, particularly in the West, according to the latest figures from the CDC.
Rates of deaths are on the decline as well. Yet, despite these changes, the impact of lung cancer is hard on black males. Although the incidence and death rates of lung cancer are comparable in black and white women, black men pose a different problem.
According to data from the NCI, the incidence and death rates in black men are roughly 30 percent higher than the rates in white men. The reason for this difference is unclear, particularly given the fact that the prevalence of smoking in both groups is similar.
Another puzzling change is the unexplained increase in the incidence of lung cancer among non-smokers. It is well known that smoking accounts for 90 percent of all cases of lung cancer.
But in the past few years lung cancer has increased in female non-smokers. “We don’t know why,” said Ebright, who cited the case of Dana Reeves, Christopher Reeve’s wife. A life-long non-smoker, she died of lung cancer at the age of 44, almost 30 years younger than the median age for smokers.
Michael Ebright, M.D.
Co-Director, Lung Cancer CyberKnife Program
Boston Medical Center
Although no professional organization as yet recommends screening for lung cancer, steps have been taken in this direction. During the National Lung Screening Trial it was found that people at risk of lung cancer — heavy current and former smokers between the ages of 55 and 74 — who received a newer type of CT scan called low-dose spiral CT had a 20 percent lower risk of dying from lung cancer than participants who received standard chest X-rays. The scan was able to detect early lung cancers and provide more detailed pictures than the X-ray. The problem is that the screening is very expensive and no standard work-up for abnormal findings has been established, according to Ebright.
Invasive tests are not without risk. The lesions that are small are particularly perplexing. “Some stay small,” he said, implying that additional testing and treatment may not be warranted.
Yet, despite these shortcomings, Ebright recommends that people in this age category who have smoked a pack a day for 30 years or two packs a day for 15 years should discuss the value of the low-dose scan with their doctors.
The treatment for lung cancer has also made great strides in the past few years. There is newer chemotherapy and now treatments can be personalized. That is, treatment can be directed toward a person’s particular genetic mutation that caused the cancer. An advanced form of radiation called stereotactic body radiation therapy has been found to improve survival in patients with inoperable early-stage lung cancer.
There are advances in surgery as well. In video-assisted thoracic surgery, it is possible to reach the tumor without spreading the ribs apart, thereby reducing the trauma of the surgery and recovery time.
Though lung cancer kills more people than any other cancer, Ebright is optimistic. “Lung cancer is not necessarily a death sentence,” he said.
Ask McNeill. In spite of her more than 30 years of smoking, fate was on her side. She was strong and, surprisingly, according to Ebright, her thoracic surgeon, had good lung function. She also was able to withstand a very aggressive treatment of chemotherapy and radiation followed by surgery.
McNeill said she made the best of it. She crocheted during her chemotherapy or watched movies.
The excuses stopped. And so did the smoking.
McNeill admits that some things are more difficult for her now that she is missing part of her left lung.
“I have trouble on inclines,” she explained. “I can do almost anything; I just take more time. Now I’m the tortoise instead of the hare.”
But she’s not complaining. “I have life,” she said.