By Elizabeth M. Whelan, Sc.D., M.P.H., Gilbert Ross, M.D.
Posted: Friday, April 8, 2005

EDITORIAL
Publication Date: April 8, 2005

Ever since ABC News anchor Peter Jennings announced last week that he had been diagnosed with lung cancer, we have observed an increased interest in the disease--particularly the probability of it occurring in former smokers.  We have spoken with dozens of former smokers and read reports of anxiety in this group, and, drawing on the American Council on Science and Health's past research, we offer facts and advice on lung cancer.  Our advice is tailored to three different groups: a) ex-smokers, b) current smokers, and c) non-smokers who are candidates to take up the habit.

Risks

First, some hard facts:

--Cigarette smoke is the leading cause of preventable death in America today, accounting for at least 450,000 premature deaths.

--Approximately 160,000 cases of lung cancer are diagnosed annually in the U.S., which means that on any given day (such as the day Mr. Jennings received his diagnosis) some 460 other Americans get the same bad news.

--Just over 90% of all lung cancers are causally linked with cigarette smoking. Indeed before cigarette smoking became popular around World War I, lung cancer was an exceedingly rare disease (tobacco was used relatively safely in the form of pipes, cigars, and snuff prior to that time).

--During the 1960s nearly 70% of American men smoked, and about 50% of American women were smokers.  We have dramatically reduced the prevalence of smoking in our country, with smokers giving up the habit and fewer young people taking up smoking--but the reality is that even among those who have quit, health risks associated with past smoking remain.  That explains why approximately 50% of the 160,000 diagnoses now made for lung cancer are made among former smokers.

--One popular argument the scientific community often makes to encourage smokers to quit stems from the theory that all of the health effects of smoking are reversible shortly after cessation, regardless of the duration or intensity of smoking exposure.  Unfortunately, this is just not true.

--Regarding lung cancer, smoking for about 25 years appears to trigger a biological switch that drives the growth of lung cells towards the development of lung cancer--even if the smoker quits.  Thus, while quitting is the best option for a smoker of any age, damage to the respiratory system, including those that can result in cancer, may continue to plague the ex-smoker for years after quitting.

--Smokers (one pack a day for twenty or more years) have a ten- to fifteen-fold greater risk of developing lung cancer compared to those who have never smoked.  The more you smoke--or smoked in the past--the greater your risk of lung cancer (and other smoking-related diseases).  Public health experts have long argued that risk declines with time after you stop, but this may be much more true for risks of heart disease than for risks of cancer, particularly with a very long history of heavy smoking.

The Case of Peter Jennings

Take the case of Peter Jennings.  News reports indicate he started smoking when he was thirteen years old (for him that would have been around 1951) and continued smoking heavily until the mid or late 1980s.  That would be more than thirty-one years of exposure to the risks of smoking.  It is unclear how much he smoked after giving up cigarettes in the 1980s (he acknowledges taking up smoking again after the 9/11/01 terrorist attacks).

Mr. Jennings, even if he was an ex-smoker after 2001, was at greatly elevated risk of lung cancer given the long history of exposure.  The question then is this: what are the lessons to be learned from Peter Jennings?  What can and should we do to reduce our own risk of being diagnosed with life-threatening lung cancer?

Advice for Risk Groups

For nonsmokers: Do not start smoking.  Do not delude yourself into believing that you can "smoke 'til I'm thirty" or "smoke until I want to have kids" and come away unscathed, returning to the same risk file as a never-smoker.  Smoking directly irritates and damages the respiratory tract.  Each year, a one-pack-a-day smoker smears the equivalent of a cup of tar over his or her respiratory tract.  This irritation and damage cause a variety of adverse effects, ones that can be reduced--but not entirely reversed--by quitting.

For current smokers: Quit now.  Get assistance if necessary.  Even if you have been smoking for many decades, you will be rewarded with health benefits, especially a rapid decline in risk from the number one cause of cigarette death: cardiovascular disease.

For (newly worried) former smokers: Be grateful you quit when you did.  If you have smoked for many years--maybe decades--and now realize you have an elevated risk of lung cancer, consider the fact that among long-term, current smokers, the chances of developing lung cancer are in the 10%-15% range.  If you quit ten or more years ago, your personal risk is below that range.

Screenings

What about regular lung cancer screenings?  Well, talk it over with your own physician--but be keenly aware of the limitations here.  Your physician may recommend a yearly chest X-ray.  This may or may not assist in diagnosing lung cancer at an early, curable stage.  (The American Cancer Society stopped recommending annual X-rays for smokers many years ago, although some physicians think such rays can be useful in finding early cancers.)

There has been some excitement in the medical community, and among the public, about screening using lower-dose CT scans--spiral or helical CTs--to enhance detection of early-stage lesions.  There are several studies now underway to see if such techniques will lead to an improvement in the real bottom line: survival rate.  Thus far, no study has shown an improvement in mortality rate from lung cancer in patient groups screened by chest X-ray or CT scan, but there have been some indications that larger-scale studies may show some beneficial impact.  Meanwhile, the fact is that many more benign lesions or indolent growths of no importance to lifespan get detected than dangerous, early-stage tumors--in other words, these CT type tests can yield lots of "false positives," causing needless anxiety and even needless surgery.  It seems counter-intuitive, but early detection has not proven to be helpful in saving lives from lung cancer...yet.

Whelan and Ross head the American Council on Science and Health, which runs the sites ACSH.org, HealthFactsAndFears.com, and theScooponSmoking.org.

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Peliculas Online

By Elizabeth M. Whelan, Sc.D., M.P.H.
Posted: Friday, April 1, 2005

ARTICLES
Publication Date: April 1, 2005

In the two weeks leading up to Terri Schiavo's death, I followed the coverage of the political and legal machinations proposed to keep her alive.  Ms. Schiavo was the forty-one year-old woman who was in a persistent vegetative state for the last fifteen years following heart failure resulting from a severe eating disorder.  The disorder triggered life-threateningly low levels of potassium, causing her heart to stop temporarily, depriving her brain of oxygen and causing permanent damage.

The emphasis on my cable station of choice (FoxNews) was on the importance of preserving life--at any cost.  Life indeed is precious.  We should be doing everything to prevent unnecessary and premature loss of human life.  The question is this: was 24/7 network coverage of one severely impaired woman the way to discourage unnecessary human death and suffering?  If indeed the TV networks want to reduce human suffering and keep Americans alive and functioning as long as possible (that is, prevent premature death, as it might be argued media were doing by focusing on Schiavo's parents' effort to have her feeding tube re-instated), are there not broader messages the media should send?

For example, there has been scant coverage of the underlying reason Terri was in a vegetative state.  Fifteen years ago, when she was in her mid-20s, Terri apparently had a health problem common among young women: bulimia.  She apparently had fought severe weight problems all her life and was limiting her food intake--and vomiting/purging--to control her caloric absorption.  She sought medical help when her menstrual periods ceased--and it was clear that her eating disorder was negatively affecting her physiological functioning.  Ultimately, the depletion of potassium had the expected effect on her heart: it stopped.  The rest is history.

Thus in the round-the-clock concern about saving a human life, why was there not any expressed concern about others--particularly young women--who might now be about to suffer Terri's fate?  In the course of a hundred hours of non-stop coverage dedicated to saving Terri's life by mandating the re-insertion of her feeding tube, how many other lives could have been saved if even 20% of those hours had focused on eating disorders (the likely victims, the deadly consequences, the existing remedies and treatments)?

Terri Schiavo was but one person.  Yet as a nation, we are committed to the value of all lives.  What about the other estimated one million (yes 1,000,0000) Americans who die prematurely each year from preventable causes?  These are people who "die before their time" because of risk factors such as cigarette smoking, for example?  Cigarettes account for one half of the one million premature deaths.  Where is the 24/7 news coverage, the fretting on FoxNews, the candle-light vigils? 

Why were President Bush, Governor Bush, Senator Frist, and various members of Congress exclusively concerned about preventing what they deemed the premature death of one person--who according to the vast majority of medical authorities was in an irreversible vegetative state--when a) thousands of families each day agree to "let go" of a loved one who cannot be saved (or make other personal life-and-death decisions) and b) there is so much information that could be communicated to Americans on how to prevent hundreds of thousands of premature deaths each year?

Dr. Elizabeth M. Whelan is president of the American Council on Science and Health.

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Peliculas Online