Preventable Death
More than 40 years ago, smoking was identified as the most preventable cause of premature death and disability in the United States. People who smoke generally die earlier and are more likely to be sick and miss work than people who don't smoke.

There is overwhelming and widely accepted evidence implicating smoking as a risk factor for, or a direct cause of, many debilitating and deadly conditions. Some smokers defensively counterattack with anecdotes describing friends, family members or acquaintances who have managed to live into old age despite a life-long smoking habit. They may also offer an account of someone who never smoked but died of catastrophic illness at an early age.

(Click image for larger version) Why should you quit smoking? Smoking is a major cause of cancers throughout the body, as well as heart disease, emphysema, and stroke. It also can affect a woman's ability to become pregnant and increase the risk of early delivery, stillbirth, infant death, and sudden infant death syndrome (SIDS). In men, it contributes to erectile dysfunction and other sexual problems. (Sources: The American Cancer Society and the National Institutes of Health)

To these people, I respond that there is a difference between anecdotes (individual stories) and statistics (where large populations are analyzed for meaningful data affecting health and longevity). Anecdotes are not data or useful information - just a collection of stories that can give false reassurance or serve as an excuse or a crutch. Only a very small percentage of my lung cancer patients have been lifetime non-smokers.

There are certainly other factors that further increase the risk of lung cancer in smokers, such as family history, radon or asbestos exposure, and some genetic factors. Surprisingly, air pollution is not felt to be one of the risk factors.

Lung Cancer
Lung cancer is the most common malignancy I deal with as a practicing oncologist. And while I certainly take care of a fair number of patients who are well into their "golden years" by the time of their lung cancer diagnosis, most of my lung cancer patients are only in their fifties and sixties. Our practice also has cared for more than a few people in their thirties and forties! Some of these nice folks are entering what should be the prime of their lives, starting to think about retirement, or spending more time with grandchildren.

While we certainly have more and better treatments for lung cancer, symptoms of early and potentially curable disease are either absent or vague, and most patients are not diagnosed until the cancer is well past an easy fix. The average survival of a patient with an inoperable lung cancer is still only a year or less - and it is unfortunately not quality time, for the most part. Overall, only about 14% of lung cancer patients are alive five years after diagnosis.

Lung cancer patients who quit smoking will not improve their chances of being cured, but they are less likely to run into complications such as pneumonia and bronchitis during the course of their illness. And they may live a little longer than those who continue to smoke.

Second-hand smoke poses a risk for exposed non-smokers. It contains the same chemicals, including at least 40 known carcinogens, as the mainstream smoke inhaled by the smoker.

Other Cancer Risks
While lung cancer gets all the press, the risk of cancers of the mouth, throat, esophagus, stomach, pancreas, kidney, cervix, and bladder are indisputably higher for smokers. The risk of acute leukemia is also higher. The magnitude of the increased risk for these cancers is not as dramatic as that seen in lung cancer. However, a second cancer of the lungs, mouth, throat or esophagus is a major cause of death in the fraction of patients who are fortunate enough to beat their first cancer.

While much of this article has been devoted to lung cancer, the other malignancies mentioned above can also be deadly. In particular, people with cancer of the esophagus or pancreas are highly unlikely to survive their illness. And acute myeloid leukemia generally has only a 25-30% cure rate. The other cancers listed are not curable with any known therapies when they spread away from the main tumor.

Benefits of Smoking Cessation
Quitting smoking leads to immediate and long-term health benefits. For example, someone who quits smoking before the age of 50 has only half the risk of dying of any cause in the next 15 years, as compared with someone who continues to smoke.

Terribly Addictive
While smoking may have gotten many of my patients into the condition they are in, there is no doubt that nicotine is terribly addictive, so I try never to sit in judgment or scold my patients about smoking. I do try to give them as much information as they need. Also, many of my patients over the years have used cigarettes primarily to calm their nerves. It is very easy to understand that someone might have trouble "laying them down" having just received a cancer diagnosis.

What people should know is that low-tar and low-nicotine cigarettes are not safer than regular cigarettes and that filtered cigarettes are not really any safer than non-filtered. The only way to lower the odds of getting a smoking-related cancer is to "lay them down."

Improving the Odds
Maybe we all know or have heard of someone who smoked three packs a day, ate six eggs and a plate of sausage for breakfast every morning, drank a fifth of whiskey after work, ran with a bad crowd, and lived until the age of 90. There also have been folks who have survived a fall from an airplane without a parachute, won millions of dollars in the lottery, or survived a gunshot wound to the head. These, my friends, are all stories.

As for cigarettes -- lay them down. You don't want to be a statistic.

About the Author: Michael Thompson, M.D., is a board-certified oncologist-hematologist on the staff of Methodist Medical Center of Oak Ridge. He also is associated with Methodist's Comprehensive Chest Clinic. Dr. Thompson earned his medical degree from Hahnemann University in Philadelphia and completed an internal medicine residency at Reading Hospital and Medical Center in West Reading, Penn. He completed a fellowship in hematology and oncology at the Health Science Center in Syracuse, N.Y. He is a member of the American College of Physicians, the American Society for Hematology and the Southern Medical Association and is in practice with Cumberland Oncology & Hematology.