Answers About Tobacco

The Smoking Gun

Women Catch Up To Men On Lung Cancer Risk

Forbes Pharma and Healthcare 1/25/1013 @ 9:42am


The horror that was the Sandy Hook massacre has finally precipitated a substantive call-to-action in the United States — a debate about who should have what kind of gun. Mass shootings aside, guns have reliably killed around 30,000 US citizens each year for the past decade.

But two papers in this week’s New England Journal of Medicine remind us that smoking tobacco products, also legal, kills six times as many US citizens annually.

Almost 200,000 people. Dead. And much easier to prevent than gun deaths.

That’s the equivalent of my city — Durham, North Carolina — being completely obliterated every year. Yes, Durham. Ironically, The-City-That-Tobacco-Built.

If you read no further, the three major take-home points are:

  • Smoking remains a widespread and expensive contributor to human suffering, especially among minority and low-income groups.
  • Women have truly gained equality with men in the sad statistic of relative risk of death due to smoking: about 25 times greater than for either gender who never smoked.
  • The good news: it’s never too late to experience the health benefits of quitting smoking

Dr. Steven Schroeder at the University of California, San Francisco wrote in his introduction to these two articles that:

[T]he importance of smoking as a health hazard needs to be elevated. More women die of lung cancer than of breast cancer. But there is no “race for the cure” for lung cancer, no brown ribbon, and no group analogous to the Susan G. Komen Breast Cancer Foundation. Because smoking has become a stigmatized behavior concentrated among persons of low social status, it risks becoming invisible to those who set health policies and research priorities.

You’ve come a long way, baby — sadly.

In the first study, Dr. Prahbat Jha and colleagues sought to answer how serious the smoking problem remains today and how effective smoking cessation programs have been on health in the years after quitting. The researchers examined the records of almost 217,000 Americans who participated in the National Health Interview Survey between 1997 and 2004. This information was then linked to the National Death Index (yes, such a database really exists).

Are you a woman hoping to live to age 80? If you never smoked, the study estimates that your chances were pretty good among the survey group: 70%. But that drops to 38% for current smokers.

Men who never smoked? A 61% chance to make it to 80. Smokers? A paltry 26%.

Let’s put that another way, and in the words of the researchers. Jha and colleagues found that, “[a]mong current smokers, survival was shorter byabout 11 years for women and by about 12 years for men, as compared with participants who had never smoked.”

The more prevalent causes of death for male and female smokers were lung cancer and other respiratory diseases followed by heart disease, stroke, and vascular disease. But the researchers found that even atypical causes of death such as accidents and injuries were elevated in smokers.

A very concerning trend among women aged 65-69 is that the pool of former smokers to current smokers was about 2 to 1 while the ratio was 4 to 1 in men of the same age. There’s something in this observation that deserves more study. Are women less motivated to quit or are they less successful when they embark on smoking cessation programs?

Getting your life back

But there’s some fantastic news in here: quitting smoking, even late in life, confers great health benefits. In fact — attention, hipsters — those quitting smoking between 25 and 34 had long-term survival nearly equal to that of never-smokers. Yes, an increase of a decade of life.

Quitters in the 45 to 54 range: six extra years. In the 55 to 64 range: four extra years. Heck, you could go get another college degree.

In the second study, Dr. Michael Thun at the American Cancer Society and his co-authors examined 50 years of smoking-related health data collected by the organization since 1959. Unlike the previous study that was more heavily weighted with minority participants and a wider range of education level, the ACS study population was more white and more likely to have a higher education level than the general population.

Nevertheless, the data show that women have indeed caught up to men in smoking-related health problems and death. For example, lung cancer deaths in women increased by almost a factor of 17 in the last 50 years, with half of that occurring in the last 20 years. The timing is coincident with the increased

Similar to the previous study, Thun and colleagues showed that quitting smoking by age 40 almost completely erases the increased risk of smoking-related death.

Some other nuances were observed. Despite the plateau in smoking rates in men in the 1980s and their subsequent decrease, men still have an increased risk of death due to chronic obstructive pulmonary disease, or COPD. The authors propose that changes since the 1950s in cigarette design and constituents that affected nicotine absorption had led smokers to inhale more deeply, exposing more of the lung to the damaging effects of smoke components. The authors cite that such changes resulted in a shift in the type of lung damage observed from smoking by the 1970s.

Revive the national call-to-action

Taken together, we shouldn’t be terribly surprised by these studies but the health risks of smoking seems to have been diluted on the national fear radar. We’re doing much better on keeping high school kids from starting to smoke but have now pushed the typical smoking initiation time further into the 20s. But the number of smoking-related deaths is still at a couple hundred thousand American per year.

And women are suffering these effects more than ever. The fact bears repeating that more US women die of lung cancer than breast cancer.

But the good news is truly good news: unequivocal proof from two large studies with different study populations that quitting smoking anytime gives you back all or part of the decade you lose by continuing to smoke. Increased attention to funding and promoting smoking cessation programs may be the most important tactic we can take to prevent the strain of smoking on the healthcare system — and on personal and family suffering.

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