Before we talk about lung cancer, let me remind you about the Eid Stamp. The post office has reported that 35 million stamps from the 75 million that were released are still available for sale. Use them for mailing your Eid cards to Pakistan.
This week we received the sad news that George Harrison had died after a long battle with lung cancer. It was a sad loss to the music world as he was part of a revolution in music. As a physician what I find saddest about his death is that it was due to long-term cigarette smoking. Everyday I see many people who have years of life, and years of quality life deprived to them due to cigarette smoking. It is difficult for me to get mad at the veterans I see in the VA, or the older generation of smokers, because they became addicted before they knew the truth. Once the health risks associated with cigarette smoking were exposed, they found it too difficult to quit. What I do find unacceptable are younger people who start smoking in spite of knowing the risks associated with it. Picking up a cigarette is akin to signing one’s death certificate. Have I scared you smokers out there? No, keep reading.
The Numbers
Lung cancer has become one of the leading causes of death in the United States. Before the advent of cigarettes, it was a rare medical problem. In 1998 about 171,000 new cases were seen in the United States. That year there were approximately 160,000 deaths. These days 28% of cancer death are owing to lung cancer. More alarming is the fact that the cancer death rate in women is increasing. Even more alarming is the finding that the number of people afflicted with lung cancer will stay high due to increased incidence of smoking in teenagers, and increased marketing to developing countries.
In men 87% of lung cancer can be attributed to smoking, and in women the number is 85%. The more and longer a person smokes also increases his chances of developing lung cancer. Quitting smoking can slowly decrease the risk of developing lung cancer, but it takes about 10 years to come down to that of the non-smoking population.
Other Risk Factors for Lung Cancer
People are always concerned about passive smoke, and its link with lung cancer. (By the way passive smoke is when a person who doesn’t smoke breathes it in from people around them who smoke.) The Environmental Protection Agency has classified that passive smoke exposure can lead to cancer. In fact increased levels of cells that lead to cancer are found in the blood of passive smokers. A number of studies have found that spouses of smokers are at an increased risk of lung cancer than spouses of non-smokers. Children of smokers are at even greater risk. In fact a child exposed to a parent who smokes a pack per day for 25 years has double the risk of developing lung cancer than a non-smoker.
Asbestos exposure as well as other occupational exposures like radon, arsenic, chromium, mustard gas, and nickel among others can increase the risk of lung cancer. The risk is worse among smokers. People have also wondered if air pollution could contribute to lung cancer risk. In fact, many studies have shown an increased incidence of lung cancer in cities as compared to rural environments. I should caution you that although cities may have an increased number of lung cancer, it is not known for sure if it is air pollution or other factors that could be the contributing factors for this higher incidence.
How Smoking Leads to Lung Cancer
Obviously multiple steps have to happen before smoking can cause lung cancer to develop. It is a difficult process to describe, but I will simplify it to the basics. Cigarette smoke contains cells that encourage mutations in the genes of the person inhaling the smoke. These mutations increase the susceptibility to cancer, and cause cells to grow out of control, which is what cancer basically is.
Symptoms and Signs
Lung cancer is so deadly because it tends to be silent. Usually people don’t manifest symptoms until it has progressed to a point where it can’t be cured. When the symptoms do occur they are usually because the tumor has grown into an airway, or other structures in the lung. It can cause a cough, wheezing, chest pain, shortness of breath, or even irregular heartbeats because of invasion into the heart. The cancer can also create hormonal disturbances. If the cancer spreads, it usually goes to the brain, bone, adrenal glands, liver, or lymph nodes in the neck and shoulders.
It is usually diagnosed as an asymptomatic, abnormal chest X-ray. Usually the X-ray is taken for another reason, not for the diagnosis of cancer. In fact screening X-rays to look for lung cancer have not proven to be useful.
Diagnosis
Once an abnormal chest X-ray has been found, it is usually followed by a CT scan of the chest. Depending on the person’s risk factors and what is found on the CT scan, the patient may then be referred for biopsy to look for cancer. If the biopsy is positive for cancer, then further studies are done to find out exactly where the cancer is, because that dictates the treatment strategies.
Treatment
Treatment includes surgery, radiation, and chemotherapy. The exact treatment is dependent on what type of cancer the patient has, and how far along it has progressed.
Outlook for Survival
The overall survival statistics for patients with lung cancer is not so good. It has been found that only 14% of patients with lung cancer, will survive for 5 years. The best survival rate is found in patients with a certain sub-type of lung cancer and found early on in the disease process. In that subgroup 40, 85% of them will survive 5 years.
Conclusion
The bottom line is that cigarette smoking, especially heavy smoking, leads to a much higher risk of lung cancer, which leads to an early death in most people. The smokers who do develop lung cancer end up living very difficult lives. They have trouble breathing, and performing easy activities that normal people take for granted. Those that have to undergo chemotherapy are generally miserable from it, as even though chemotherapy may extend their lives, it is an uncomfortable life that they lead.
The smokers reading this column must be thinking, “OK, Dr. Aliya, you have scared me enough, what now?” Besides being happy that I have accomplished my goal, what such people have to do is to quit smoking. How? Tune in next week for strategies to help in quitting smoking.
Please feel free to write any comments, questions, or suggestions for future columns to aliya_hasan@hotmail.com.