Focusing prevention of smoking in young best way to curb lung cancer
Focusing prevention of smoking in young best way to curb lung cancer
Most smokers develop the habit before the age of 18
Smoking causes 90% of all lung cancer. While not all smokers develop the disease, the longer and more intensely a person smokes the greater the likelihood of getting lung cancer, says David W. Wetter, PhD, professor and chair of the Department of Health Disparities Research at the University of Texas M.D. Anderson Cancer Center in Houston.
Wetter says the greater the amount of exposure to tobacco smoke the greater the risk for lung cancer. It is similar to throwing baseballs at your head — while you may be able to dodge the first five the sixth one will get you, and the more baseballs thrown at your head the more likely you eventually will get hit.
"Theoretically, you could prevent more than 90% of all lung cancers if everyone in the United States stopped smoking tomorrow. It would take 20, 30, maybe 40 years, but basically lung cancer would disappear over that period of time," says Frederic Grannis, Jr., MD, a surgeon in the Department of Thoracic Surgery at City of Hope National Medical Center in Duarte, CA.
It would take decades to eradicate lung cancer because anyone who has smoked is at greater risk for developing the disease. Grannis says that every puff from a cigarette is like buying a ticket in the lung cancer lottery. The more people smoke and the longer they smoke, the greater their chances of winning the lottery.
Obviously it is best if people never start smoking. Research shows that most start before the age of 18 and become lifelong smokers because of their addiction to nicotine. Therefore children are good targets for prevention interventions.
According to Wetter there are many prevention programs targeting kids that have been shown to be effective. However, they need to be longer and more sustained — a great intervention for sixth and seventh grade students is usually not followed throughout high school. "You need to keep coming back to it and focusing on the issue," he says.
It is not enough to let kids know the dangers of smoking, says Wetter. Interventions should include education on ways teens can cope with their emotions, stress, and awkward social situations. In addition, the education must be individualized.
"Regular education is fine as a starting point, but now we know more and we can pick interventions and change them so they make sense for particular kids," says Wetter.
In addition to knowing that most people begin smoking at a young age, research shows that smoking rates are highest in populations that have fewer resources.
Also smoking rates are very high among individuals that have comorbidities — for example, those who have other substance abuse problems, those who are depressed or those who have other kinds of mental disorders.
"To some extent, smoking has become somewhat of a social justice issue. It is really concentrated in our most disadvantaged populations," says Wetter.
Many barriers to overcome
One reason simple educational outreach programs cannot stand alone is that they are up against ad campaigns from the tobacco industry, which spends $15 billion annually on advertising. The health care community doesn't have the resources to counter the messages enticing young people to smoke, says Grannis.
Teens often smoke to be cool and sophisticated, the message of many of the tobacco ads. Grannis says the only solution to the problem is to stop all advertising of tobacco products.
According to Wetter there are twice as many ads for tobacco products in poor, inner-city neighborhoods than wealthier neighborhoods.
To keep children from smoking, no matter what their socioeconomic status, parents must learn that they set the example. Grannis says that parental role modeling is critically important, so parents must stop smoking to set a proper example for their children. Teens also set an example for younger children, as do movie actors. A lot of children start smoking because they want to look like their favorite movie star, explains Grannis.
"There is a lot more research we need to do to try to find out exactly what educational messages get through to children," says Grannis. Research has identified that teens don't like to be manipulated and lied to by adults, so advertising that shows the tobacco industry is deliberately lying to them to entrap them would be effective, he says. Also, information on how smoking will change their appearance is helpful because the way teens look is important to them.
"There are probably better programs we can develop, and one of the areas that is getting a tremendous amount of attention right now is the use of technology. People are trying to develop interventions that can be delivered over the Internet or on a cell phone or something along those lines," says Wetter.
Once teens are hooked on tobacco the education must focus on smoking cessation. It is not clear how to help teens stop smoking, either, says Grannis. Interventions, such as group counseling, that work for adults don't necessarily work for teens, he says.
For adults smoking cessation strategies are clearer. Pharmaceutical interventions are helpful such as the nicotine patch or gum or prescription medications. However a person's chances of successfully quitting are doubled if he or she receives counseling as well.
Advice can come from a physician, a trained counselor, or one of the toll-free telephone services that have been established around the country. For example, a counselor could help people structure their home environment so that cigarettes aren't available and relatives and friends no longer smoke around them.
"It is really critical for people who want to have their best chance of quitting to incorporate both of those approaches into their quit attempt, use some medications, and get some help. The help can be at any level people want, it can be going to a group or it can simply be the telephone counseling. It is incredibly easy and convenient to do so," says Wetter.
Yet many people do not quit smoking, increasing their chance for developing lung cancer. There are a multitude of reasons why, according to Wetter. The longer and more intensely people smoke the more difficult it is to quit. A person's genetic makeup also is a factor in nicotine dependence. It is more difficult to quit when people are struggling with negative emotions such as depression or stress. Also the environment a person lives and works in has a major impact.
Non-smoking policies and laws that prevent people from smoking in public places such as restaurants have a profound effect, says Wetter.
Grannis says it is easier for people to quit when they work at a place where they can't smoke. Also it cuts down the consumption of cigarettes. City of Hope has been smoke-free for 20 years and a simple research project determined that employees who are smokers had an average of two to three cigarettes less each day at work than when they were off.
"That is important, for the cumulative effect of the number of cigarettes they smoke is important over a long period of time," says Grannis.
When people are not ready to quit it is often because the barriers seem insurmountable so talking with them about why they smoke can sometimes provide ideas for ways around the obstacles, helping people to rethink their position, says Wetter.
Regardless of a person's readiness to quit, a patient's smoking status should be a topic of conversation at each health care visit. The health care professional should give advice on why the patient should not smoke and try to personalize the message as much as possible, says Grannis.
"We try to personalize the message by doing a pulmonary function test to show people how their lung age is 60 even though they are only 40," he says.
Once a person is willing to quit it is important to select a quit date and arrange for counseling and nicotine-replacement therapy.
Grannis says people must understand that even if they have stopped smoking they are still at greater risk for lung cancer. He recommends that people more than 40 years old who have more than 10 pack years of cigarettes (one pack a day for 10 years or two packs a day for five years) be screened for lung cancer.
City of Hope is participating in a research project on screening for lung cancer in which 30,000 people have undergone an X-ray method called spiral CT scanning. Grannis says that more than 80% of the lung cancer detected is picked up in stage one using this method, while currently throughout the United States only 15% of lung cancer is diagnosed at stage one.
Of those patients at City of Hope who have had their cancers removed surgically only 3.9% have died in five years. "To me the proof is strong enough that we should be screening on a national level now," says Grannis.
With 150,000 or more dying of lung cancer annually in the United States screening should be paired with education on prevention and early detection just as it is with breast cancer, he says.
Sources
For more information about the prevention of lung cancer, contact:
- Frederic Grannis, Jr., Md, Department of Thoracic Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010-0269. Phone: (626) 256-4673 extension 67100. E-mail: [email protected].
- David W. Wetter, PhD, professor and chair UT M.D. Anderson Cancer Center Department of Health Disparities Research, P.O. Box 301439, Unit 1330, Houston, TX 77230-1439. Phone: (713) 745-2682. E-mail: [email protected].
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.