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Former smokers should rest easy

Thu Apr 7, 6:11 AM ET

By Sharon Jayson, USA TODAY

Reformed smokers, take a deep breath. You've battled the addiction, knowing that one less puff on that cigarette could make a life-or-death difference.

But then you hear about ABC News' chief anchor Peter Jennings, who on Tuesday disclosed his lung cancer diagnosis. Yes, he quit smoking 20 years ago. But he also has said he has struggled with backsliding since Sept. 11, 2001.

"Nicotine is an incredibly powerful addiction," says Peter Shields, a professor of medicine at the Lombardi Cancer Center at Georgetown University Medical Center. "A lot of smokers 20 years later are still dreaming about smoking."

Lung cancer is the leading cause of cancer death. Estimates from the American Cancer Society suggest 172,570 new cases this year, with 163,510 deaths from the disease. Health care officials say factors such as age when you quit, how long you smoked and heredity all play a role in whether someone will develop cancer or another smoking-related disease.

"If people have quit smoking, they have done the most important thing they can do to improve the quality of life and their life expectancy," says physician Corinne Husten of the Office on Smoking and Health, part of the federal Centers for Disease Control and Prevention.

Research shows that former smokers reduce their risk of developing heart disease and stroke to the risk level of non-smokers within a few years after quitting. It takes about 10 years to reduce the risk for lung cancer and other cancers, but risk never drops to the level of someone who has never smoked, says physician Michael Thun, head of epidemiological research at the American Cancer Society.

Genetic damage accumulates

"Cancers require multiple bits of genetic damage in a single cell to become malignant and permanent," he says. "What continued smoking does is increases the chances that a genetically damaged cell will continue to accumulate more genetic damage and be transformed into a life-threatening cancer."

Risk diminishes with time, physicians say. Former smokers can go a few steps further toward reducing their cancer risk by maintaining a healthy body weight, getting regular physical activity, drinking alcohol in moderation and getting tested for cancers that have screenings.

Alexander Prokhorov, a behavioral scientist at Houston's M.D. Anderson Cancer Center who helps physicians counsel patients, understands why Jennings may have lapsed even though he had quit years ago.

"There are concerns regarding all these years that people have been smoking and what's going to happen to them as a result," he says. "I tell the physicians to simply explain to their patients that by quitting smoking, you obviously reduce a laundry list of diseases."

Smoking-related diseases include a risk for heart disease and stroke as well as cancers of the mouth, larynx, throat, esophagus, bladder, kidney, pancreas, liver, cervix, colon and stomach.

Screening trial underway

An interesting finding, says Margaret Spitz, chair of epidemiology at M.D. Anderson, is that less than 20% of long-term smokers develop lung cancer. Still, she says 85% of all lung cancers occur in former or current smokers, which is why the focus of her research is how to identify the subgroup of smokers at highest risk for developing lung cancer.

There is currently no reliable way to screen for lung cancer. But a $200 million National Lung Screening Trial is underway with 50,000 patients. Its aim is to determine whether early screening with either X-rays or spiral computed tomography (CT scans) will prevent deaths from the disease. The trial, by the National Cancer Institute, will take several years, says Eva Szabo of the institute's division of cancer prevention.

But Thun says screening for lung cancer is a bit of a dilemma because finding and removing growths identified from early screenings might actually do more harm than good.

"What's not clear is whether the benefit of removing (small growths) exceeds the harm of the surgery," he says. "It finds them early, but it's a big operation to have your chest cut open and your lung operated on."

Despite the screening question, researchers, scientists and physicians all agree on the best way to prevent smoking-related illnesses: "The only thing better than quitting smoking is never beginning," Thun says.

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"What's not clear is whether the benefit of removing (small growths) exceeds the harm of the surgery," he says. "It finds them early, but it's a big operation to have your chest cut open and your lung operated on."



Having your abdomen opened up to remove an inflamed Apendix is a big operation. Having your abdomen opened up to remove a ruptured Appendix and perform a major cleanup is an even "bigger" operation.

I'm pretty sure the same thing applies to removal of miscellaneous organ cysts that are in danger of rupture or causing pain. And let's don't forget gall stones, and sometimes Kidney Stones.

I can't help but wonder what the heck people are thinking. And I think that when a statement like the one above comes into play what they're doing is trying to find a way to rationalize an unethical and invalid ideas.

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