Dangers and Stigma of Smoking Have Helped Snuff Lung Cancer's Lethal Toll -- But Still Not Enough

If you've ever watched the television series Mad Men, you've probably noticed how its main characters chain smoke like it's an Olympic sport. The show's dapper lead man, advertising executive Don Draper, is rarely without a cigarette in hand as he maneuvers through Madison Avenue of the 1960s. Smoking, of course, was a sign of the times -- a cool fashion, whether you were a housewife, a hippie or a high-society ad man.

Thankfully, adult smoking rates have dropped by half in the decades since Draper lit up. But that good news masks some disturbing trends: Lung cancer is still the second leading cause of cancer in the U.S., behind only cancers of the prostate for men and the breast for women.

Perhaps even more troubling is the fact that more American men and women die from lung cancer than from any other form of the disease. This year alone, lung cancer is expected to claim the lives of 160,000 people. That's more than the total numbers of deaths from cancers of the colon, prostate, breast, liver and kidney combined.

And the outlook remains grim for too many patients, given the challenges of diagnosing the disease early and the poor prognosis for those who discover it late. More than half of patients with lung cancer die within one year of their diagnoses. Less than 16 percent survive beyond five years; only pancreatic cancer has a lower survival rate.

All of this illness not only devastates families, it also drives up medical spending: Lung cancer accounted for an estimated $12 billion in medical costs in 2010, according to a government analysis.
Despite these troubling figures, lung cancer rarely gets the sort of attention -- or research funding -- showered on other higher-profile forms of the disease, particularly breast and prostate cancers. Perhaps that's because of the stigma attached to it. Lung cancer is a smoker's disease, to be sure, mostly a self-inflicted death sentence in the eyes of many. In fact, smoking is the leading cause of lung cancer, accounting for 90 percent of such deaths in men and 80 percent in women.

Killer Tobacco

Smokers should beware: Even if you stop, it doesn't wipe the slate clean. Damage caused by smoking can linger for decades. And if you're a nonsmoker, you're not necessarily free from harm either. The recent death of pop diva Donna Summer at age 63 was a vivid reminder. She had never smoked and yet died from the disease, one of about 3,400 adult nonsmokers who succumb to lung cancer each year. Second-hand smoke also increases the risk of heart disease, causing an estimated 46,000 deaths annually among adults in this country who do not light up. It presents other hazards as well: Pregnant women who are exposed to secondhand smoke face the risk of giving birth to low-weight babies. Children, meanwhile, have a greater risk of infections, colds, pneumonia and asthma.

One of my Cedars-Sinai colleagues, thoracic surgeon Robert J. McKenna Jr., M.D., sees all of these variations in his practice. McKenna, medical director of Thoracic Surgery and Trauma and co-director of the Women's Guild Lung Institute, says the perception that only smokers get lung cancer is off base. About one in five of his patients never smoked, while a significant percentage quit as many as 20 years before their cancers appeared.

"They did the right thing," he says, "and still went on to get lung cancer."

If smokers knew what they were putting into their bodies, they might think twice about their habit. Consider these frightening facts: Tobacco smoke contains more than 7,000 chemicals, and at least 69 of them can cause cancer, including arsenic, benzene, beryllium, chromium, nickel and vinyl chloride. This toxic buffet bathes cells in harmful metals, hazardous gas, even radioactivity.

A Huge Toll

Zab Mosenifar, M.D., another of my colleagues and a preeminent lung specialist and runner, explains that cigarette smoke can take a huge toll on the lungs and the body. Carbon monoxide molecules that result from smoking hamper the hemoglobin's ability to pick up oxygen from the lungs and distribute it, robbing precious oxygen from muscles and vital organs. Mosenifar, medical director of the Women's Guild Lung Institute at Cedars-Sinai, says that nicotine, a vasoconstrictor, narrows the muscular walls of blood vessels and slows blood flow, potentially causing permanent damage to arteries. Reduced blood flow and oxygen ultimately decreases strength, energy and function of organs throughout the body.

Smoking cessation, Mosenifar says, is the best and most important means of preventing lung cancer. Those who do smoke also face the risk cancers of the esophagus, larynx, mouth, throat, kidney, bladder and pancreas. And that's not all. Tobacco use contributes to a multitude of other health problems for millions of people, increasing the risks of strokes, coronary heart disease, emphysema and other diseases. Indeed, smoking's adverse health effects account for about 443,000 deaths, or nearly one in five, each year in the U.S., according to the U.S. Centers for Disease Control and Prevention.

The federal agency also reports that smoking causes more U.S. deaths annually than the combined fatalities from alcohol, auto accidents, HIV, illegal drugs, murders and suicides.

Anti-smoking advocates, seizing on the frightening statistics, have fought for years to curb cigarette use. Groups have sought to raise taxes on cigarette packs and have waged public safety campaigns to keep children and adults from picking up cigarettes in the first place. One of the most recent of these efforts, the Proposition 29 ballot initiative in California, narrowly was rejected by voters. The $1-per-pack tax on tobacco would have raised $860 million for research on tobacco-related diseases and smoking-prevention programs. It faced unyielding opposition by tobacco giants Philip Morris USA and R.J. Reynolds Tobacco Co., who spent millions of dollars to defeat it.

Public health authorities know all too well that the scourge of smoking is not confined to American borders. Tobacco killed an estimated 100 million people worldwide in the 20th century and, if current trends hold, will kill another 1 billion people this century, many of them in poor or developing countries. Indeed, tobacco use is the most preventable cause of death worldwide.