Reporting of Lung Cancer and Smoking

Lung cancer is generally viewed as a preventable disease because of its strong link with cigarette smoking. In fact, over 85% of lung cancer cases have been found to be caused by smoking (Oung, p. 1360). To see people die of lung cancer and to realize that they might be living had it not been for their smoking habit makes me feel that smoking is a suicidal habit that must be somehow overcome. Approximately 400,000 Americans die each year from the hazards of cigarette smoking and in particular, smoking increases the risk of lung cancer 22 times in men and 12 times in women (Bhagat and Schmetzer, p. 46). Between 1960 and 1990, when women increasingly began to smoke cigarettes, deaths from lung cancer in women increased 400%, and by the mid1980s they surpassed deaths from breast cancer in women (Bagar and Schmetzer, p. 46). The relative risks for lung cancer increase with the number of cigarettes smoked each day and with the duration of smoking (Corporation et al, p. 793). Further, exposure to second-hand smoke causes an estimated 3,000 deaths annually (Centers for Disease Control and Prevention, 2006). Despite these alarming trends, the national prevalence of smoking in 2004 averaged about 22% percent of the population (United Health Foundation, 2006) and a shockingly high percentage of smokers among my friends still live in a state of denial and refuse to accept that their cigarettes can cause them harm. It is best to remember the words by Colditz and Hunter (2000): “smoking just a few cigarettes per day is equivalent to working in an underground mine for many years in terms of lung cancer risk (Colditz and Hunter, p. 128).

Smokers generally begin smoking when they are young and acquire lung cancer in middle age or later. The first suggestion of a link between smoking and cancer appeared in 1795 when a German report suggested that cancer of the lip was the result of pipe smoking (Young, p. 253). In the 1920s, German pathologists published their findings that lung cancer victims were mostly smokers. However, it was also suggested that lung cancer might be caused by road tar, automobile exhaust, and the 1919 flu epidemic (Young, p. 253). In 1939, Franz Muller published a case-control study that showed that more people among lung cancer victims were smokers. Statistical data on per capita cigarette consumption and lung cancer mortality was published during the first half of the century. In 1950, five case-control studies were published that clearly established the link between smoking and lung cancer mortality. Ernest Wynder and Evarts Graham published their study that was based on histologically confirmed bronchogenic carcinoma cases in men from hospitals in 12 states across the United States and analyzed their smoking history (Young, p. 253). They found a strong association between smoking and lung cancer. The 1964 Smoking and Health report by the Surgeon General of the US is credited with reversing the trend in smoking consumption in North America. The report concluded that cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action (Young, p. 255).

There are two types of lung cancer – non-small celllung cancer and small cell lung cancer, of which the former is the most common. SCLC and NSCLC spread in different ways and need to be treated differently. SCLC accounts for about 20-25% of all lung cancers and it is almost always caused by tobacco smoking. According to the Alliance for Lung Cancer Advocacy, Support and Education (CASE) only about 1% of SCLC occurs in non-smokers. As SCLC is characterized by rapid spreading, the patients generally have a poor prognosis. The American lung association claims that the survival rate of a patient diagnosed with SCLC is only 35 weeks (Walker,  p. 10).

Scientific studies show that tobacco smoke is a dangerous combination of carcinogens such as polynuclear aromatic hydrocarbons, N-nitrosamines, aromatic amines, and other compounds. According to Andrew Salmon, a toxicologist at California’s EPA’s Office of Environmental Hazard Assessment, they contain directly genotoxic DNA-damaging compounds (“initiators”), compounds that enhance the action of these initiators (“promoters”), and compounds that do both. Moreover, some of these dangerous chemicals are more abundant in sidestream smoke, which comes off the tip of the cigarette, than the smoke inhaled by smokers themselves. This sidestream smoke is the major source of secondhand smoking or passive smoking (Betts, 136), which may account for about one-fourth of the lung cancer cases among nonsmokers (USA Today, 1995). According to EPA findings, when a nonsmoker is exposed to secondhand smoke in social environments such as restaurants and pubs, their risk of getting lung cancer increases by one in a thousand, but for those with a smoking spouse, the increase is doubled. This underlines the importance of banning smoking in public places like theaters, restaurants, bus stops, banks, etc.

A great deal of research has been conduction on the relationship between tobacco smoking and cancer and most of the studies are conclusive in their finding that cigarette smoking is a major cause of lung cancer. These studies include epidemiologic studies, autopsy reports, and experimental animal data reviewed in the original U.S. Surgeon General’s Report of 1964 and later in the reports of the U.S. Department of Health, Education and Welfare (Ruddon, p. 82). A summary of these findings are as follows: a strong link between cigarette smoking and lung cancer mortality has been demonstrated both in the case of men and women with the risk being higher in the case of those who are heavy smokers; risks of developing lung cancer for all smokers as a group ranges from 11 to 22 times those of non-smokers; and mortality from lung cancer that has been induced by smoking is more in urban areas and in the presence of other environmental hazards such as uranium mining and exposure to asbestos; results from autopsy studies reveal that the bronchial mucosa changes that precede the development of bronchogenic carcinoma are more common in the case of smokers than in nonsmokers; chronic inhalation of cigarette smoke has been found to cause lung cancer in experimental animals such as dogs and hamsters and finally, cell culture studies prove that tobacco smoke contains chemicals that can produce a malignant transformation of cells (Ruddon, p. 82).

The fact that only about 10% of lung cancer victims and the fact that the organ affected is the organ exposed to smoke undoubtedly prove that lung cancer is mostly caused by smoking (Ashton and Stepney,  p. 129). However, not all smokers share the same risk of getting lung cancer as only a fraction of smokers develop lung cancer (Ruddon, p. 82). An interesting question in this context is that why do only 10-20% of smokers develop lung cancer, seen with similar smoking histories, while up to 15% of lung cancers occur in individuals who have never smoked? Where I grew up in West Virginia, a large section of the population is made up of coal miners, railroaders, loggers. I have some of them afflicted with lung cancer even though they were nonsmokers but of course, most of the lung cancer victims were also smokers. This shows that apart from smoking there are other factors that can act on their own or compound the effect of smoking and lead to lung cancer. This play of other factors shows that the level of susceptibility to lung cancer will differ from individual to individual depending on his smoking habits, his genetics, and environment. Moreover, it has been found that people who are considered to be at risk for any type of cancer are susceptible to acquiring lung cancer whether they smoke or not. This suggests there may be factors other than smoking causing lung cancer. It has been proposed that differing susceptibilities to lung cancer risk may be based on genetics as many authors have reported increased incidences of lung cancers in the families of lung cancer victims. The genetic susceptibility to cancer is explained by the “inherited polymorphisms of genes that affect an individual’s ability to repair DNA damage from carcinogen exposures, to metabolize carcinogens to more potent forms or to detoxify carcinogens” (Zander et al, p. 176). But it is also said that family members may inherit lung cancer because they share a common environment with common risk factors such as secondhand smoke or similar smoking habits. Though these inherited polymorphisms may not actually cause lung cancer, they may affect a certain exposure’s effect or affect an individual’s response to that exposure (Zander et al, p. 176).

The risk of lung cancer in ex-smokers begins to decline about five years after quitting, and after 15 to 20 years their risk is 80% less than that of smokers (CE, 29401). When cigarette smoking was reduced as a result of the 1964 report of the Surgeon General’s Advisory Committee on Health it was accompanied by a decrease in the incidence of lung cancer in the 1990s and this decrease averaged more than 1% per year from 1990 to 1995 (CE, 29401). Having established the link between lung cancer and smoking, it is now clear that to reduce the risk level of lung cancer in society, smoking must be curbed.

In my childhood days, I have noticed that it is the teens who take up smoking. The dangers of lung cancer are not known to them. By the time they reach middle age, they are struck with the disease and it is said that the mortality rate of lung cancer victims is very high. It is best that teenagers are made aware of the dangers of smoking. They must be informed while they are still young through community programs, the media, and education. There must be more movements to fight against youngsters taking up smoking

Smoking is a very addictive habit and hence like most addictions, it must be treated from multiple angles – biological, psychological, and social. On the pharmacological side, Nicotine Replacement Therapies (NRTs) and bupropion, a nicotine-free alternative, are considered important therapies. There are also more recent medications such as nortriptyline and clonidine. In 2006, the U.S. Food and Drug Administration approved varenicline tartrate, also a nicotine-free medication, for smoking cessation. Apart from medications, social and political measures such as banning smoking in public places can help minimize exposure to second-hand smoking (Bhagat and Schmetzer, 46). But whatever the treatment, I personally feel that the desire to quit smoking must come strongly from the individual, and only then, any treatment will be successful. For this, a deep awareness of the dangers of smoking should be ingrained into the youth of today while they are still getting their education.

Life is precious and no amount of regret or treatment can help save a person once he or she is diagnosed with small cell lung cancer that is caused by smoking. The perils of smoking should be made publicly available to all through scientific literature and responsible media coverage. Showing smoking in movies, as a sign of being macho or as a sign of sophistication has to stop. On the other hand, the mortality rate of lung cancer victims and how their families suffer after their death should be revealed to smokers – both young and old. Just like Alcoholic Anonymous, there must be a community program for people to quit smoking. And laws that ban smoking in public places should be in place. Brand-building efforts of cigarette companies must be thwarted through taxes and regulations. When such measures are taken, we might someday look forward to a smoke-free world where small lung cancer is a thing of the past.

References

  1. Ashton, Heather and Stepney, Rob (1982). Smoking: psychology and pharmacology. Taylor & Francis, 1982
  2. Betts, S. Kellyn (2007). Secondhand Suspicions: Breast Cancer and Passive Smoking. Environmental Health Perspectives, Volume: 115, Issue: 3, 2007
  3. Bhagar, A. Harpriya and Schmetzer, D. Alan (2007). Smoking Cessation Pharmacology. Annals of the American Psychotherapy Association, Volume: 10, Issue: 3, 2007
  4. CE (Columbia Encyclopedia) (2007). Lung Cancer. Columbia University Press, New York, 2007
  5. Colditz, A. Graham and Hunter, John David (2000). Cancer Prevention: The Causes and Prevention of Cancer. Springer Publications, 2000
  6. Corporation, C. Marshall; Fraser, J. Victoria; Burd, Laurence; Liebson, Elizabeth; Lipschik, Y. Gregg and Peterson, C. Matthew (2007). Diseases and Disorders. Marshall Cavendish Publishers, 2007
  7. Ong, Yau Yong (2004). A clinical approach to medicine. World Scientific Publishing, 2004
  8. USA Today (2005). Nonsmokers Are Also at Risk. USA Today, Volume: 124, Issue: 2605, 1995, p. 2.
  9. Walker, Julie (2005). Lung Cancer: Current and Emerging Trends in Detection and Treatment. The Rosen Publishing Group, 2005
  10. Young, T. Kue (2005). Population health: concepts and methods. Oxford University Press US, 2005
  11. Zander, S. Dani; Popper, H. Helmut; Jagirdar, Jaishree; Haque, K. Abida and Cagle, T. Philip (2007). Molecular Pathology of Lung Diseases. Springer Publications, 2007

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