April 26, 2005
Should Ex-Smokers Worry?
People Who Have Quit Account For an Increasing Percentage Of Victims of
Lung Cancer
By KEVIN HELLIKER
Staff Reporter of THE WALL STREET JOURNAL

A few days ago, a friend told me she used to smoke. This was news to
me. During the 15 years I've known her, she has been a health-conscious
mother of two. The smoking occurred during her teens and 20s, she told
me. Now it had her worried. "Peter Jennings," she said.

Kicking the habit is supposed to free nicotine addicts from worry. But
the former smoker often continues sharing the primary fear of the
current one: lung cancer. That worry deepened this month when Mr.
Jennings, anchor of ABC's "World News Tonight," informed viewers he had
lung cancer. The part that was especially scary for former smokers was
when he said that, except for a brief relapse in 2001, he had quit
smoking 20 years ago.

An alarming-sounding trend may add to this jolt: Former smokers are
rising as a percentage of lung-cancer victims, and current smokers are
declining, according to the American Cancer Society. This has led some
clinicians to wonder if the risks for former smokers are understated.
Many ex-smokers like my friend find themselves wondering, "Should I be
screened for lung cancer?"

Certainly no amount of smoking has been shown to be risk-free. But
research long has demonstrated that quitting smoking significantly
reduces the risk of cardiovascular disease, lung cancer and emphysema
-- the biggest health problems associated with smoking. The rising
proportion of nonsmokers among lung-cancer victims merely reflects the
growth in the legions of Americans who have freed themselves from a
powerful addiction.

With significant declines in the smoking rate -- for example, 25% of
men in this country smoke today, compared with 57% 50 years ago --
there are now more former smokers than current ones, says Michael Thun,
who heads epidemiological research for the American Cancer Society in
Atlanta. In all, former and current smokers will account for about 87%
of the anticipated 163,500 deaths this year from lung cancer, which
kills more Americans than any other kind of cancer, according to the
cancer society.

New research is suggesting that those who quit early enough have little
reason to worry. A 50-year study of cigarette-addicted British doctors
published last summer in the British Medical Journal found that on
average smokers lived 10 fewer years than nonsmokers. The study also
found that those who quit smoking at age 30 or younger had roughly the
same life expectancy as people who never smoked.

Whether former smokers can do anything other than worry is a matter of
medical debate. Tests such as X-rays and CT scans can detect lung
cancer, but the American Cancer Society, among other medical
organizations, doesn't recommend using such tests to screen people who
have no symptoms. Insurance won't pay for lung-cancer screening in
people without symptoms (which can include persistent cough and
spitting up blood). The main reason is that, while screens can detect
small, early cancers, it isn't always clear that such tiny tumors would
ever grow into something dangerous. So the thinking goes that screening
could lead to unnecessary cancer treatment, which itself can be fatal.

Some physicians believe the science already supports screening. Twelve
years of using spiral CT scans to detect early-stage lung cancer have
convinced Claudia Henschke, professor of radiology at Cornell
University's Weill Medical College in New York, that early detection
and treatment can reduce lung-cancer deaths as much as 70%. She
recommends a spiral CT scan, which costs about $300, for former smokers
-- but not for every former smoker.

Having scanned more than 28,000 people, Dr. Henschke says she and her
colleagues believe they have identified the threshold that makes
screening worthwhile in people under age 60: 10 "pack years." That's
the equivalent of a pack a day for 10 years -- 3,650 packs, or 72,000
cigarettes -- smoked over any period of time. Generally, people under
age 60 who have smoked less than that don't need to be scanned, Dr.
Henschke says. Older people have higher cancer rates in general, so
other factors are at play.

Because her studies haven't included a control group, the medical
establishment remains unconvinced that early screening saves lives. Dr.
Henschke and her colleagues may be finding and treating lung cancers
that "patients would have died with, not from," says Barnett Kramer,
associate director of disease prevention at the National Institutes of
Health.

It will likely be years before a couple of government-run studies that
feature control groups determine whether screening in asymptomatic
people saves lives.

Worry about lung cancer is in one sense misguided, because the primary
cause of death from smoking is cardiovascular disease. But
cardiovascular disease affects a broad swath of people, while lung
cancer is overwhelmingly a smoker's problem.

Dread about lung cancer may be especially great not only because it
kills 85% of its victims -- painfully -- but also because it can feel
like a judgment. Patients who smoked must deal with the knowledge that
they probably brought it on themselves.

"Yes, I was a smoker," said Mr. Jennings, 66, in his message to ABC
viewers. Acknowledging that his abstinence from cigarettes underwent a
brief interruption following the terrorist attacks of 2001, Mr.
Jennings said, "I was weak."