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 May 12, 2005
Jennings' Case Highlights Risk to Ex-Smokers
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By Amanda Gardner, HealthDay Reporter

WEDNESDAY, April 6 (HealthDay News) -- Two gospels of medicine, preached over and over during the past 40 years, have been the dangers of smoking and the benefits to health of quitting.

But a footnote to that gospel is that there's never a guarantee.

TV newscaster Peter Jennings, who announced Tuesday that he had lung cancer, is an ex-smoker.

According to the American Lung Association, about 87 percent of lung cancer cases are caused by smoking, and 40 percent to 50 percent of new cases may occur in former smokers.

Because most lung cancers are diagnosed at a late stage, the five-year survival rate is only 15.2 percent, compared with 63 percent for colon cancer, 88 percent for breast cancer and 99 percent for prostate cancer, according to the American Lung Association.

In 2005, lung cancer will take about 163,500 American lives and will maintain its place as the number one cancer killer, outpacing deaths from the second, third, fourth and fifth most common causes of cancer deaths combined, said Dr. Bill Solomon, associate professor of medicine at SUNY Downstate Medical Center in New York City.

Ninety percent of people who are diagnosed with lung cancer will eventually die of the disease, added Dr. Jay Brooks, chairman of hematology/oncology at the Ochsner Clinic Foundation in Baton Rouge, La.

Not everyone who smokes will get lung cancer and not everyone who quits will be protected. Why? No one knows for sure.

People who smoke have a 10- to 15-fold greater risk of developing lung cancer than those who never light up, experts say. And, for the most part, the more you smoke -- or smoked in the past -- the greater your accumulated risk.

"The risk does decline with time after you stop but those numbers aren't clear," said Dr. Norman Edelman, chief medical officer of the American Lung Association.

A landmark study published last year in the British Medical Journal found that cigarette smokers die an average of 10 years sooner than nonsmokers. At least half, and possibly up to two-thirds, of people who smoke from youth on are eventually killed by their habit, a quarter of them in middle age, the study reported.

But the study also found that quitting can offer big advantages. Stopping at age 50 cuts the risk of dying in half, while quitting at age 30 almost eliminates the risk.

But individuals are still, well, individuals. Jennings quit smoking 20 years ago but admitted starting again after the Sept. 11, 2001, terrorist attacks. That might have further damaged lungs that were not yet healed, Brooks said.

There are likely other factors at play as well.

"We're gambling with other things in the environment or genes or both," Edelman pointed out. "The fact that Jennings smoked for a long period of time increased his risk of getting lung cancer. How much that risk was dissipated by stopping for 20 years I don't know, but it was obviously not entirely."

In one way, Jennings appears to be typical of many people with lung cancer: his cancer seems to be later stage.

"He probably has relatively advanced disease," Solomon said. "If he's getting neoadjuvant chemo [chemotherapy first], he probably has inoperable lung cancer."

Jennings said he will begin chemotherapy next week.

The ABC News anchor joins a long list of celebrities who smoked and developed lung cancer, including Desi Arnez, Yul Brynner, Nat King Cole, Gary Cooper, Walt Disney, Duke Ellington, Betty Grable and Ed Sullivan.

Lung cancer, however, is not the only pitfall of smoking. "Smoking is also responsible for many cases of bladder cancer in males, head and neck cancer, esophageal cancer and pancreatic cancer," Solomon said.

Actor Michael Landon's four-pack-a-day habit likely contributed to his fatal pancreatic cancer. Humphrey Bogart and Sammy Davis Jr. both were smokers and both developed throat cancer.

Given the troubling news about Jennings, experts advise that if you're an ex-smoker with a cough, get to a doctor and get screened.

Some ex-smokers are opting for sophisticated spiral CT scans, even if they have no untoward symptoms. "We do pick up a large number of curable cancers but the downside is that there are many false-positives and people have to undergo resections that are unnecessary," Solomon said.

If you're a smoker, stop.

"Quitting is good. It's always good to quit, no matter how long you've smoked," Edelman said. "You'll reduce your risk of lung cancer, reduce the degree to which you have chronic obstructive pulmonary disease, reduce your risk of other types of cancer and of heart disease. The data is very clear. Even if you're 75, you can benefit from stopping."

More information

For more on quitting smoking, visit the American Lung Association (www.kintera.org ).

SOURCES: Bill Solomon, M.D., associate professor of medicine, SUNY Downstate Medical Center, New York City; Jay Brooks, M.D., chairman of hematology/oncology, Ochsner Clinic Foundation, Baton Rouge, La.; Norman Edelman, M.D., chief medical officer, American Lung Association; Entertainment Industry Council's "Tobacco in the Media Project" and "Cigarette Hall of Fame"; photo courtesy of ABC News

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