It was an offhand conversation with a neighbor that sent me back to the keyboard today, this time to write about cigarettes and other forms of tobacco, prevention, denial, and death. Said neighbor and his 12-year-old son were building my two-year-old’s new easel, a birthday present from Grandma — a job that would have taken me weeks, and even then I would have probably built it upside-down. An old friend had stopped by, and we were talking about changes in “The Valley,” the frontier community where we live. Another neighbor and friend had passed away shortly after my daughter’s birth. Ed had died from metastatic lung cancer shortly before his 75th birthday. He had quit smoking two years before his death — as it turns out, when he had first received the cancer diagnosis. But he never mentioned the cancer to any of us until about three months before his death, when aggressive tumors appeared. I don’t think hid the original diagnosis from us. I just think he didn’t believe it until the cancer hit full-force, like a runaway train.
My neighbor recalled a conversation he had with a physician who had explained to him that aggressive early treatment probably wouldn’t have made much difference for Ed. Lung cancers can be treated, but the prognosis is generally poor. Fewer than 10 percent of people with primary lung cancer remain alive 5 years after being diagnosed with the disease. Survival rates vary greatly depending on the stage of the cancer when it is diagnosed, the person’s age, and other factors. But still, that’s a pretty grim overall outlook.
“And to think,” I said. “Almost 90 percent of those cancers could have been prevented simply by not smoking.”
“Oh, I don’t believe that,” he responded. “That’s just hype and lies. ‘They’ just want to scare you.” (Okay, so those weren’t his exact words, but that was pretty much the gist of it).
The stopping-by friend offered the other usual logical fallacy, “But I know people in their nineties who’ve smoked all their lives and are still going strong.”
“No,” I explained. “You didn’t hear what I said, which is that close to 90 percent of cases of lung cancer could have been prevented by not smoking. I didn’t say that 90 percent of people who smoke will get lung cancer. That’s a different question.”
I didn’t add — but easily could have — that lung cancer is only one of the ways that tobacco hastens death. Besides contributing to a host of other cancers, tobacco use is directly linked to hypertension, poor blood lipid profiles, chronic obstructive pulmonary disease, heart disease, and multiple other chronic conditions. That includes commercial and hand-rolled cigarettes, pipes, cigars, hookahs, and any other way you can imagine to light the stuff and take a whiff, chew it, or otherwise expose yourself to it. As the U.S. Surgeon General reported in 2004, smoking tobacco is associated with disease in every organ of the body.
Both smokers and people exposed to their smoke are deeply affected. Not only does tobacco use account for 87 percent of lung cancer deaths, it accounts for 30 percent of all cancer deaths. According to the American Cancer Society, one out of five deaths in the United States can be attributed to tobacco use — to the tune of nearly 450,000 early deaths each year between 2000 and 2004. Among those deaths are 3,40o non-smoking adults. And those data are only about the things most easily tracked and measured effect: death. They’re not about illness and disability (referred to as “morbidity”), such as asthma and other chronic diseases.
I knew better than to plunge into explanations of the data sources and statistical analyses that led to those numbers (okay, so I really, really wanted that easel built). But those are solid statistics, based on years of data collection and analysis. Those methods become more sophisticated every year, in ways that someone who shrugs the findings off as “something they want you to believe” is not likely to be willing to hear. For instance, methods for estimating the number of new cases of cancer diagnosed every year, called incidence, were recently updated. Since 2007, estimated new cancer cases have been computed using a more accurate method developed by researchers at the National Cancer Institute and the American Cancer Society. The new model uses data from a much larger percentage of the U.S. population, allows for geographical variation in cancer incidence, takes into account delays in reporting, and includes many socio-demographic, medical facility, lifestyle, and cancer screening behavior variables.
Are lung cancer statistics perfect? No way. But the estimates are good enough for me to say, with certainty, that Ed would probably still be alive today had he not been a smoker. He probably wouldn’t have been a smoker had he not lived in an era and cultural, familial, and work environments where smoking was the norm. And I sure hope that’s the message that my neighbor’s 12-year-old left my house with yesterday.
I’d better go admire my budding artist’s work…