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Life After Cancer A Roadmap for Cancer Survivors

Tobacco and Cancer
Ernest H. Rosenbaum, MD

Leading Cause of Death

Leading Cause of Death
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Tobacco use is one of the leading causes of death in America - more than 440,000 premature deaths are attributed to it every year. Smoking has been causally related to lung, bladder, head and neck, cervix, kidney, and esophagus cancer, cardiovascular disease, stroke, emphysema, and chronic obstructive pulmonary disease (COPD).

If they were real people, the Virginia Slims woman and the Marlboro man would be dead by now. Indeed two of the actors who portrayed the rugged cowboy with the tanned, leathery face in Marlboro commercials died of lung cancer from smoking. The Virginia Slims commercial, You've come a long way, baby, is true. Women have caught up with men in lung cancer mortality, and more women now die of lung cancer than breast cancer.

No form of tobacco is safe to use; unfortunately, approximately 25% of cancer survivors smoke. The good news is that when smoking is stopped, the cancer risk is reduced even when smokers are over 50 years of age and even after a cancer diagnosis.

Secondhand smoke still remains a problem. The Surgeon General estimates that 126,000 nonsmoking Americans were exposed to secondhand smoke putting them at risk for cancer, cardiovascular disease, emphysema, and COPD. Children are at greatest risk at home when exposed to secondhand smoke.

In addition to disease risk from tobacco use and second hand smoke, the thousands of harmful chemicals in cigarette smoke reduce the lungs' ability to cleanse themselves, thereby lowering resistance to infection and increasing vulnerability to many illnesses.

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Of the 44.5 million current smokers, 70% want to quit. According to a National Institutes of Health (NIH) study, smoking cessation interventions, such as nicotine replacement therapy, telephone quit lines, and counseling could double or triple quit rates. Five minutes of a physician's advice on how to stop smoking can be very successful. Indeed, most people who do quit attribute a portion of their motivation to advice from their physician.

Smoking is a tough addiction to break because smokers develop both a physiological and a psychological dependence on nicotine - but it can be done. Of the ex-smokers in the United States today 95% kicked the habit on their own. Last year alone, one in every eight smokers stopped lighting up.

The best approach for smoking cessation combines pharmacologic and behavioral methods with counseling, stress reduction, and supportive treatments. Currently nicotine replacement therapy for nicotine dependence is the mainstay of therapy (chewing gum, tablets, skin patches, inhalers and nasal sprays) for replacement therapy for withdrawal symptoms to replace nicotine in the blood. Recently released drugs that block the nicotine receptors in the brain are also available.

Preparing to quit:
Designate your quit day a week in advance
Buy one pack of cigarettes at a time
Keep a daily record of each cigarette smoked
Smoke only when you strongly crave a cigarette
Wait five minutes after an urge occurs before lighting up
Don't smoke the last third of a cigarette - it's the most toxic part
Give up your cigarette lighters, cases and holders
Use nicotine substitutes instead of cigarettes
Focus on your role in protecting your body from the poisons of cigarette smoke - emphasize what you are for rather than what you are against

Information about cigarette substitutes is available at and at The most popular substitute materials are available in drugstores. Pharmaceutical supports for quitting are available by prescription from your physician.

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