Lung Cancer Rates on the Decline

The rates of new lung cancer cases in the United States dropped among men in 35 states and among women in 6 states between 1999 and 2008 Among women, lung cancer incidence decreased nationwide between 2006 and 2008, after increasing steadily for decades.

The decrease in lung cancer cases corresponds closely with smoking patterns across the nation. In the West, where smoking prevalence is lower among men and women than in other regions, lung cancer incidence is decreasing faster. Studies show declines in lung cancer rates can be seen as soon as five years after smoking rates decline.

The report also noted that states that make greater investments in effective tobacco control strategies see larger reductions in smoking; and the longer they invest, the greater the savings in smoking–related health care costs. Such strategies include higher tobacco prices, hard–hitting media campaigns, 100 percent smoke-free policies, and easily accessible quitting treatments and services for those who want to quit.

“Although lung cancer among men and women has decreased over the past few years,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “too many people continue to get sick and die from lung cancers, most of which are caused by smoking.  The more we invest in proven tobacco control efforts, the fewer people will die from lung cancer.”

Lung cancer is the most commonly diagnosed cancer that affects both men and women, and is the leading cause of cancer death in the United States. Cigarette smoking and exposure to secondhand smoke cause most lung cancer deaths in the United States. To further reduce lung cancer incidence, intensified efforts to reduce smoking are needed.

For this report, researchers analyzed lung cancer data from CDC′s National Program of Cancer Registries and the National Cancer Institute′s Surveillance, Epidemiology, and End Results Program. They estimated smoking behavior by state using the CDC′s Behavioral Risk Factor Surveillance System.

Study findings include:

  • Among men, lung cancer rates continued to decrease nationwide.
  • From 1999 to 2008 lung cancer rates among men decreased in 35 states and remained stable in nine states (change could not be assessed in six states and the District of Columbia).
  • States with the lowest lung cancer incidence among men were clustered in the West.
  • After increasing for years, lung cancer rates among women decreased nationwide between 2006 and 2008.
  • Lung cancer rates decreased between 1999 and 2008 among women in California, Florida, Nevada, Oregon, Texas, and Washington.
  • Lung cancer rates among women remained stable in 24 states, and increased slightly in 14 states (change could not be assessed in six states and the District of Columbia).

Source: CDC

Smoking While Pregnant Raises Risk of Infant Heart Defects by Up to 70%

Maternal cigarette smoking in the first trimester was associated with a 20 to 70 percent greater likelihood that a baby would be born with certain types of congenital heart defects, according to a study by the Centers for Disease Control and Prevention. Congenital heart defects are the most common type of birth defects, contributing to approximately 30 percent of infant deaths from birth defects annually.

The study found an association between tobacco exposure and certain types of defects such as those that obstruct the flow of blood from the right side of the heart into the lungs (right ventricular outflow tract obstructions) and openings between the upper chambers of the heart (atrial septal defects). The study is in the Feb. 28 issue of the journal Pediatrics. [Read more…]

Nicotine Content In Womens’ Toenails Can Predict Heart Disease

The level of nicotine in womens’ toenails can predict the risk of coronary heart disease, say researchers from the University of California, San Diego.

By analyzing the nicotine levels in the toenails of more than 60,000 women, the researchers found that those who had suffered heart disease had on average twice the levels of nicotine in their toenails than women without heart disease.

“Using toenail nicotine is a novel way to objectively measure exposure to tobacco smoke, and ultimately, to increase our understanding of tobacco-related illnesses,” explained Wael Al-Delaimy, Ph.D., Department of Family and Preventive Medicine, UC San Diego School of Medicine. “It has advantages over using other biomarkers and could become a useful test to identify high-risk individuals in the future. This would be especially helpful in situations where smoking history is not available or is biased.”

Researchers found no difference in age, body mass index, aspirin use, or history of high cholesterol corresponding to the toenail nicotine levels. Women with the highest toenail nicotine levels were physically less active, had a lower body mass index, drank a higher amount of alcohol, and were more likely to have histories of high blood pressure, diabetes, and family history of heart attack than women with lower levels.

Why toenails? The toenails have an advantage over other existing biomarkers of smoking because they grow more slowly. The levels detected in the nails represent nicotine taken up from blood by nails during growth. The slow growth rates of toenails provide a more stable estimate of average exposure, which is most relevant for illnesses related to tobacco smoke, such as heart disease. Using toenail samples in epidemiological studies is also an attractive concept because they’re easy to collect and store for relatively low cost.

The study was conducted by researchers at University of California, San Diego, School of Medicine, in collaboration with colleagues from Harvard University, and published in the April, 2008 issue of the American Journal of Epidemiology.

Quitting Smoking Leads to Significant Reduction in Mortality Risks After 5 Years

Women smokers who quit reduce the risk of death from heart disease within 5 years, and their risk of any other smoking-related death by 20%, according to a recent study.

"Tobacco use remains the leading preventable cause of death in the United States. Globally, approximately 5 million premature deaths were attributable to smoking in 2000. The World Health Organization projects by 2030 that tobacco-attributable deaths will annually account for 3 million deaths in industrialized countries and 7 million in developing countries," the authors write. They add that the rate of mortality risk reduction after quitting compared with continuing to smoke is uncertain.

By analyzing data from the Nurses’ Health Study, an observational study of 104,519 female participants, with follow-up from 1980 to 2004, Stacey A. Kenfield, Sc.D., of the Harvard School of Public Health, Boston and his colleagues measured the relationship between cigarette smoking and quitting smoking on mortality in women. 12,483 deaths were recorded in this group, of which 4,485 (35.9%) had never smoked, 3,602 (28.9%) were current smokers, and 4,396 (35.2%) were among past smokers.

A 13% risk reduction in mortality from any cause within the first 5 years of stopping smoking (compared with continuing to smoke), with the excess risk falling to the level of someone who had never smoked 20 years after quitting.

According to the study, "Significant trends were observed with increasing years since quitting for all major cause-specific outcomes. A more rapid decline in risk after quitting smoking compared with continuing to smoke was observed in the first 5 years for vascular diseases compared with other causes."

In regard to coronary heart disease, 61% of the full benefit of quitting was realized within the first 5 years; similarly for cerebrovascular mortality where 42% of the potential benefit was realized within the first 5 years after quitting. Death due to respiratory disease showed an 18% reduction in risk within 5 to 10 years of quitting.

Lung cancer mortality showed a 21% risk reduction during the first 5 years compared with people who did not quit, but the excess risk remained for 30 years. Past smokers with 20 to less than 30 years of not smoking showed an 87% reduction in risk of lung cancer mortality compared with continuing smokers. The researchers also found that approximately 64 percent of deaths among current smokers and 28 percent of deaths among former smokers were attributable to cigarette smoking.

"Early age at initiation is associated with an increased mortality risk so implementing and maintaining school tobacco prevention programs, in addition to enforcing youth access laws, are key preventive strategies. Effectively communicating risks to smokers and helping them quit successfully should be an integral part of public health programs," the authors conclude.

Source: Journal of the American Medical Association (JAMA), April 7, 2008 – 2008;299[17]:2037-2047

Should Docs Recommend Smokeless Tobacco as Last Resort to Quit Smoking?

If people are unable to kick the smoking habit, are doctors justified in recommending smokeless tobacco such as Snus or other smokeless tobacco products? That is the question under debate in a recent article in the British Medical Journal.

More than 100,000 people a year in the UK die because of smoking, primarily from lung cancer, heart disease, and chronic obstructive pulmonary disease, says John Britton, Professor of Epidemiology at City Hospital, Nottingham. An estimated 77% of smokers want to stop smoking, and 78% have tried but failed because of nicotine addiction.

While the best course would be for health professionals to urge quitting all nicotine use, he suggests that switching to a medicinal nicotine product is the logical option for those who want to quit but repeatedly fail.

Dr. Britton suggests that if all else fails, doctors may want to recommend a smokeless tobacco product, such as Snus. He maintains that Snus would be acceptable as a measure of last resort. But it first needs to be tested, he says.

Meanwhile, Alexander Macara, President of the National Heart Forum, while allowing that smokeless tobacco is less addictive than smoked tobacco, quotes studies that show smokeless tobacco to be carcinogenic, with an increased risk of oral and pancreatic cancers and heart attacks. In addition, he says, 60% of people who use Snus become chronic Snus users.

Action on Smoking and Health and the Royal College of Physicians of London have reviewed safer sources of nicotine as a means of reducing the harm caused by smoking, but Macara is concerned that if products such as Snus are recommended as a means to quit smoking, its use may be adopted by more people, particularly young people, who might never have smoked in the first place.

Source: British Medical Journal (BMJ Volume 336 pp 358-9

FDA Warns of Possible Neuropsychiatric Side Effects to Pfizer’s Anti-Smoking Drug, Chantix (varenicline)

The U.S. Food and Drug Administration (FDA) has issued a Public Health Advisory to alert health care providers, patients, and caregivers to new safety warnings concerning Prfizer’s anti-smoking drug, Chantix (varenicline). The FDA’s "Early Communication" advises that the agency is evaluating adverse event reports on Chantix related to changes in behavior, agitation, depressed mood, suicidal ideation, and actual suicidal behavior.

As the agency’s review of the adverse event reports proceeds, it appears increasingly likely that there may be an association between Chantix and serious neuropsychiatric symptoms. As a result, FDA has requested that Pfizer, the manufacturer of Chantix, elevate the prominence of this safety information to the warnings and precautions section of the Chantix prescribing information, or labeling. In addition, FDA is working with Pfizer to finalize a Medication Guide for patients. This is an example of FDA working with drug manufacturers throughout products’ lifecycles to keep health care professionals and patients informed of new and emerging safety data.

"Chantix has proven to be effective in smokers motivated to quit, but patients and health care professionals need the latest safety information to make an informed decision regarding whether or not to use this product," said Bob Rappaport, M.D., director of the FDA’s Division of Anesthesia, Analgesia and Rheumatology Products. "While Chantix has demonstrated clear evidence of efficacy, it is important to consider these safety concerns and alert the public about these risks. Patients should talk with their doctors about this new information and whether Chantix is the right drug for them, and health care professionals should closely monitor patients for behavior and mood changes if they are taking this drug."

Chantix was approved by FDA in May 2006 as a smoking cessation drug. Chantix acts at sites in the brain affected by nicotine and may help those who wish to stop smoking by providing some nicotine effects to ease the withdrawal symptoms and by blocking the effects of nicotine from cigarettes if users resume smoking.

In the Public Health Advisory and a Health Care Professional Sheet that was also issued today, FDA emphasized the following safety information for patients, caregivers, and health care professionals:

Patients should tell their health care provider about any history of psychiatric illness prior to starting Chantix. Chantix may cause worsening of current psychiatric illness even if it is currently under control. It may also cause an old psychiatric illness to reoccur. FDA notes that patients with these illnesses were not included in the studies conducted for the drug’s approval.

Health care professionals, patients, patients’ families, and caregivers should be alert to and monitor for changes in mood and behavior in patients treated with Chantix. Symptoms may include anxiety, nervousness, tension, depressed mood, unusual behaviors and thinking about or attempting suicide. In most cases, neuropsychiatric symptoms developed during Chantix treatment, but in others, symptoms developed following withdrawal of varenicline therapy.

Patients should immediately report changes in mood and behavior to their doctor.

Vivid, unusual, or strange dreams may occur while taking Chantix.

Patients taking Chantix may experience impairment of the ability to drive or operate heavy machinery.

FDA will continue to update health care professionals with new information from FDA’s continuing review or if new information is received on Chantix and serious neuropsychiatric symptoms. FDA may consider requesting further revisions to the labeling or taking other regulatory action as the agency’s continuing reviews and conclusions warrant.

Source: FDA, February 1, 2008

Counseling Plus Medication May Help Teens Quit Smoking

A clinical trial of 312 teenagers aged 14 to 17 who smoked six or more cigarettes a day and had tried quitting at least twice, found that counseling and medication may help teens quit smoking, though in some cases (26-week time period), the placebo group had higher quit-rates than those taking the drug tested in the study, bupropion.

The subjects were divided into three groups and administered 150 milligrams (105 teens) or 300 milligrams (104 teens) of bupropion daily, or a placebo (103 teens).

Students received six weeks of treatment and one week of post-treatment, in addition to 10-20 minutes of individual counseling. Followup interviews were conducted by phone after 12 weeks, and in person after 26 weeks.

Quit rates were higher for the 300 milligram group every week except the fourth week. After six weeks, 5.6 percent of subjects in the placebo group, 10.7 percent taking 150 milligrams of bupropion, and 14.5 percent taking 300 milligrams of bupropion had quit smoking. At 26 weeks, 10.3 percent of placebo subjects, 3.1 percent of those taking 150 milligrams of bupropion, and 13.9 percent who took 300 milligrams were still not smoking.

The results indicate that although 300 milligrams of bupropion plus counseling were effective in helping teens quit smoking in the short term, quit rates at the end of the treatment were lower than for adults taking the same medication.

The high rate of relapse after medication stopped suggests the need for a longer treatment period than the 12 weeks recommended for adults may be needed.

"This study provides hope for helping a generation of smokers to quit before they become adults," the authors conclude. "These results are critically important because few effective treatment options are available for adolescent smokers who want to quit."

This study noted that fully one fourth of U.S. high school student currently smoke cigarettes.

The study was conducted by Myra L. Muramoto, M.D., M.P.H., Scott Leischow, Ph.D., and colleagues at the University of Arizona, Tucson, and supported by a National Cancer Institute grant, The Robert Wood Johnson Foundation (financial support for all aspects of the study) and GlaxoSmithKline (maker of bupropion).

Source: Arch Pediatr Adolesc Med. 2007;161(11):1068-1074

Smoking Hooks Kids Almost Immediately, New Study Shows

According to a study published in the July issue of the Archives of Pediatrics and Adolescent Medicine, 10% of 217 studied children who inhaled cigarettes "lost autonomy over their tobacco" use within two days of their first cigarette. Another quarter became addicted within thirty days, and a full half were addicted after smoking only seven cigarettes per month.

The conclusions contradict "conventional wisdom" which believed that it took multiple cigarettes (at least five to six) per day to become addicted to nicotine.

It isn’t long term use that causes addiction, a study author noted, but it is the addiction that causes the heavy use.

Archives of Pediatric and Adolescent Medicine 

Smoking May Lead to Early Menopause

Regular smoking has been known to cause more than 85 percent of all deaths due to lung cancer. It may also lead to many other types of cancer and a large array of other health-related issues.

According to BMC Public Health, early menopause onset, before the age of 45, is more than twice as likely in women who smoke heavily.

The study also looked at effects of passive smoking, alcohol, and coffee consumption and found that these activities do not have a significant effect on early menopause.

Anti-Smoking Drug Varenicline May Help Curb Drinking

A single pill appears to hold promise in curbing the urges to both smoke and drink, according to researchers trying to help people overcome addiction by targeting a pleasure center in the brain.

The drug, called varenicline, already is sold to help smokers kick the habit. New but preliminary research suggests it could gain a second use in helping heavy drinkers quit, too.