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

New Drug (Daliresp) to Treat COPD Approved

The U.S. Food and Drug Administration approved roflumilast (Daliresp), a pill taken daily to decrease the frequency of flare-ups  or worsening of symptoms from severe chronic obstructive pulmonary disease (COPD).

COPD is a serious lung disease that makes breathing difficult. Symptoms can include breathlessness, chronic cough and excessive phlegm. An exacerbation can last up to several weeks and result in lung function decline, increased risk of death, and may be associated with severe anxiety.

Cigarette smoking is the leading cause of COPD, according to the National Heart, Lung, and Blood Institute. COPD is the fourth leading cause of death in the United States. [Read more…]

Medicare Patches and Hotline Help Seniors Quit Smoking

Seniors trying to quit smoking can be helped by Medicare-supplied nicotine patches and a Medicare hotline, according to new research conducted to estimate the cost of such a Medicare program. The study revealed that close to 20% of seniors who tried the program quit smoking for a year.

“From a public health perspective, it works,” said study lead author Geoffrey Joyce, a senior economist with RAND, which provides research services to the government. While most antismoking efforts focus on younger people, “Nobody has really paid attention to the elderly,” Joyce said.

Even inveterate smokers among seniors can benefit from quitting: a 1986 study showed that a senior who smokes 20 or more cigarettes a day and quits at age 65 could expect to add two to three years to his or her life.

The question being asked by Medicare meanwhile was—is it cost-effective to help seniors quit smoking? This new study was published in the current online issue of the journal Health Services Research.

7,354 seniors participated in the study, and all had enrolled in smoking cessation programs in 7 states between 2002 and 2003. The researchers divided the seniors into 4 groups—one group was given a brochure on smoking cessation; one group was paid for four counselling sessions with doctors; another group was given counseling and a nicotine patch, or the smoking-cessation drug bupropion. Thje last group used a nicotine patch and a hotline.

The one-year quit rates for the first three groups were 10%, 14% and 16%. For the last group the rate was 19%, and participants did not tuch cigarettes for the ensuing year.

Joyce said the difference between the 10 percent quit rate in the brochure group and the 19 percent quit rate in the hotline and patch group was significant: “You can double quit rates with a telephone quitline and a free patch.” Helen Ann Halpin, director of the Center for Health and Public Policy Studies at the University of California at Berkeley, said the study results suggest that “older smokers are motivated to quit and that quitlines and pharmacotherapy greatly increase the odds of successfully quitting.” She added that all 50 states now have a quitline for smokers of all ages.

As for Medicare’s need for cost-effective care, “what we don’t know is how much money this really saves if saving money is your goal,” Joyce said. Still, it seems clear that “if you just look at it from a strict budget perspective, it’s not going to save Medicare a lot one way or another.”

Source: Health Behavior News Service, August, 2008

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

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

Surprising Statin Finding: Slowing the Decline in Lung Functioning

In a recent paper published by the American Thoracic Society (October 2007), the use of statins appears to slow down the rate in which lung function declines in the senior population. More surprisingly, the decline decrease also is evident in smokers.

The researchers postulate that statins’ known anti-inflammatory properties (along with antioxidant properties) cause this effect.

Dr. Joel Schwartz, the lead researcher on the study, and a professor of environmental epidemiology at Harvard School of Public health, points out that his study shows the importance of "a possibility of reducing the rate of decline."

The primary indication for prescription of statins such as Lipitor and Zocor is for the treatment of high cholesterol.

Source: American Thoracic Society  

Cardiologists Call for New Approach in Treating Chest Pain

In a joint statement by the American College of Cardiology (ACC) and the American Heart Association (AHA), physicians are calling for a more aggressive approach to evaluating patients presenting with chest pain (unstable angina)—and quickly determining whether the therapeutic approach should be medical, invasive or a combination of two.

Guidelines released today by the ACC encourage the early use of tests such as a stress test, an echocardiogram or a radionuclide angiogram (which visualizes the coronary arteries) in patients considered stable.

Cessation of smoking, lowering blood pressure, and lowering cholesterol are all part of the effort to lower the risk of heart attack.

The new guidelines call for an LDL cholesterol to be lower than 100 mg/dL, with a target number of 70 mg/dL. Blood pressure should be lower than 140/90.

A significant new recommendation is the guideline to cease prescribing hormone replacement therapy (HRT) for post-menopausal women.

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