For me, and perhaps many of you, no place soothes my soul more than the sea - specifically the shore. I love the sand, the sun, the sound of the waves and the great, vast, body of water that looms before me. I am protective of my beautiful place - of the earth in general - and I most passionately and avidly promote tobacco free beaches, parks and trails.
If I could be responsible for passing one law - it would not be diet related - it would be one that led to Tobacco Free Beaches USA.
Today I heard a public service announcement from a Legacy Foundation and Leave No Trace Center for Outdoor Ethics partnership. The PSA was launched over a year ago, in honor of Earth Day 2013. I am sharing the PSA with you so you will consider joining in the effort to rid the earth of toxic cigarette waste. If you are a smoker, I hope you are like many I see who respect the earth and dispose of their butts responsibly (i.e., not out the car window or on the ground). {I have to add, if you are a smoker, quitting smoking is hard, but doable and it will change your life! Click here for help.}
Cigarette butts are not readily biodegradable; they don't break down and harmlessly evaporate into the air. The filters breakdown (after many years) into particles of a harmful plastic compound and the chemical components are absorbed into the soil or worse, children and or animals (dogs, cats, fish, etc) come into contact with the discarded cigarettes and are poisoned by them.
Please listen to the PSA by clicking on the arrow and to learn more, go to the rethinkbutts website here.
Showing posts with label smoking. Show all posts
Showing posts with label smoking. Show all posts
Sunday, October 12, 2014
Tuesday, January 7, 2014
Giving Smokers a False Sense of Security: New Lung Cancer Screening Guidelines
In December the United States Preventative Task Force completed its review of the available science on whether using a low dose CT scan could reduce the number of lung cancer deaths. Lung cancer is the most lethal cancer, likely due to its late detection. Treatment in late stage lung cancer is seldom successful, and is invasive (i.e., surgery, radiation, chemotherapy).
The task force members reviewed 6 effectiveness studies and 20 studies that explored adverse effects from low dose CT - including exposure to radiation, the rate of false positives and the associated stress and unnecessary procedures that follow false positives. You can read the summary and full report from the task force here.
It appears that only one of the studies that found a protective effect from low dose CT was of high quality. That study showed reduced lung cancer death as well as reduced death from any cause (all cause mortality) in the smokers who received the CT. The evidence from this study and several moderate quality studies was convincing enough to some to recommend the screening change.
I am addressing the issue in my blog for two reasons, 1) I have worked in the smoking cessation field and 2) I often post about medical radiation and my grave concern over excessive use of imaging. Almost four years ago, I wrote this post which was an over view of chapter 4 in the President's Cancer Panel report on Reducing Environmental Cancer Risk. Chapter 4 is Exposure to Hazards from Medical Sources. From that chapter we learned that CT scans are over used, that they expose the patient to high levels of radiation (higher levels than are necessary for the scans to be effective) and that the radiation dose from a CT scan can increase a person's risk for cancer.
The new recommendations are for physicians to offer the low dose CT (LDCT) to persons who are between the ages of 55 and 74 who have smoked 1 pack of cigarettes per day for 30 years or 2 packs per day for 15 years, or any other combination that would equal 30 pack years. If a person has this smoking history, but has quit smoking, they should still have the screens if they have been smoke free for less than 15 years. [Notice the significant screening criteria - SMOKERS only. To me this is as strong a declaration on the lethal consequences of smoking as one will ever hear.]
According to the task force, 20% more lung cancer deaths could be prevented if these heavy smokers were screened with LDCT instead of a chest x-ray. I do not know what this means in actual numbers, i.e., 20% of how many - how many do X rays find?
What I did spend time looking for was the amount of radiation a low dose CT provided. Recall from chapter 4, not all imaging machines deliver the same amount per test .. so a rough estimate is the best we can do. The estimate is that low dose CT delivers the radiation equivalent of about 15 xrays. Fifteen! Radiation in this case is measured as millisieverts, or mSv. A regular chest CT has 5 to 20 mSv and the low dose CT has 1 to 4 mSv. Better - still a heck of a lot and more than I would routinely expose myself to. (To be fair, some estimates of the radiation in regular chest CT suggest the equivalence of 350 Xrays... yes that is three hundred - so to answer my question; indeed, the low dose CT is a lower dose of radiation)
In the summary from the report, it is clearly stated that most lung cancer is caused by smoking and that the most important thing we can do to reduce death and disease from lung cancer is to reduce smoking.
I am really concerned that smokers will keep smoking because they believe that this screening will find a tumor in time to remove it. That is a HUGE risk. Click here to learn more about quitting.. I did it, so can you.
The task force members reviewed 6 effectiveness studies and 20 studies that explored adverse effects from low dose CT - including exposure to radiation, the rate of false positives and the associated stress and unnecessary procedures that follow false positives. You can read the summary and full report from the task force here.
It appears that only one of the studies that found a protective effect from low dose CT was of high quality. That study showed reduced lung cancer death as well as reduced death from any cause (all cause mortality) in the smokers who received the CT. The evidence from this study and several moderate quality studies was convincing enough to some to recommend the screening change.
I am addressing the issue in my blog for two reasons, 1) I have worked in the smoking cessation field and 2) I often post about medical radiation and my grave concern over excessive use of imaging. Almost four years ago, I wrote this post which was an over view of chapter 4 in the President's Cancer Panel report on Reducing Environmental Cancer Risk. Chapter 4 is Exposure to Hazards from Medical Sources. From that chapter we learned that CT scans are over used, that they expose the patient to high levels of radiation (higher levels than are necessary for the scans to be effective) and that the radiation dose from a CT scan can increase a person's risk for cancer.
The new recommendations are for physicians to offer the low dose CT (LDCT) to persons who are between the ages of 55 and 74 who have smoked 1 pack of cigarettes per day for 30 years or 2 packs per day for 15 years, or any other combination that would equal 30 pack years. If a person has this smoking history, but has quit smoking, they should still have the screens if they have been smoke free for less than 15 years. [Notice the significant screening criteria - SMOKERS only. To me this is as strong a declaration on the lethal consequences of smoking as one will ever hear.]
According to the task force, 20% more lung cancer deaths could be prevented if these heavy smokers were screened with LDCT instead of a chest x-ray. I do not know what this means in actual numbers, i.e., 20% of how many - how many do X rays find?
What I did spend time looking for was the amount of radiation a low dose CT provided. Recall from chapter 4, not all imaging machines deliver the same amount per test .. so a rough estimate is the best we can do. The estimate is that low dose CT delivers the radiation equivalent of about 15 xrays. Fifteen! Radiation in this case is measured as millisieverts, or mSv. A regular chest CT has 5 to 20 mSv and the low dose CT has 1 to 4 mSv. Better - still a heck of a lot and more than I would routinely expose myself to. (To be fair, some estimates of the radiation in regular chest CT suggest the equivalence of 350 Xrays... yes that is three hundred - so to answer my question; indeed, the low dose CT is a lower dose of radiation)
In the summary from the report, it is clearly stated that most lung cancer is caused by smoking and that the most important thing we can do to reduce death and disease from lung cancer is to reduce smoking.
I am really concerned that smokers will keep smoking because they believe that this screening will find a tumor in time to remove it. That is a HUGE risk. Click here to learn more about quitting.. I did it, so can you.
Sunday, September 9, 2012
Let's Make Prevention the Priority
At the end of August, the World Cancer Congress 2012 was held in Canada. The congress is a meeting of professionals - research and practice - that occurs every two years. The purpose is to share experience and knowledge to impact change in cancer occurrence and outcomes (death).
Once again, but with growing unity and urgency, people who study cancer in labs, communities and patients and those who treat patients, tell us that at the very least 50% of cancer can be prevented.
Prevented by what we do, what we are exposed to, whether or not we are immune to viruses (HPV, HCV, HBV) and the screenings we complete (PAP, sigmoidoscopy).
Graham Colditz, PhD, DrPH was one of the presenters. He notes smoking as the cause of 30% of all cancer and said that reducing smoking rates to 11% (like in Utah) would reduce smoking related cancers by 75%. He also noted that being overweight accounts for about 20% of cancers (and that to prevent cancer the BMI range should be between 21 to 23). Physical inactivity and poor diet ( defined as a diet that does not include the better foods in adequate amounts and does not limit others (salt, trans fat, sat fat, sugar) each cause about 5% of cancer and if improved would reduce the new cases of cancer substantially.
I have no doubt that this is true. Therefore, I have strong reservations on spending my money (donations) or the governments money to explore treatment/cures when we are doing nothing to stop the cases from coming. It is like this familiar health care story. Do we keep training EMTs, buying ambulances and expanding hospital ER rooms to treat drowning victims - or do we fix the hole in the bridge. Public health folks, like me, want to fix the bridge. {some people would do neither and just educate people to stop falling into the hole!}
I would like money to be spent on improving our environment so that eating well, moving more, consuming the right amount of calories, getting appropriate and evidence based health screenings and vaccinations is EASY. (even if this means some kind of regulation)
We are fools to keep treating things that we can prevent. (I in no way place blame on cancer or heart disease patients and I am not suggesting that we not treat their illnesses. [the pharmaceutical industry would never have that!] I just want to point out the futility on a population level. I see the environment and health care system as places to intervene, and when situations are truly conducive to good health, then I view personal responsibility as a possible nationwide focus.)
See more about the World Cancer Congress and the UICC here.
{note when looking at studies or speeches like this - there are two sets of numbers to explore - the percent of cancer that is accounted for by a factor and the amount that can be prevented if that factor is addressed}
Once again, but with growing unity and urgency, people who study cancer in labs, communities and patients and those who treat patients, tell us that at the very least 50% of cancer can be prevented.
Prevented by what we do, what we are exposed to, whether or not we are immune to viruses (HPV, HCV, HBV) and the screenings we complete (PAP, sigmoidoscopy).
Graham Colditz, PhD, DrPH was one of the presenters. He notes smoking as the cause of 30% of all cancer and said that reducing smoking rates to 11% (like in Utah) would reduce smoking related cancers by 75%. He also noted that being overweight accounts for about 20% of cancers (and that to prevent cancer the BMI range should be between 21 to 23). Physical inactivity and poor diet ( defined as a diet that does not include the better foods in adequate amounts and does not limit others (salt, trans fat, sat fat, sugar) each cause about 5% of cancer and if improved would reduce the new cases of cancer substantially.
I have no doubt that this is true. Therefore, I have strong reservations on spending my money (donations) or the governments money to explore treatment/cures when we are doing nothing to stop the cases from coming. It is like this familiar health care story. Do we keep training EMTs, buying ambulances and expanding hospital ER rooms to treat drowning victims - or do we fix the hole in the bridge. Public health folks, like me, want to fix the bridge. {some people would do neither and just educate people to stop falling into the hole!}
I would like money to be spent on improving our environment so that eating well, moving more, consuming the right amount of calories, getting appropriate and evidence based health screenings and vaccinations is EASY. (even if this means some kind of regulation)
We are fools to keep treating things that we can prevent. (I in no way place blame on cancer or heart disease patients and I am not suggesting that we not treat their illnesses. [the pharmaceutical industry would never have that!] I just want to point out the futility on a population level. I see the environment and health care system as places to intervene, and when situations are truly conducive to good health, then I view personal responsibility as a possible nationwide focus.)
See more about the World Cancer Congress and the UICC here.
{note when looking at studies or speeches like this - there are two sets of numbers to explore - the percent of cancer that is accounted for by a factor and the amount that can be prevented if that factor is addressed}
Friday, August 17, 2012
Another Choice for Smokers
With Australia on the books and the UK likely to follow, smokers now have label options among their choices. Actually, it is not going to be a choice but lets pretend that it is for my post. When buying cigarettes smokers can choose from:
Health experts use labels to dissuade people from smoking or to encourage them to quit. Warning labels were expanded with the Family Smoking Prevention and Tobacco Control Act of 2008 (they had to take up more space on the labels), but graphic pictures are due in 2014. Other countries have been using them for some time. The USA used the evidence from Australia and the UK to make a case for graphic messages in the 2008 law. The current CDC print and television ads are also graphic in nature.
Graphic labels are effective - but there are not VERY effective.
People who smoke have difficulty quitting due to the nature of nicotine addiction. But why do people even start? Why do thousands of adolescents try cigarettes every day and many become life long smokers. Currently 18% of high school students smoke. Read more statistics about youth smoking at the Tobacco Free Kids website here.
People start smoking when they are young - usually under the age of 18. Very few current smokers started after the age of 21. (I started when I was 15 and smoked 17 years. I have been quit 15)
Who is most susceptible to the promise of glamor, sophistication, popularity, success??? Youth. It is hoped that by making the cigarette packs plain there will be less of a branding effect. This change may lead to a true reduction in the prevalence of smoking.
We will have to wait a few years to test the effect of the Australia law - but it sure sounds reasonable in theory!
- reg(shorts) or 100s
- menthol or non-menthol
- mild or full flavored (aka light vs not light)
- graphic or Logo package
- graphic or brand(logo) or plain package
Health experts use labels to dissuade people from smoking or to encourage them to quit. Warning labels were expanded with the Family Smoking Prevention and Tobacco Control Act of 2008 (they had to take up more space on the labels), but graphic pictures are due in 2014. Other countries have been using them for some time. The USA used the evidence from Australia and the UK to make a case for graphic messages in the 2008 law. The current CDC print and television ads are also graphic in nature.
Graphic labels are effective - but there are not VERY effective.
People who smoke have difficulty quitting due to the nature of nicotine addiction. But why do people even start? Why do thousands of adolescents try cigarettes every day and many become life long smokers. Currently 18% of high school students smoke. Read more statistics about youth smoking at the Tobacco Free Kids website here.
People start smoking when they are young - usually under the age of 18. Very few current smokers started after the age of 21. (I started when I was 15 and smoked 17 years. I have been quit 15)
Who is most susceptible to the promise of glamor, sophistication, popularity, success??? Youth. It is hoped that by making the cigarette packs plain there will be less of a branding effect. This change may lead to a true reduction in the prevalence of smoking.
We will have to wait a few years to test the effect of the Australia law - but it sure sounds reasonable in theory!
Saturday, November 26, 2011
Spirometry
A year or two ago, I wrote a few passionate posts regarding smokers and the risk for COPD. Earlier this year, I wrote with similar passion when results from a national lung cancer screening trial suggested that smokers received CT scans as a measure to prevent lung cancer or lung cancer death.
My concern has always been the under use of the spirometer for lung function status. Forced Expired Volume or FEV is a measure of lung health (how much air can a person blow out in seconds). The value is used to determine if one has COPD. COPD is one of the leading causes of death in the USA. More smokers are effected by COPD than lung cancer and many cases of COPD go undetected and thus untreated. It is a devastating disease, but I have said all this in the past.
Today I am quite jazzed to report that a public service campaign is underway - I uncovered it by accident. The public service announcement or PSAs appear to be grounded in sports.
I am beyond thrilled to say that one of my favorite former NYGiants football players is part of the initiative.
When I did presentations regarding the medical consequences of smoking, I often had my audience jog in place while breathing through a straw. In the PSA I heard, Michael Strahan says that COPD is like breathing through a straw.
I found the website associated with the campaign and you can visit it here.
The campaign or awareness goal is to get people tested - this is grand. A lung function test is simple and cheap. Keeping a person with COPD from having exacerbations is essential in preserving lung tissue and lung function.
Tuesday, June 30, 2009
Lung Cancer Addendum
I want to revisit this just briefly today as I still worry over the confusion that follows a statement such as the one I read this weekend. "A majority (60%) of new lung cancer cases are in never and former smokers." It just sends the wrong message and could, if left unchallenged, derail some persons plans to quit smoking.
So again... 85% percent of lung cancer (NSCLC and SCLC) is directly related to cigarette smoking. The people who are diagnosed with lung cancer years after they quit smoking did NOT get it because they quit, but HAD IT when they quit.
Lung cancer most often begins in the bronchi or tubes of the lungs when cells change into precancerous lesions after coming into repeated contact with carcinogens in the tobacco smoke. (If you ever had a white patch in your mouth, which is referred to as leukoplakia, you can use that as a visual.
Lung tissue changes because of the assault or injury from tobacco smoke and if the cells become cancerous they will multiply incredibly fast. Cancer cells secrete or emit a chemical that creates new blood vessels that actually feed the cancer cells. NONE of this can be seen on an XRAY but it is happening just the same. When a tumor forms from these cancerous cells THEN it can be seen. Symptoms may come at that stage, but not usually before so.
The time it takes for the cells to change into cancerous cells is YEARS and because we have gone from a national smoking rate of 42% to a near 19% we have a LOT of former smokers. These people had lung damage when they stopped smoking they did not get lung damage because they quit.
In NSCLC the tumor is usually isolated and can be removed. In SCLC, the one that does not have many nonsmokers as victims, the spread is so fast and symptomless that treatment must involve drug therapy and the five year survival rate is less than 10 percent.
Many times a smoker will tell me that they had a lung scan and the doctor said that everything was just fine. Here is what I want these people to understand:
The xray or scan will show when you HAVE cancer not that your GETTING cancer.
A person who quits smoking will have at least 1/2 the risk of getting lung cancer after ten years as one who continues to smoke. I have been quit since 1997 and well, I just have to keep my fingers crossed and do everything else healthy that I possibly can.
I understand also that disease sometimes JUST happens but that means that I need to prepare my body for such a challenge by living as healthy a lifestyle that is in my power to live.
So again... 85% percent of lung cancer (NSCLC and SCLC) is directly related to cigarette smoking. The people who are diagnosed with lung cancer years after they quit smoking did NOT get it because they quit, but HAD IT when they quit.
Lung cancer most often begins in the bronchi or tubes of the lungs when cells change into precancerous lesions after coming into repeated contact with carcinogens in the tobacco smoke. (If you ever had a white patch in your mouth, which is referred to as leukoplakia, you can use that as a visual.
Lung tissue changes because of the assault or injury from tobacco smoke and if the cells become cancerous they will multiply incredibly fast. Cancer cells secrete or emit a chemical that creates new blood vessels that actually feed the cancer cells. NONE of this can be seen on an XRAY but it is happening just the same. When a tumor forms from these cancerous cells THEN it can be seen. Symptoms may come at that stage, but not usually before so.
The time it takes for the cells to change into cancerous cells is YEARS and because we have gone from a national smoking rate of 42% to a near 19% we have a LOT of former smokers. These people had lung damage when they stopped smoking they did not get lung damage because they quit.
In NSCLC the tumor is usually isolated and can be removed. In SCLC, the one that does not have many nonsmokers as victims, the spread is so fast and symptomless that treatment must involve drug therapy and the five year survival rate is less than 10 percent.
Many times a smoker will tell me that they had a lung scan and the doctor said that everything was just fine. Here is what I want these people to understand:
The xray or scan will show when you HAVE cancer not that your GETTING cancer.
A person who quits smoking will have at least 1/2 the risk of getting lung cancer after ten years as one who continues to smoke. I have been quit since 1997 and well, I just have to keep my fingers crossed and do everything else healthy that I possibly can.
I understand also that disease sometimes JUST happens but that means that I need to prepare my body for such a challenge by living as healthy a lifestyle that is in my power to live.
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