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Welcome to "Maryland Health Today."
I'm Ellen Beth Levitt.
Many health problems can be prevented,
and perhaps the best example of that is the connection between smoking and lung cancer.
More than 85% of lung cancer cases are smoking-related.
On the show today we'll talk with a chest surgeon who specializes in treating lung and esophageal cancer.
My guest is Dr. Richard Battafarano.
He's the head of thoracic surgery at the University of Maryland Medical Center,
and Dr. Battafarano is also an Associate Professor of Surgery at the University of Maryland School of Medicine.
Welcome to the show.
Thanks for having me.
Well, a lot of people have quit smoking over the years, but still more continue to smoke.
And I guess there are more and more young people who are taking it up every day, so it's still a major problem, right?
Yeah the fact that young people are smoking now is kind of discouraging
because we've known for over 40 years that association between not only cigarette smoking and lung cancer,
but also other diseases such as emphysema and heart disease.
But I think it's important for us to just keep getting the message out that smoking is not healthy for us
and that we have to do everything we can to help one another to stop it if we know a smoker.
And is lung chance the number one cause of cancer death among both men and women?
Yes, in men it's about 30% or 31%,
and then in women it's approximately 25% of all cancer deaths in women are from lung cancer.
And interestingly, lung cancer causes more deaths than breast cancer,
uterine cancer, ovarian cancer and cervical cancer combined.
So it's really a women's health issue and I think it's important that we do everything we can to help women,
if they are smokers, to stop.
And in terms of men, I know prostate cancer is a lot more prevalent than lung cancer.
But in terms of being a fatal cancer, lung cancer is the top one.
Oh, by far.
It's important too because, like I say, we should do everything we can for prostate cancer with screening
and things but it's important that we also remember that lung cancer actually kills many more men than prostate cancer.
Why is lung cancer such a deadly disease?
Well, I think there's two factors that are associated with it.
One is, by the time someone knows they have lung cancer they're either losing weight or coughing up blood,
often times the cancer is quite advanced whereas if it's down on the chest X-ray performed for another reason,
then the tumors are quite small and we have a chance to help them more fully.
The other thing is, is lung cancer tends to be a more virulent cancer, it tends to be more aggressive.
And for reasons that aren't completely clear, but many men can have prostate cancer that can grow slowly for years
and years and years where colon cancer can begin as a little polyp and then it may grow larger.
But lung cancer, it just seems to be that those tumors can grow more quickly
and also acquire that capacity to break off from the main tumor and travel either to the lymph nodes
or to other parts of the body.
Is that because of the way lung tissue is made up?
Well, I think it has something to do with that, is that when a cancer grows in the spongy part of the lung,
or the parenchyma of the lung,
it quickly has access to the lymphatics which carry fluid from the lung
back toward the center of the chest and to the heart.
And there's a number of lymph nodes that are connected to those lymphatic channels
that are along the path toward the center of the chest.
And so I do think that these cancers do have access to the lymphatics a little quickly --
or a little more quickly than in other parts of the body.
And we'll talk about treatments for lung cancer a little bit later on in the show,
but I wanted to ask you about smoking.
What is the rate of smoking in the United States now?
Well, the last check by the Centers for Disease Control
was approximately 21% of all Americans today are current smokers.
Here in Maryland we're doing a little better, it's about 19%,
but clearly we're not doing as well as California or Utah in which the smoking rates are much lower.
And it was the goal of the Centers for Disease Control
to actually get down to a prevalence of cigarette smoking in the country of about 10%.
And so you can see we have a long way to go before we reach that goal.
What about the trends in smoking?
Has there been a big drop-off in the last few decades?
Yeah, I think it was very, very common in the -- after World War II through about the mid-'60s.
But once the Surgeon General came out and said that smoking was bad for us,
associated with lung cancer and other diseases, I think many people got the message and stopped.
Unfortunately, there's been sort of a plateauing in the rates of smoking,
that is, there was a big drop-off in the early '60s when we know smoking was so bad for us.
But now again it's really been staying at about 20% of Americans smoking
and we have to do everything we can go try to get that lowered, get down to the 10% mark if we can achieve that.
What do you look at as far as what's most harmful?
Is it the number of years that you smoke or is it the number of cigarettes that you have smoked?
Well, really it's a combination of the two.
So if a person smokes a pack a day, which is a pretty common amount that a smoker will smoke,
if they smoke a pack of cigarettes per day for 20 years, when we take their history
and talk with them we'll call that a 20 pack year exposure.
If a smoker smokes two packs a day for 10 years, they also have the 20-pack year smoker.
Or if you smoke a half a pack for 40 years, it all comes up to that 20-pack year number.
The reason why that's important is we know that it's that combination of the number of cigarettes
and the number of years smoked.
The higher that number is, the more likely one is to develop not only lung cancer but emphysema or heart disease
or other diseases that we know are smoking-related.
Does quitting really make a difference in your risk of lung cancer?
Yes, because it automatically will decrease that number of pack years, which we know is associated with it.
But I think the other thing about it is,
is that it preserves the lung so that when you stop smoking it may be that your body has absorbed carcinogens,
or cancer-causing agents, that could lead to lung cancer in the future.
But at least you're not having more exposure and also the risk for emphysema
or other heart or vascular diseases goes down as soon as you stop smoking.
So it's important to stop.
So people who say, "Oh, the damage is already done."
The damage in that individual had been done,
but if they continue to smoke, it will only increase more.
So the idea is to stop this process as soon as we possibly can.
What happens in the lungs when somebody is smoking?
Well, first of all, the smoke it is hot and so I'm sure there's some injury just from the heat.
The byproduct of cigarettes contain carbon monoxide, which competes with oxygen,
so it makes it hard for our body to function properly.
And then those carcinogens probably combine with other byproducts in the smoke
actually injure the air sacs of the lung and that will lead to emphysema.
And part of that injury process allows the cells to be exposed to the carcinogens
that actually injure the DNA of the body, our genes, our genetic makeup.
And so that puts everybody who smokes at risk of ultimately developing cancer in the future.
That's interesting, so is there a genetic link?
Are some people more at risk of lung cancer because of their genetic makeup
or perhaps if they had a first-degree relative who had lung cancer?
Yes, any cancer history tells us that the body can make cancers in that family
or even sometimes in that individual person.
What happens is, the body has the capacity to actually repair the injuries caused by these cancer-causing agents.
But what happens is, if you get enough of those injuries it just kind of overwhelms the repair system
or it could be that some of these patients will have an inability,
that their repair mechanism isn't as efficient as others.
And that's something that we can sometimes see in families.
So I think when we talk to patients, we're interested is there a family history of any cancer, not just lung cancer.
You know, it could be a breast cancer in a mother, it could be prostate cancer in a father, colon cancer.
But also we have a number of patients who have colon cancer or breast cancer
that was caught early and they've done quite well.
But if they've been lifetime smokers then we know their body can make cancers.
You put 30 years of smoking on top of it, their lifetime risk of developing cancer is quite high.
All right, so they're more vulnerable.
Exactly.
Because clearly there are people who have smoked their whole lives who aren't going to get lung cancer, fortunately.
Absolutely and most people say that's not fair
because they'll see somebody they know who smoked like a chimney their whole lives
and have done everything wrong and they don't get cancer.
And then you have somebody how smoked for 20 years and stopped in their 40s
and now all of a sudden in their 60s or 70s they're dealing with lung cancer.
What is the role of second-hand smoke or the danger of second-hand smoke?
I know that's been somewhat controversial.
Well, I think, you know, being exposed to smoke is never good.
And we know that young children who grow up in a household with smoking parents
or other family members who smoke are more likely to have upper respiratory infections, they miss school,
some of them are being told they have asthma and reactive airway disease.
So we know that second-hand smoke is not good for us.
In persons who have maybe lived with a spouse who are heavy smokers
for over their whole lifetime, men or women who worked in bars
or restaurants in which they are exposed for long periods of time as part of their work to heavy cigarette smoke,
even flight attendants who for years were the flight attendants on transatlantic planes where there's smoking allowed,
you can see in some of those persons that they'll have changes of early emphysema for instance.
But it's harder to make a causal link between second-hand smoke and that person developing lung cancer
than it is for somebody who's smoking a pack a day, for instance, for many years.
Are there some other things that put you at risk for lung cancer?
Well, I think that --
I guess there are some industrial --
Right, people that -- organic chemists,
people who work with organic solvents, they're at increased risk but not just for lung cancer but other cancers.
So I think that there is some occupational risks, too.
Okay, well we have to take a break but when we come back we'll talk about detecting and treating lung cancer.
So stay with us.