Quote of the Week

Number One Cancer Killer - Lung Cancer
I recently received two periodicals dealing with National Cancer Statistics. One was a reprint of The Annual Report to the Nation on the status of Cancer, 1973-1996 in Oncology and Economics Vol. 1, No. 1. This actually was their premiere issue. The other was CA the May/June 1999 issue of the American Cancer Society's Journal which reported World wide Breast Cancer Statistics. I do not want to bore you, but I do think some of these are very interesting and some very disturbing.

The good news is for the period 1990-1996 the incidence for Cancer at all sites except Non-Hodgkin's Lymphoma, Melanoma of the Skin, and Female Lung Cancer has declined. Likewise the Annual Percent Change (APC) in U.S. Cancer Death Rates is down except for, there again, Non-Hodgkin's Lymphoma and Female Lung Cancer. They did not list Melanoma of the skin. These statistic are for all ages, sexes, and ethnic groups.

Let's look at the Number One Cancer Killer - Lung Cancer. It is one of the top four incidence sites for each racial and ethnic group. The incidence varies widely among ethnic groups. There is a high of 73.9 per 100,000 among blacks compared to 27.6 per 100,000 for Hispanics. The rate for American Indians and Alaskan Natives is only 29.7 per 100,000 however there is a wide variation geographically. It goes from a low of 10.3 per 100,000 for Indians of New Mexico to 76.4 per 100,000 among Indians in Alaska. The death rate for Lung Cancer in Kentucky is 103.4 per 100,000 for all males and 41.9 per 100,000 for all females. The total is 67.9 per 100,000 both sexes and all of these figures are the highest in the U.S. for any state.

The Tobacco Smoking percentage for males in Kentucky is 33.1% and 28.7% is the rate for females. The percentage for males in Kentucky is the highest compared to other states. Whereas the rate for females is second to Nevada. It does not take a mathematical genius to see the relationship between smoking percentages and LUNG CANCER DEATH RATES in Kentucky. The future does not look good for Kentucky either, considering that their adolescent smoking percentage is likewise the highest in the Nation both for males and females, 48.4% and 45.3% respectively. THIS IS HIGHER THAN THE ADULT. Hopefully they are addressing this problem.

About 90% of lung cancer is caused from tobacco smoking - either cigarette, pipe, or cigar. Other causes are exposure to second hand smoke, radon, and asbestos. In the early part of the 20th century, lung cancer was rarely seen. The meteoric escalation of the incidence is directly related to the increase in the use of manufactured cigarettes. The per capita consumption of cigarettes has risen from 54 per adult in 1900 to 4,345 per adult in the peak year of 1963. The rate of cigarette smoking in females lagged behind that of men until it reached a peak of 55% among females born between 1935 and 1944. Earlier in the 20th century women started smoking at an average age of 30 whereas the majority of teenage female smokers began after World War II. Age at the onset of the tobacco habit dictates lifetime patterns. Since Nicotine is so addictive it is difficult to stop the habit. The death rates associated with smoking are reflected 20 to 50 years after starting the habit and that is one of the reasons that it is so distressing to see teenage smoking rates as high as those in Kentucky and in the rest of the US.

The overall decline in the incidence and mortality of Cancer in the U.S. is encouraging, but there is room for improvement - especially in the field of prevention. Since LUNG CANCER makes up 14% of new cancer diagnoses in the U.S. each year and 28% of cancer deaths per year this would be a good place to start especially knowing the cause and effect in that cancer as opposed to speculation as to the causes of other type cancers.

What can be done to correct this problem? I am going to quote from the feature article in Oncology Economics Vol 1, No. 1, which as I already alluded to is the source of the preceding statistics. "Start programs and policies that deter smoking initiation, promote cessation, and protect nonsmokers from environmental tobacco smoke. Efforts to prevent initiation include; 1)reducing minors access to and the appeal of tobacco products; 2)widely disseminating effective school-based tobacco use prevention curricula, which would be optimally combined with community and media-based strategies; and 3)increasing the support and involvement of parents.

"Others are: 1)Raising the cost of tobacco products; 2)using excise taxes to finance community and mass media strategies; 3)reimbursement by health care insurers and managed care organizations for safe and effective quitting programs; 4) smoke free laws and policies; 5)stimulate health care professionals to continue to monitor the patterns, determinants, and consequences of tobacco use; 6)continue to monitor tobacco product manufacturers regarding marketing practices and quality."

     Ed.I think the greatest inroads can be made by an innovative school-based program. A way to make the use of tobacco products "un-cool" is needed. Teenagers do not respond to the cancer scare because they say they will stop before it's a problem. They don't realize the extreme addictiveness of nicotine. Increasing the price so that tobacco products are not affordable may help, but then there is the risk of criminal black-marketing. It won't be easy but that should not deter the challenge.

"Tobacco, divine, rare, superexcellent tobacco, which goes far beyond all their panaceas, potable gold, and philosopher's stones, a sovereign remedy to all diseases...But, as it is commonly abused by most men which take it as tinkers do ale, is a plague, a mischief, a violent purger of goods, lands, health, hellish, devilish, and damned tobacco, the ruin and overthrow of body and soul."
     - Robert Burton (1577-1640), Anatomy of Melancholy, ptII.

Take care until next time,
RJT, Editor.

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