ABC News' Dr. Tim Answers Questions About Smoking

Nov. 9, 2005 — -- Question: There is a lot of emphasis on lung cancer, but what about cancer of the throat, mouth, etc.? Is that a lesser cancer from smoking? My mother smoked for over 50 years and when she was 78 developed throat cancer. At 86, she's smoke and cancer free, but I have to wonder why her lungs were never affected.
-- Emily Stuart, Kansas City, Missouri

Answer: Smoking causes both lung cancer and head and neck cancer as well as other forms of cancer. Head and neck cancer is less common than lung cancer, so it gets a lot less press. We don't know why some patients smoke and never get any form of cancer, while others develop lung and/or head and neck cancer. It might relate to their genetic make up and their ability to repair the genetic damage done by cigarette smoke.
Source: Dr. Carol Bradford, director of Head and Neck Oncology at the University of Michigan Comprehensive Cancer Center

Question:I have three questions. I quit smoking five months ago after a lobectomy that found early limited stage small cell lung cancer that had not spread thank God. I just finished chemo and doctors say my cancer is cured. Now, however, they want me to have preventative brain radiation.
1) Is this worth the neurological risks? I was lucky to have found this 7mm tumor early because of a CT scan for another reason.
2) Should people who are high risk (i.e. smokers) have screening CT scans? I know it saved my life.
And finally, I've seen advertisements for quit smoking aids that include anesthesia where they say that anesthesia helps quell the urge to smoke. I know each time I've had surgery, I've had no urge to smoke. And after my thoracic surgery this summer, it was much easier for me to completely quit. 3) Does anesthesia help people quit smoking? Thank you.
-- Susan Willey, West Palm Beach, Fla.

Answer: #1: Brain radiation is recommended after curative treatment for small cell lung cancer due to the high risk of the cancer spreading to the brain. Research has proven a decrease in spread to the brain and an improvement in survival with the addition of brain radiation. That said, the decision to proceed with brain radiation must be made on an individual patient basis based on the person's potential benefits and the risks of side effects. In people who are elderly or who have underlying neurologic problems the risks of brain radiation need to be considered very carefully.

#2: To date there is no evidence that screening for lung cancer with CT reduces lung cancer mortality. All of the research studies to date have shown that CT finds small spots on the lungs in up to half of all patients, the great majority of which ARE NOT cancer (99%). Most of these nodules are less than 7-8 mm, and for these there is not much we can do to figure out which are cancer and which are not, so patients end up getting multiple CTs over the next 2-3 years to prove they are not growing, which means extra radiation. The ongoing National Lung Screening Trial has enrolled over 50,000 people to see if CT reduces lung cancer mortality. It will take time to get the results.

#3: It is likely that you quit because of the psychological trauma of being told you had cancer and the significant physical trauma of undergoing chest surgery, rather than from the anesthesia itself. Several medications can help people quit smoking in the short term, but long term quitting requires a committment that can only come from wanting to quit.
Consultation: University of Michigan Comprehensive Cancer Center

Question: I quit smoking two months ago, but I fear the damage that I may have already done to my lungs. What should I look out for and are there any tests I should have done to make sure that I'm OK?
-- Naomi Barbee, Philadelphia

Answer:The damage that exists is likely to be related to the amount and duration of your smoking. If you were smoking daily for twenty or more years then you have increased risk of heart and lung disease and several cancers. A cardiac exercise stress test and an echo to look for abnormalities in your aorta would help discover latent disease in the cardiovascular system, and lung function studies can determine whether there has been clinically significant lung damage.
Consultation: U.C. San Diego Cancer Center

Question: I am a healthy male 59 years old. I smoked over a pack a day for 13 years from age 18 to 31. Have I outlived the ill effects of having smoked? What are the chances of lung cancer? Increased risk of heart disease? Any tests or other things that I can do to monitor these health conditions beyond annual physical?
-- Jack Richardson, Orange Park, Florida

Answer: Your decision to quit earlier in life has been a very important one both because disease risks decline relative to continuing smokers with increasing duration of smoking and because your duration of smoking was relatively short decreasing your exposure to the toxicants and carcinogens in smoke. At this point in time your risk of heart disease is similar to that of someone who has never smoked and your risk of lung cancer is only about 5% (as opposed to 1000% had you continued to smoke) greater than that of a never smoker. If you do not have respiratory problems currently, it is unlikely that you will develop cigarette related lung disease in the future. Since your risks are so close to those of a never smoker no additional testing would be necessary because of your past smoking unless you have respiratory symptoms where lung function studies might be helpful. As always, these are individual decisions which you can discuss with your physician at the time of your annual physical so that your concerns can be addressed more specifically in that setting.
Consultation: U.C. San Diego Cancer Center