FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

20 "PACK YEARS" = HIGH CANCER-RISK TERRITORY

Question: I'm worried. Three of my friends have been diagnosed with lung cancer in the last six months. Is lung cancer increasing, and what are the signs of having it?

Answer: Lung cancer is a deadly killer. For the last three decades it has been the leading cancer killer of men, and it has recently displaced breast cancer as the leading cause of cancer deaths among women. Each year in the United States there are more than 100,000 deaths from lung cancer. So as you suggest, lung cancer is more frequent than it once was.

Lung cancer, including its several sub-types, is related to exposure to specific hazardous substances. As an example, exposure to asbestos fibers can cause an uncommon cancer of the lung called mesothelioma. But the most common hazardous material that causes lung cancer is a drum role for emphasis please tobacco smoke!

There have been many scientific studies that clearly show a person's exposure to tobacco smoke is the best predictor of his or her chances of getting lung cancer. The number of years of smoking, the amount smoked, and the tar and nicotine content of the cigarettes are all important in determining lung cancer risk. Even second-hand smoke increases the risk of dying from this terrible killer.

All tobacco companies and about half of the smokers I talk to try to refute these studies claiming that tobacco doesn't "cause" lung cancer because all smokers don't get it. In the strictest interpretation, they are correct. The relationship is more complicated than simple "cause" and "effect." However, the risk of developing cancer in an individual that smokes is irrefutably increased. If you desire to die of lung cancer smoke tobacco! If you smoke now and would like to live a little longer stop smoking today.

Now let me verbally climb down from this "anti-smoking" pulpit and answer more of your question. The symptoms of lung cancer are rather vague when the cancer is small. There is usually a general lack of energy accompanied with just feeling run down. There may be a slight cough or occasional mild episodes of chest discomfort. As the cancer increases in size, the coughing becomes more prominent. It is also common to cough up blood-colored mucus. As the cancer continues to enlarge and spread to other areas, a wide variety of other symptoms can develop.

Since there is no one specific symptom of lung cancer, it is wise for all smokers to have yearly physical exams. This is increasingly important as the amount of smoking exceeds 20 "pack years." (A pack year is one pack per day for one year, two packs per day for one-half year, a half pack per day for two years, etc.) A careful history, a chest X-ray, and a doctor and patient worried about lung cancer are the most effective tools for early diagnosis of lung cancer.

If you don't smoke and have little exposure at home or work to second-hand smoke, your risk of lung cancer is probably low. However, there are other hazardous chemicals, such as asbestos, that need to be considered when determining your risk. I recommend that you talk with your family doctor specifically about your risks and also about changes you can make to lower them.

For more information on lung cancer and other lung diseases, write to the American Lung Association at 1740 Broadway, New York, N.Y. 10019-4374.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.