Smokers Die Ten Years Sooner Than Non-Smokers (by María Valero)

We all know that smoking is bad for our health. But how bad is bad? The answer is very bad, life changing in fact. But everyone also knows someone who has smoked all their adult life, never gotten lung cancer or a respiratory disease of any kind and lived to a ripe old age. George Burns, the famous comedian, who lived to be 100 hundred years old, often remarked "I smoke ten to fifteen cigars a day. At my age I have to hold on to something".

So, true enough - but in the discussion ahead you will find that these individuals are very much the rare exception and certainly not the rule. It is important to know that, on average, smokers die twelve years sooner than non-smokers. Twelve years! That's more than a decade! It means life for smokers is more than ten percent shorter than for non-smokers. These are big numbers.

Is this just fear mongering or is there substance to such a statement? It is real. The data is in and it is very strong.

No other preventable cause of illness or death is more important than smoking. This is the clear message of two new studies that investigated the overall impact of smoking across a very large cohort of Americans. The studies, conducted by Jha et al¹ and by Thun et al ² along with an editorial by Schroeder³, were published by the New England Journal of Medicine on January 24, 2013. They support earlier studies that came to similar conclusions based on smaller numbers of observed individuals.

So, here are the facts of the matter. According to the National Cancer Institute (NCI), tobacco is the leading cause of preventable illness and death in the United States and that, in 2011, an estimated 19 percent of U.S. adults were cigarette smokers.⁴ This is down from over 40% a few decades ago. Good progress. But for those who do smoke, diseases leading to death are common.

Smoker's mortality rates are nearly 3 times greater than those of nonsmokers and essentially equal between men and women. People who smoke are up to six times more likely to suffer a heart attack than nonsmokers, and the risk increases with the number of cigarettes smoked. Cigarette smoking causes an estimated 443,000 deaths each year, including approximately 49,000 deaths due to exposure to secondhand smoke.

Smoking also causes most cases of chronic obstructive lung disease. Lung cancer is the leading cause of cancer death among both men and women in the United States, and 90 percent of lung cancer deaths among men and approximately 80 percent of lung cancer deaths among women are due to smoking currently or in the past. Certain diseases, such as ischemic heart disease (heart attacks and related coronary artery disease), stroke, chronic lung disease and lung cancer, have been clearly linked to smoking and were found to be the cause of death in approximately 60% of the smokers' in these studies.

Smoking causes or predisposes to many other types of cancer, including cancers of the throat, mouth, nasal cavity, esophagus, stomach, pancreas, kidney, bladder, and cervix, and acute myeloid leukemia.

The chance that a young person will live to age 80 is about 70% for nonsmokers but only 35% for smokers. Stated differently, a smoker loses about 11(women) to 12 (men) years of life compared to nonsmokers. Sadly, the NCI's 2011 report confirms that nearly 16 percent of high school students smoke cigarettes.

The vertical lines at 80 years of age represent the 99% confidence intervals for cumulative survival probabilities, as derived from the standard errors estimated with the use of the jackknife procedure. Survival probabilities have been scaled from the National Health Interview Survey to the U.S. rates of death from all causes at these ages for 2004,13,16 with adjustment for differences in age, educational level, alcohol consumption, and adiposity (body-mass index). Source: NEJM.

 The Thun Study

The Thun study compared data from three time periods reaching back 50 years. Overall, mortality rates during this fifty year period declined by 50%; largely as a result of the progress against heart disease. However, this was a benefit enjoyed solely by the nonsmokers.

Thun made some key observations:

• Smoking deaths continue to increase among women because women who smoke now smoke as much as men do


• Death from all causes is at least 3X higher for smokers than for nonsmokers with at least two thirds of all deaths in smokers directly related to smoking


• The rate of death from chronic lung disease (COPD) is rising among both men and women. They hypothesize that this rise in incidence is related to the changes in cigarettes over the years that encourage deeper inhalation; consequently delivering more toxins to the deep, peripheral regions of the lungs - the alveoli or air sacs.
  
  Using the same reasoning, they suggest that deeper inhalation than in the past may be causing the increased incidence of peripheral lung cancers, especially adenocarcinomas, versus the more centrally located and mostly squamous cell cancers that were more common in the past.


• Quitting smoking lowers death rates quite substantially and quitting before the age of 40 can eliminate the relative risk of early death.

Economic Implications

The economic realities of smoking do not stop there, either. The cost of smoking-related disease is a significant cost burden on the Gross Domestic Product of the US economy. Of the $2.2 trillion the US spends on health care, annually, $1.1 trillion of that spend is related directly to the cost burdens of chronic non communicable diseases. Of this $1.1 trillion cost burden pulmonary disease and lung cancer account for $154 billion. Nearly 15%! The cost of heart disease and stroke accounts for a $444 billion cost burden.

A quick extrapolation of the statistics from Thun et al and Jha et al would relate that smoking related diseases, associated with just lung, heart and vascular ailments, pose an economic cost burden to the US GDP in the hundreds of billions of dollars, annually. So, both the humanitarian and financial consequences of smoking and tobacco certainly cannot be overstated.

The Value of Quitting

It is well understood that tobacco is addictive and that smoking is easy to start and hard to quit. Many try each year only to go back on. If someone has smoked for a long time, does it make any difference or is it just too late? What value does quitting smoking have, if any in these circumstances? The answer is that quitting is exceptionally valuable and it is never too late to have a meaningful effect.

Those who quit smoking will gain back substantial years of life, with more years gained the sooner one ceases smoking. For example, in Jha's analysis, those who quit in the age range 25-34 reverted almost to the nonsmoker status - they gained back 10 years of life. Stopping between 35-44 years of age gained 9 years and between 45-54 years of age the gain was 6 years. So it is always a good time to quit.

The total and excess risks of death are shown for NHIS participants who continued smoking, as compared with those who quit smoking. CI denotes confidence interval. Source: NEJM.

 Quitting today is the single most important step a smoker can take to improve their health over the years to come. Some argue that if they quit they will gain weight and that will make them more susceptible to diabetes mellitus or coronary artery disease. A possibly logical argument, but the data is in - quitting may lead to some weight gain, but it is hardly enough to have a significant or serious impact and so does not - by far - overcome the benefits of smoking cessation. Moreover, it is an argument that fails in comparison to the extension of one's life.

Quitting is difficult. No question. Nevertheless, it is well worth it! The best approach is to use a combination of techniques all at once. Counseling by the patient's physician and augmented by a professional cessation counselor can have a major impact. Nicotine patches can help slowly and gently ease one off of the nicotine addiction. Support groups, whether they be real or virtual, in person or via social media can be very helpful; after all, each person in the group is going through the same difficult transition. Incentives help as well as a strong family and friends' support system. Workplace tobacco cessation programs are very useful and if one is not available many health departments can make a referral. The success of quitting goes way up when these and other techniques are used together, rather than just trying to quit "cold turkey" on one's own.

To assist an individual, the provider (physician, nurse, nurse practitioner) needs to follow the Public Health Service "5As" model:

1. Ask each patient if they smoke
2. Advise all smokers to quit
3. Assess the smoker's willingness to quit (readiness)
4. Assist with the quitting
5. Arrange appropriate follow-up contact both with the provider and others such as counselors

This all takes some time, but it is essential to high rates of success.

A concept called self-efficacy is important here. Those with low self-efficacy are those with low personal expectations that they will be successful at quitting. Their relapse rate is higher so they need to be identified early and offered special assistance.

Often not recognized by the general population is the value of smoking cessation before a surgical procedure. Smokers have higher rates of complications during and after surgery than do nonsmokers. For elective procedures many surgeons now insist on cessation for some month's pre surgery. This is a good idea which needs to be augmented post-surgery to prevent later relapse.

Fortunately, there have been active efforts for many years to warn of the dangers of smoking and to assist individuals to quit. However, smoking has become a stigmatized behavior so that those who smoke are shunned and those who develop smoking related illnesses like lung cancer are stigmatized ("you brought it on yourself") as well.

Lung cancer kills more women than breast cancer, but there is no "Pink Ribbon" Campaign or "Race for the Cure." Women have proven themselves to be the best advocates for a healthy society. Women's leadership in the fight against breast cancer has been the single best disease advocacy and funding initiative ever seen. The reality is that lung cancer killed 74,000 women in 2010 as compared to the 38,000 lost to breast cancer. Nearly twice as many women were lost to lung cancer in 2010 than breast cancer.

So, where are the voices? There is a compelling case to be made for a renewed focus on prevention and treatment of pulmonary disease and lung cancer, in particular. Over 96 million Americans have admitted to smoking for at least six months during their lifetime, an exposure rate that puts one third of America's population at least at some level of risk.

So, why be prejudiced toward those with pulmonary disease and lung cancer? The fact is that we are all paying for the cost burden of smoking on our society in real dollars and in real lives. There is a significant need for a nonjudgmental attitude toward those who are afflicted. Getting past the "blame game" removes the stigma and allows a more constructive approach to tobacco cessation and disease prevention and treatment.
( from :http://www.medicalnewstoday.com/articles/261091.php )