Examining the No. 1 cancer in the nation

By: George Sedlacek

On October 17, the Marquette Rangers hockey team and Marquette General Hospital teamed up for a fantastic evening of fundraising for breast cancer treatment programs. The public recognizes the significance of pink ribbons signifying the fight against breast cancer. There is another cancer out there that is even more prevalent in our community than breast cancer—one that doesn’t get a lot of ink, but is much more deadly. Lung cancer is the No. 1 cancer in the nation as well as in Marquette County.
From 2002 through 2006 (the most recent complete five-year data that we have), there were 265 cases of lung cancer diagnosed, with 208 deaths. By comparison, breast cancer had nearly as many cases, 242 but with far fewer deaths at forty-two. The best explanation is that breast cancer is very treatable if caught early, and most breast cancers are. Breast self-examinations along with mammography screening has been an overwhelming success.
Lung cancer is much more difficult to catch early. By the time symptoms begin to show, the cancer has progressed to a largely untreatable format. There are screening tools doctors sometimes use, but there haven’t been any large scale studies that prove screening for lung cancer is effective.
There is one thing lung cancer has going for it that breast cancer does not—and that is prevention advice. Smoking cigarettes is the largest risk factor for lung cancer, with between eighty to ninety percent of all lung cancers attributable to this one factor.
Lung cancer was very rare before the invention of cigarettes. The Marlboro cowboy is a myth. Very few cowboys smoked cigarettes because vending machines were not available on the more than 1,000 miles of open land these cowboys traveled herding cows. In the nineteenth century, tobacco was smoked by gentlemen only in the form of cigars. Cigarettes, basically the sweepings off the floor of the cigar factory, were only smoked by the very poor.
James “Buck” Reynolds was the first to see cigarette rolling machines in the late 1880s as an opportunity to bring smoking to the public in the form of mass-produced cigarettes. This machine from a public health viewpoint can be seen as something that led to the early deaths of literally more than a billion people, far more lethal than bombs, or other weapons of war.
As machines to mass produce cigarettes came in the 1880s, smoking cigarettes became more common, but the number of cigarettes smoked still was relatively small. Reynolds and other tobacco companies began to advertise cigarettes in ways that are common today. They simply paired the behavior of smoking cigarettes with activities that people enjoy doing.
One of the promotions somewhat backfired when companies began to put baseball cards into cigarette packs. The best known ball player in the first decade of the last century was Honus Wagner, the Flying Dutchman. Wagner arguably is the best baseball player of all time—Ty Cobb said so. Wagner was incensed that the tobacco companies would put his picture in with their cigs and sued them. The result was the companies destroyed all packs containing his photo except for sixty or so. (If you have a Wagner card that advertised the Piedmont and Sweet Caporal brands of cigarettes produced at Factory 25 in Virginia, as indicated by the factory stamp imprinted on the back of the card it’s now worth more than $400,000.)
In the early 1900s, lung cancer still was extremely rare. That was soon to change. World War I provided tobacco companies the chance to be both patriotic and develop a new ad campaign that would attract millions of people to use their product. General Blackjack Pershing himself said tobacco was as valuable to the war effort as food and bullets. Trench warfare was extremely boring with moments of “excitement”…ninety-nine percent of the time was spent waiting around for the moment the whistle blew to “go over the wall.” The tobacco companies did all they could to get cigs into every man’s rations.
John Harvey Kellogg of cereal fame was one of the lone voices against providing cigs to soldiers. He stated: “the millions of cigarettes fired at our soldiers’ will everyone hit its mark and do its mischief. More Americans will be damaged by the cigarette than by German bullets.” How right he was. My grandfather went to France barely over seventeen years of age. When he came back his hair was white. From my point of view, he became a casualty of that long-ago war when he died from emphysema caused by smoking. When these soldiers came back, all were addicted. Even more on the home front now used cigarettes, because after all, cigarettes helped our soldiers become fighters and not “shirkers.”
By the late ’30s and ’40s, lung cancer became a not-too-infrequent cause of cancer deaths. Doctors who learned about the extremely rare cases of lung cancers in the 1920s were seeing regular cancer patients by the 1950s. Even most doctors of that era smoked, and some even appeared in magazine ads about the soothing effects of Chesterfield cigarettes.
Since there is a time lag of approximately twenty to thirty years between the onset of smoking and the development of lung cancer, the damage done was not apparent immediately. Doctors were surprised to see a sudden epidemic of lung cancer cases in the 1930s. They quickly discovered the association between smoking and lung cancer. Large statistical studies in England and the United States in the 1950s (Doll and Hill, Cutler) proved beyond any shadow of a doubt that cigarette smoking markedly increased the chances of developing lung cancer. By the 1970s, lung cancer had gone from one of the rarest of cancers to the No. 1 killer cancer in the Western world
In the 1950s, Reader’s Digest began the first articles claiming the harmful effects of smoking as noted by many research scientists of the time who noticed that the rates of smoking nearly match the rise in lung cancer deaths after twenty to thirty years of use. That led to the First Surgeon General’s report on cigarettes and health in 1964. Since that time, major educational campaigns have led to a complete swing from most Americans smoking to less than one in four today.
In 1977, the American Cancer Society began the first Great American Smokeout. At that time, more than half of all adults smoked cigarettes, despite it being well known if you smoked “coffin nails,” you were much more likely to meet your maker sooner than wished. Around that same time, both my favorite uncle, a hard-living railroad worker, died at age fifty from lung cancer and grandmother, too.
I had a health education professor who required students do some community service. I somehow got drafted to lead the Campus Smokeout effort at Central Michigan University. That was the second annual smokeout in 1978. At that time, I didn’t realize I would spend nearly my entire career in public health working on this important health issue. I mean, if you knew you’d be cutting your life back almost ten minutes for every smoke, who’d do it? I figured that most people wouldn’t give it the time of day.
Today, when I give lectures to school kids, they don’t know that the Fred Flintstone TV show sold Winston cigarettes. After all “Winston tastes good like a cigarette should.” Most of these kids also never experienced the joy of secondhand smoke on a plane or even at home. Our tobacco rates today are less than twenty percent. This brings me back to lung cancer.
There are other causes of lung cancer than smoking. Radon, asbestos and other environmental pollutants are known to increase risks. A local doctor suggested we have a “gray ribbon” campaign for lung cancer. Dying from this disease is every bit as painful as other forms of cancer. Public perception that patients with lung cancer are to blame for their disease has created disparity with less common causes of cancer death that are relatively better funded.
Nearly half of patients with lung cancer diagnosed today are never-smokers or ex-smokers and many of them victims of secondhand smoking, particularly women. An effective fight against cancer of the lung will require prevention, early detection programs and early intervention. Research and more prevention work need to be done.
Something is not right when we’ve known about the dangers of secondhand smoke for more than twenty-five years. Michigan is one of the “unlucky thirteen” states that still does not protect its residents from the dangers of secondhand smoke.
The American Lung Association of Michigan has a Web page you can use to contact your legislators to let them know how you feel about this issue. Visit www.lungaction.org
And for gosh sakes, if you smoke, join in the thirty-third annual Great American Smokeout on November 19. The American Cancer Society Web site—www.cancer.org—has great information on how to quit smoking. For Upper Peninsula-specific information, visit www.smokefreeup.org
—George Sedlacek

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