8/26/17. Smoking Cessation and Cancer Prevention Jussuf T. Kaifi, MD, PhD, FACS Chief, Section for Thoracic Surgery. Cancer in the United States

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1 Smoking Cessation and Cancer Prevention Jussuf T. Kaifi, MD, PhD, FACS Chief, Section for Thoracic Surgery Cancer in the United States CDC and ASCO: Cancer leading cause of death in 22 states In 2033: Cancer No.1 cause of death 1,688,780 new cancer cases in 2017 US population: million in 2016 Cancer in the State of Missouri New cancer cases 2017 in Missouri: 34,400 Missouri population in 2016: 6.09 million 1

2 Cancer-related Deaths: Estimates 2017 Lung cancer: #1 Cause for Cancer-related Deaths Siegel et al, Cancer Statistics CA Cancer J Clin 2011 Costs of Cancer Care in the US $88 billion were spent for cancer care in 2014 Cardiovascular care: $315 billion Total Health Care Spending Budget in 2017: $1,592 billion Tobacco advertising 2014 in US: $9 billion Medical Expenditure Panel Survey (SEPS) Government of the United States of America 2

3 5-year survival rates: : 48.9% to 66.7% in 2003 (SEER database by NCI) Cancer Deaths Attributable to Smoking Adults >35 years, US 2011 Cigarette consumption : 1 st report of smoking and premature death (Pear) 1941: Relation of smoking and lung cancer (Ochsner and DeBakey) 1964: Surgeon General of the United States: cigarette smoking is major cause of lung cancer 3

4 Cigarette smoking 2016: 258 billion cigarettes sold in the US 50 pack years: 365,000 cigarettes Missouri: $5.64/pack (=20 cigarettes) (8 th cheapest State) 75 pack years: $154,395 expense Cancer Prevention Cancer prevention: active measures to decrease the risk of cancer Cancer is considered as a largely preventable disease It offers the most cost-effective long-term strategy: 40% of cancers are preventable Levels of Prevention 4

5 Secondary prevention = Screening Breast: mammography Cervix: Pap smear, HPV DNA test Colorectal: colonoscopy Lung: low-dose CT Prostate: PSA level Melanoma: skin exam Impact of Celebrities on Secondary Prevention Celebrity cancer diagnoses promote cancer screening (Noar et al., 2013) President Ronald Reagan's colon cancer diagnosis: 400% increase in calls to a national colon cancer hotline (Brown and Potosky, 1990) Kylie Minogue's breast cancer diagnosis: 40% increase in mammography appointments (Chapman et al., 2005) Most-studied risk factors for cancer Age Alcohol Cancer-Causing Substances Chronic Inflammation Diet Genes Hormones Immunosuppression Infections Obesity Radiation Sunlight Tobacco 5

6 Cancer prevention 20% of cancers in the US are due to combined effects of alcohol consumption, poor nutrition, physical inactivity, obesity Adults following healthy lifestyle: 10-20% less likely to be diagnosed with cancer, 20-30% less likely to die from it Vitamin and dietary supplements have not been shown to prevent cancer World Cancer Research Fund Preventable risk factor: Obesity Obesity: Prevalence in US adults years: 38% Increases the risk of 13 cancers: Uterine corpus Esophageal adenocarcinoma Stomach (gastric cardia) Liver Renal cell Meningioma Multiple myeloma Pancreas Colorectal Gallbladder Ovary Breast (postmenopausal) Thyroid Also evidence that risk of recurrence & survival is negatively impacted (International Agency for Research on Cancer) Primary surgical prevention: Bilateral mastectomy (BRCA1/2 mutation: 60% risk) Prophylactic salpingo-oophorectomy (BRCA1/2 mutation, family history: >30% risk) Total colectomy (Familial adenomatous polyposis: APC gene mutation: 93% by age 53) Total gastrectomy (hereditary diffuse gastric cancer; CDH1/E-cadherin mutation: up to 83% risk) 6

7 Physical activity and healthy diet 150 min moderate-intensity, 75 minutes vigorous-intensity activity each week, or an equivalent combination, preferably spread throughout the week Healthy diet: quantity, limit red and processed meat, 2.5 cups of vegetables and fruits each day, whole grains instead of refined-grain products American Cancer Society 2017 Balance as a primary prevention Risk factors and cancer: statistical association My father: 86 years old Doctors will find something on me to make money No major medical issues Born and raised on a farm in India >30 py smoker, stopped in his 50ies Drinks 1 glass of Whiskey and a beer every night Regular and balanced habits: 3 meals a day, daily walks, socially active, travels Paracelsus ( ): Father of Toxicology Swiss pioneer physician and alchemist of the Renaissance The dose makes the poison. (The Louvre, Paris) 7