Smokers: The formers versus the nevers

It is hard to imagine that the term "smoking" and "benefit" can be used in the same sentence, but in this week's blog, we present the results of some encouraging information suggesting that it is never too late to quit smoking. And in so doing, a "benefit" can occur — in terms of lessening the risk for lung disease, both cancerous and non-cancerous.

I have found that one gentle reminder to my patients about two items — obesity and cigarette smoking — is all that it takes to modify behavior. As a young physician, I often lectured about the evils of both, though obesity evils had not yet surfaced to the extent they have now. Now, I gently remind my patients of key facts about smoking, and based upon this new data, will simply encourage those who still smoke that quitting can be beneficial. Hopefully as time goes by, more of my patients will be "never smokers." But in any case, it's certainly better to be a "former" than a "current."

Here's an article from the July 2008 Harvard Health Letter that discusses the newest data on the benefits of quitting smoking. 

Former smokers now outnumber current ones in the United States, and, thankfully, one of the rewards for giving up the nasty habit is reduced risk for many smoking-related diseases. But the question has been by how much do the risks go down, and how fast. Findings published in the May 7, 2008, issue of The Journal of the American Medical Association suggest that former smokers do eventually catch up to never smokers, even when it comes to lung cancer.

The Harvard researchers who conducted the analysis compared the mortality rates of current, former, and never smokers in the Nurses' Health Study. Their findings about heart attack and stroke risk agreed with what others have found: The risks go down pretty fast. Five years after her last cigarette, a former smoker's risk of dying from a heart attack was about 60% less than if she was still smoking, and risk of dying from stroke fell by roughly 40%. And after about 20 years, her risk was down to the same level as the never smokers.

But research has suggested that it takes longer for the lungs to recover from a tobacco habit, which makes sense because the lungs come into direct contact with tobacco's carcinogens. Previous studies have found that even 20 years after quitting, former smokers' risk of coming down with chronic obstructive pulmonary disease (COPD) or lung cancer hovers slightly above that of their never-smoking counterparts. This study, though, found that the COPD risk fell to the never smokers' level after 20 years and that the lung cancer risk did so after 30. That's a long time to wait, but it's certainly something worth waiting for.

Although the Nurses' Health Study includes only women, Stacey Kenfield, a researcher at the Harvard School of Public Health and lead author of the study, believes that men are likely to experience similar declines in risk.

Of course it is best to have never smoked, but these findings strengthen the message that quitting is worthwhile, and the sooner, the better. Other research has shown that if you quit at age 60, you stand to tack on about three years to your life expectancy. Quit at 50, and you earn six added years. Quit at 30, and a whole decade is deposited into your life expectancy account. There's no better health deal around.

Marc Garnick, M.D., is an internationally renowned expert in medical oncology and urologic cancer, with a special emphasis on prostate cancer. He is a Clinical Professor of Medicine at Harvard Medical School and maintains an active oncology practice at Beth Israel Deaconess Medical Center. Dr. Garnick serves as Editor in Chief of Perspectives on Prostate Diseases, a quarterly report from Harvard Health Publications.

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