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Women and Lung CancerDebra Roney, a 39-year-old
secretary in UMDNJ-New Jersey Medical School’s Department That really hit home for me. She’s about my age," says Roney, who felt frightened enough to finally do something about her smoking habit. She joined a group at the Tobacco Dependence Clinic (www.tobaccoclinic.org) run by UMDNJ-School of Public Health (SPH). Her step came not a moment too soon in view of the grim statistics. There’s an epidemic of lung cancer in women today, and cigarettes are the chief cause. Why are women being hit so hard by this disease at the same time the death rate for men is beginning to level off – and what can be done about it? The answers are complex. But a major new public health initiative in New Jersey offers real hope and help. YOU'VE COME A LONG WAY, BABY Experts blame the
lung cancer epidemic in women on key factors, including gender-related
smoking patterns. Smoking became popular with men in the early 1900s,
but didn’t catch on with women until about 35 years later. The smoking
rate in men began to level off in the 1960s, after the first studies showed
the link between cigarettes and lung cancer. Males continue to quit at
a higher rate than women today. "It takes Tobacco companies play a big role as well. They’ve fueled the popularity of cigarettes by marketing them to women as fashion accessories. We’re witnessing a rise in the use of cigarettes in movies right now. Some research shows women may also be more susceptible to lung cancer. They may develop the disease earlier and be more vulnerable to passive smoke. But these issues are controversial and unresolved. Surprisingly, however, the environment’s effect on lung cancer is overestimated, according to Aisner, who is also a professor of medicine at UMDNJ-Robert Wood Johnson Medical School (RWJMS). "We hear about radon in the basement, pollution in the air, asbestos in the schools, but the reality is that in the absence of cigarette smoking, these factors impact on lung cancer in a very minor way. On the other hand, the presence of cigarette smoking multiplies the impact of other carcinogens," he says. A nonsmoker who is exposed to asbestos has a zero to three times greater risk of developing lung cancer. The risk is 30 times greater for a smoker with the same exposure. That’s true of other carcinogens, too, according to Aisner. It’s the smoking in combination with something else that multiplies the risk.
PROGRAMS THAT WORK What does it take to attack it? Because lung cancer is preventable, progress is essential on three fronts, says Slade: (1) reduce cigarette usage among women; (2) halt the initiation to smoking among children (four out of five smokers began their habit as teenagers); (3) protect nonsmokers from second- hand smoke. "A combination of media programs, community efforts and treatment works best," says Slade. Such coordinated action in Massachusetts and California has already cut tobacco use significantly in those states in the last decade or so. Inspired by their success, New Jersey launched its own Comprehensive Tobacco Control Program less than a year ago. The anti-tobacco effort is funded by $30 million from the master settlement agreement between tobacco companies and 46 states. It includes the five components described below: Treatment Programs Over one million New Jerseyans smoke, according to the Depart- ment of Health and Senior Services. These programs are available to them free or for a small charge.
There is a clinic charge in many cases, but it is dependent on the ability to pay (and sometimes covered by health insurance). No one interested in quitting is turned away. Quitline. This free phone service for smokers who want to quit is funded by New Jersey, but housed in the Mayo Clinic in Minnesota. Call the toll-free number (1-866-NJSTOPS) to speak with a counselor. Quitnet. This Web site (www.njqui net.com) can act as your free "coach" to quit smoking. It offers an "ask the expert" feature and other information, plus a peer chatline for support. Media Campaigns An advertising campaign has promoted these resources through radio, newspapers, buses, billboards, targeted mailings to doctors, dentists, and hospitals, and other media. Community Partnerships "Many things influence smoking rates, including price, marketing, and availability of smoke-free spaces," says Slade. A coalition of organizations is working to change the environment in New Jersey, helping smokers to smoke less and protecting nonsmokers. One of them for example, New Jersey GASP (Group Against Smoking Pollution), helps restaurants go smoke free, offers a list of smoke-free restaurants online (njgasp.org), and helps towns pass ordinances for smoke-free beaches, parks, and other public areas. Youth Programs A big goal is helping young people quit smoking or refuse to start in the first place. A "Not for Sale" advertising campaign aimed at youth (which alerts young people that they can tell Big Tobacco that they’re "not for sale") is reaching over 90 percent of New Jersey teens. That’s also the rallying cry of REBEL (Reaching Everyone By Exposing Lies), the state’s youth anti-tobacco movement. Evaluation With the state dedicating substantial amounts of money to the initiative, evaluation is a cornerstone. A UMDNJ program run by Cristine Delnevo, PhD, assistant professor of health education/behavioral science at SPH, is the statewide evaluator for the comprehensive tobacco control program. It conducts surveys and otherwise measures the effects of tobacco in the state and the impact of interventions. In May 2001, the New Jersey Commissioner of Health and Senior Services released the program’s report, establisheing baseline measures of tobacco use, attitudes, and policies in the state. Among the findings: 19 more local tobacco control ordinances have already been passed; 145 more work places and 218 more restaurants have become smoke-free. Almost 2,300 smokers have turned to Quitnet, Quitline, or Quit Centers. The initiative is a major opportunity for public health advocates and for the entire state. Cigarette smoking shortens a woman’s life by an average 14 years, according to the surgeon general. It not only causes lung cancer, but coronary heart disease and a host of other conditions. Yet the smoking rate for women continues to rise. "With the new initiative, I think we’re going to make a difference," says Slade. It’s called saving lives. |
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The magazine of the University of Medicine and Dentistry of New Jersey |
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of
Physical Medicine and Rehabilitation, regularly took her smoking breaks
outside of University Hospital. About a year ago, she began to talk to
another woman she frequently saw smoking at the same time. Roney recalls,
"She came to the hospital for medical reasons, and we’d run
into each other having a cigarette near the hospital entrance. We became
friendly." Then Roney's smoking buddy suddenly stopped showing up.
Weeks later, when Roney saw the woman at the hospital, she asked where
she’d been. "I have lung cancer," she answered.
"Lung
cancer is now the leading cause of cancer death in women," says Joseph
Aisner, MD, (right), Associate Director for Clinical Sciences at The Cancer
Institute of New Jersey (CINJ). "It kills as many women as breast
and colon cancer combined." Almost 68,000 women will die of it this
year alone, according to the 2001 Surgeon General’s Report. (Lung
cancer also remains the leading cause of cancer death in men, although
it is beginning to slow.)
20
or 30 years of exposure before cancer occurs. So the epidemic of lung
cancer may have peaked for men, but not for women," says John Slade,
MD, (right), professor of health services and policy at SPH.
Despite
these alarming facts, about 22 percent of women in the U.S. smoke, including
30 percent of high school senior girls. According to "Smoking in
Women," a published report in the December 1998 issue of
the Journal of the American Osteopathic Association (JAOA), by Carman
Ciervo, DO, (left) and Loretta Mueller, DO, (right), 40 percent of young
women report using cigarettes as a weight-control aid. Ciervo, chair of
family medicine at UMDNJ-School of Osteopathic Medicine (SOM) and Mueller,
director of the University Headache Center at SOM, also point out that
many female adolescents initiate smoking to control weight. The result
is an enormous public health problem.
Quit
Centers. The School of Public Health's Tobacco Dependence Clinic
in New Brunswick is headed by Jonathan Foulds, PhD, (left), Director of
the UMDNJ Tobacco Dependence Program and an associate professor at SPH.
The university also runs a second clinic at Mercer-Trenton Addiction Science
Center in Trenton, under the direction of Douglas Ziedonis, MD, MPH, (right)
an addiction expert on the faculty of the Department of Psychiatry at
RWJMS. These clinics are among 15 (see sidebar, page 25) which offer treatment
for smokers. The Tobacco Dependence Program at UMDNJ also provides technical
assistance to 14 other clinics funded by the state, including training,
ongoing coordination, and consultation.