Cigarette Century

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Quitting requires motivation, an urgent reason for wanting to quit. Simply deciding that it’s a good idea is not enough, and smoking will always retain a powerful attraction. Surely we don’t smoke only because we are addicted. Smoking provides relaxation, mild euphoria, relief of tension, improvement in attention time and concentration. World War II memoirs often recall the pleasure of enjoying a cigarette after a long period of intense stress, and many surgeons who once smoked still remember the relief they felt when lighting up after a long, difficult operation. To what extent such relief and relaxation represent the alleviation of short-term withdrawal symptoms—fatigue, anxiety, irritability, and the like—is at least partly a matter of definition. In normal daily life, smokers develop a habitual pattern of motor activity that is familiar and reassuring, an ever-present support and a generally accepted way of reducing social tension.

 

Surgical removal of the lung, or an appropriate part of it, remains the only real potential cure for lung cancer, and then only when the cancer has not yet begun to spread. Unfortunately, spreading cancer cells may be impossible to identify before the operation and afterward can give rise to recurrence or metastasis, the transmission of the disease to a new site. As a result the surgeon can speak of having effected a cure only in terms of the passage of time. Lung cancer will generally recur within three years or less if it is to recur at all. Among all patients with a new diagnosis of lung cancer, not quite one in ten will live five years.

Of the other methods of treatment, radiation therapy retains a small potential for cure in selected cases where there has been no spread and when the tumor itself cannot be removed surgically. Of the four or five major types of lung cancer, one, small-cell carcinoma, is characterized by especially malignant behavior. Almost always widely spread when first discovered, it is usually not controllable by surgery but does respond to chemotherapy and radiation therapy, though only a bare few patients can be cured. The other types of lung cancer respond so poorly to chemotherapy that it is still not clear whether the treatment is of any benefit for them at all.

Probably no other human affliction besides AIDS depends so completely on prevention. Having risen from obscurity in our own century, lung cancer remains the number-one killer among all cancers. And despite all the sophisticated high-technology methods of treatment, the chances for today’s patient are really no different than they were for Dr. Gilmore sixty years ago.