Point of View

Here's to a smokeless New Year

December 2, 2011 

— As we approach the New Year and think about resolutions to improve our health, perhaps as a state we should resolve to address the major cause of cancer in North Carolina. Thirty years after the Surgeon's Report on Tobacco and Cancer, more North Carolinians (men and women, blacks and white, seniors and adults) still die of lung cancer than prostate, colon and breast cancer combined.

Ironically, we can dream of a different future. One hundred years ago, when a case of lung cancer was diagnosed, doctors would gather up their young students and say, "study this real hard, as you might not see another case in your lifetime." Yet, entering 2012, lung cancer remains the major cause of cancer death for every single county in North Carolina, 35,000 new cases diagnosed in the last five years, people who are our friends, family members and patients. While these statistics are striking and sobering, hope exists.

In our work at the University of North Carolina Nicotine Dependence Program ( www.ndp.unc.edu), we meet people with lung cancer from across North Carolina, each with a unique life story and reasons to quit tobacco use. A strong thread runs through the stories as they report desires to have never started smoking. Their wishes, stories and hard work put into quitting bring into focus what we know about curbing the epidemic impact lung cancer has on our state.

We know that 85 percent of all lung cancer cases are due to tobacco use, fostered dually by nicotine addiction and tobacco marketing. North Carolina's lung cancer death rate is higher than the national rate, as is our adult smoking rate. We know that preventing youth from smoking and getting adults to quit are keys to lowering lung cancer rates. Ten years after quitting, a former smoker's risk of dying from lung cancer drops to half of a person who continues smoking.

Recently, one of our patients battling late-stage lung cancer became tobacco-free after decades of smoking. She told us that she was proud of herself and could breathe better.

She said that this was one of the hardest things she had ever done, but that even if she were going to die from lung cancer, she was going to die tobacco-free.

Making effective tobacco-use treatment available to all North Carolinians requires smart policy decisions at many levels. The North Carolina Quitline (1-800-QUIT- NOW) provides free counseling, in English and Spanish, to every resident. Yet it must continue to receive adequate funding from tobacco settlement funds by the North Carolina legislature.

FDA-approved tobacco cessation medications can double chances of quitting successfully, but these medications require insurers to cover them with little to no co-pays. Health care systems, doctors and nurses must screen patients for tobacco use and provide all with medication and counseling, A consultation with a tobacco treatment specialist can improve chances of long-term successful cessation.

As our patients tell us, it is better to never become addicted to tobacco than to have to break an addiction. We have made incredible progress reducing the number of youth who take up smoking, with rates reaching historic lows in 2009. Comprehensive teen tobacco prevention initiatives launched in 2003 and the powerful TRU, Tobacco. Reality. Unfiltered. media campaign on the air since 2004 have played substantial roles in preventing more than 50,000 youth from beginning to smoke.

The North Carolina legislature needs to continue supporting these proven, cost-effective programs to improve our lung cancer outcomes. Prevention and cessation programs must continue if we are going to turn the tide against lung cancer.

We know what needs to happen in the New Year to accelerate progress against our state's No. 1 cancer killer. In many ways, the solutions are simple. The question is whether policymakers, insurance companies and the health care systems are willing to show a resolve to continue investing in successful tobacco prevention and cessation for the next 20, 30 and 40 years, until one New Year, lung cancer once again becomes a rare disease.

Adam O. Goldstein, M.D., is a professor of medicine at UNC-Chapel Hill and director of the UNC Tobacco Intervention Programs. Anna McCullough is manager of N.C. Cancer Hospital's Nicotine Dependence Program.

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