Highlight HEALTH

As 2007 comes to a close, I would like to thank you for your readership. Just over one year ago, I launched two websites, Highlight HEALTH and the Highlight HEALTH Web Directory. Here at Highlight HEALTH, my goal was to write about biomedical research I found interesting and to make it easier for people to understand research findings, empowering them to have more productive discussions with their physicians and to make informed decisions about healthcare. The Highlight HEALTH Web Directory is my endeavor to catalog and make available health-related websites I find to be informative and useful. More recently, I’ve also started writing about Web 2.0 in Health, Fitness and Medicine, and plan to publish a series of review articles on a number of health-focused social networks.

This past month, I started the Highlight HEALTH Network, an aggregation of content from both sites to allow readers to keep up with the latest articles on Highlight HEALTH and the newest additions to the Highlight HEALTH Web Directory, all from a single source.

Here are the most popular articles for 2007 (top 20 based on the number of page views/number of days posted):

1. The Highlight HEALTH Network RSS Dashboard Widget
2. Smoking Cessation Timeline: What Happens When You Quit
3. Dichloroacetate Not Ready for Therapeutic Use
4. The Highlight HEALTH Network
5. New Common Cold Virus Variant Deadly
6. Common Therapy for Prostate Cancer May Promote Metastasis
7. Overweight Kids and TV: An Advertising Epidemic
8. Saline Nasal Irrigation More Effective than Spray for Chronic Sinus Symptoms
9. Pediatric Grand Rounds 2.8
10. The Genetics of Panic Disorder
11. Smoking Duration vs. Intensity and the Impact on Lung Cancer Risk
12. Social Networks and Health - The Research and the Reviews
13. Quercetin
14. American Obesity Rate Levels Off
15. Biodegradable Polymers for Drug and Gene Delivery
16. Individual Genetics, Coffee Consumption, BRCA1 and Breast Cancer
17. The Flu, Your Health and the Importance of Vaccination
18. SCHIP Funding and Fiscal Irresponsibility
19. DNA Amplification by Polymerase Chain Reaction (PCR)
20. Sinus Congestion

Thank you and Best of Health in the coming year!

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Today, the American Cancer Society (ACS) celebrates the Great American Smokeout, an annual event in the U.S. to encourage Americans to quit smoking. According to the U.S. Centers for Disease Control and Prevention (CDC), in 2006 one in five U.S. adults smoked [1]. The Great American Smokeout challenges those people to smoke less or quit smoking for the day. The event also raises awareness of the many effective ways to quit for good.

The ACS has just wrapped up their first ever video contest on YouTube, where they asked people to create videos - one minute or less - to discourage smoking. You can check out the contest winners at the American Cancer Society.

You can also read more about the harmful effects of smoking and tobacco smoke in these articles here at Highlight HEALTH:

• Smoking Duration vs. Intensity and the Impact on Lung Cancer Risk
• Irreversible Gene Expression Changes From Smoking
• Smoking Cessation Timeline: What Happens When You Quit
• Second-hand Smoke Exposure Linked to Psychological Problems in Children

Accept the Great American Smokeout Challenge.
Quit for one day, or quit for good.

References

1. Cigarette smoking among adults–United States, 2006. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep. 2007 Nov 9;56(44):1157-61.
   View abstract

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We’ve discussed smoking and health a number of times recently:

• Smoking Cessation Timeline: What Happens When You Quit
• Irreversible Gene Expression Changes From Smoking

Ian Gibson asked a question I’m sure many have us have wondered about at one time or another:

Which is worse for the development of lung cancer — smoking heavily over a short period of time or smoking fewer cigarettes over many years?

My answer slowly evolved from a comment to a post of its own. Here’s what the research has to say:

In 2003, researchers at Memorial Sloan-Kettering Cancer Center created a prediction tool that can assess a long-term smoker’s absolute risk of developing lung cancer within 10 years. How long and how much people have smoked, as well as how long it’s been since their last puff, affect the risk of getting lung cancer.

The formula for the study was published in the Journal of the National Cancer Institute. I’ve linked to the full article since it’s publicly available. The study uses a number of predictors, including age, duration of smoking, average amount smoked per day while smoking and duration of abstinence from smoking (for former smokers) [1]. These predictors are not only identifiable from a clinical history but they are established or strongly suspected risk factors for lung cancer. Additionally, they are also risk factors for all-cause mortality.

Figure 1 models multivariable relations between 1-year lung cancer risk and (A) duration of smoking, (B) average number of cigarettes smoked per day, (C) duration of abstinence and (D) age. In panel A, the relative risk of lung cancer increases exponentially with duration of smoking. In contrast, panel B shows that the relative risk of lung cancer tends to level off between 30 and 60 cigarettes smoked per day.

What does this mean? It means that the relative risk of tobacco-attributable lung cancer sharply increases with increasing duration of smoking, much more so than smoking intensity (i.e. the number of cigarettes smoked per day).

The model for the prediction tool was derived from data collected during CARET, a multicenter, randomized, controlled study that evaluated the impact of beta-carotene and vitamin A supplementation on lung cancer incidence and mortality [2]. Unfortunately, the prediction tool only works for people age 50 and older who smoked at least 10 cigarettes a day for at least 25 years, since those were the people tracked for cancer development in the study.

Further research found that the model described above slightly underestimated the observed risk of lung cancer over 10 years [3]. I choose to write about this particular study because of the accessibility of the online prediction tool. However, other risk models have been developed [4-6].

Additional studies have also suggested that smoking duration has a stronger effect in the prediction of lung cancer risk than number of cigarettes smoked per day [7-10]. These models are consistent with the results from epidemiologic studies, which indicate that risks of lung cancer, as well as bladder cancer, tend to level off with increased smoking intensity [11].

Smoking cessation at any age is beneficial. Nevertheless, lower lung cancer death risk is observed for people who quit at younger ages [12]. Indeed, cessation of smoking prior to middle age is associated with a more than 90% reduction in cancer risk attributed to tobacco [13].

This isn’t to say that smoking intensity isn’t a major contributor to tobacco-attributable cancer risk. However, the take-home message is that long-term smoking clearly impacts lung cancer risk to a greater extent. That’s why it’s more important than ever to quit smoking now.

Did you ever smoke? How long were you a smoker? At what age did you quit?

References

1. Bach et al. Variations in lung cancer risk among smokers. J Natl Cancer Inst. 2003 Mar 19;95(6):470-8.
   View abstract
2. Omenn et al. The beta-carotene and retinol efficacy trial (CARET) for chemoprevention of lung cancer in high risk populations: smokers and asbestos-exposed workers. Cancer Res. 1994 Apr 1;54(7 Suppl):2038s-2043s.
   View abstract
3. Cronin et al. Validation of a model of lung cancer risk prediction among smokers. J Natl Cancer Inst. 2006 May 3;98(9):637-40.
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4. Peto et al. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. BMJ. 2000 Aug 5;321(7257):323-9.
   View abstract
5. Prindiville et al. Sputum cytological atypia as a predictor of incident lung cancer in a cohort of heavy smokers with airflow obstruction. Cancer Epidemiol Biomarkers Prev. 2003 Oct;12:987-93.
   View abstract
6. Cassidy et al. Defining high-risk individuals in a population-based molecular-epidemiological study of lung cancer. Int J Oncol. 2006 May;28(5):1295-301.
   View abstract
7. Doll and Peto. Cigarette smoking and bronchial carcinoma: dose and time relationships among regular smokers and lifelong non-smokers. J Epidemiol Community Health. 1978 Dec;32(4):303-13.
   View abstract
8. Peto, R Influence of dose and duration of smoking on lung cancer rates. Zaridze, D Peto, R eds. Tobacco: a major international health hazard; proceedings of an international meeting Moscow, USSR, June 4–6, 1985. 1986 World Health Organization, International Agency for Research on Cancer Lyon, France. International Agency for Research on Cancer Science Publication No. 74, 23–33.
9. Flanders et al. Lung cancer mortality in relation to age, duration of smoking, and daily cigarette consumption: results from Cancer Prevention Study II. Cancer Res. 2003 Oct 1;63(19):6556-62.
   View abstract
10. Lubin and Caporaso. Cigarette smoking and lung cancer: modeling total exposure and intensity. Cancer Epidemiol Biomarkers Prev. 2006 Mar;15(3):517-23.
    View abstract
11. Vineis et al. Levelling-off of the risk of lung and bladder cancer in heavy smokers: an analysis based on multicentric case-control studies and a metabolic interpretation. Mutat Res. 2000 Jul;463(1):103-10.
    View abstract
12. Halpern et al. Patterns of absolute risk of lung cancer mortality in former smokers. J Natl Cancer Inst. 1993 Mar 17;85(6):457-64.
    View abstract
13. Peto et al. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. BMJ. 2000;321:323-329.
    View abstract

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