Smoke Alarm! Is It Now OK to Smoke?

Rebecca Bechhold, MD

The US Preventive Services Task Force (USPSTF) is poised to recommend annual screening CT scans for the detection of lung cancer in high-risk individuals. The data to support this statement is from the National Cancer Institute (NCI) National Lung Screening Trial. The conclusion is that CT scans are better than chest x-rays at detecting lung cancer in the early stages and allowing for life saving treatment for some patients.

Michael LeFevre, co-vice chair of the task force said, “up to 20,000 deaths a year” could be prevented by annual screenings “of generally health people who have smoked a pack … a day for 30 years or more.” The panel estimates that the eligible population would be 9 million Americans. Are there enough CT scanners to handle the volume? The LLC’s are forming now to put a dedicated lung screening CT machine next to every convenience store. Get your carton and CT in one stop! Brilliant.

Hmmm. Let’s think, how long ago did we learn that smoking caused lung cancer? And how much have those smokers spent on cigarettes over those 50 years? Maybe they should pay for their own screening CT scan?

There are two things I am intolerant of-obesity (see blog before this) and smoking, because these are behaviors under our control. What concerns me is the public’s impression that it is OK to smoke because there is a screening process, which means early detection. And we all know if you find cancer early we can always cure it, right?

On the other hand, maybe more detection will drive more clinical trials and better ways to treat all lung cancers. We all seem to be treating more nonsmokers with lung cancer; 10% to 15% of lung cancers are in nonsmokers, two-thirds of which are in women.

I saw a new patient yesterday typical of this demographic. She is 62, extremely healthy, works out regularly, healthy eater, no medical problems, takes no medications. Presents with spontaneous bone fracture and found to have metastatic adenocarcinoma. I want desperately to help her. Not that I don’t want to help my smoking patients, but really, I am unsettled by the cost of millions of CT scans for smokers when I want to see more money spent on research for better treatment and prevention.  Why can’t smokers pay into a fund with each pack purchased that can pay for the CT scans? Or they could stop smoking. As Barnett Kramer, director of the division of cancer prevention at the NCI said “the benefit of stopping smoking is much, much larger than the benefit of CT screening.”

Go to any city with a vibrant downtown and watch the crowds. It is disturbing to me to see legions of young people smoking away. (And the tattoos, not a fan, but that is a future blog.) Ask them about it and they will nonchalantly say that they only smoke a little bit and always when they are out drinking because the two go together so well. Did they not get the memo? Everything in moderation except drugs and tobacco. Zero tolerance there.

While there may be good hard data for this recommendation, I think it sends the wrong message. Just because you think you can fix something, is it OK to break it? As physicians, I believe it is our duty to continue to provide serious anti-smoking pressure to the public and smoking cessation advice to current smokers.

Just as annual mammograms do not promise 100% early detection and a cure for breast cancer, screening CT scans for smokers should not be used as a crutch by smokers to let them and their families think that medical care will fix what they broke.

As always, I hope these columns stimulate discussion and I appreciate your comments.