Fifty years ago, when U.S. Surgeon General Luther Terry released the first report definitively linking smoking and lung cancer, the dark cloud over American smokers wasn't a fear of death.
In 1963, Americans puffed a then-record 523 billion cigarettes, more or less with impunity. They smoked at home and in the office, in cars, bars and businesses.
The report, released Jan. 11, 1964, was a death knell for the habit as Americans had come to know it. The 387-page document identified smoking as a cause of lung cancer in men, a likely cause of lung cancer in women, and a likely cause of emphysema and chronic bronchitis. It represented the first true salvo in the war against tobacco use and the deadly, preventable diseases it causes.
"Before the report, smoking was accepted and encouraged and thought to be cool. It was the first time there had been any kind of official statement," said Jenifer Marks, a general thoracic surgeon at Memorial Hospital in Colorado Springs. "Now we know that it's linked to many other cancers, respiratory problems and diseases, too."
While the number of Americans who smoke has declined significantly since peaking in 1981, with an annual consumption of 640 billion cigarettes, lung cancer remains the leading cancer killer for both men and women. Cigarette smoking is to blame for one in five deaths in the U.S., according to the American Lung Association.
"We have made tremendous progress over the last 50 years, helping the public understand the risks from smoking and working to reduce smoking rates across America," said Paul G. Billings, the senior vice president of advocacy and education for the American Lung Association. "However, the job is far from complete and every year more than 443,000 Americans lose their lives to tobacco-related illness."
Can't say we haven't been warned. The 1964 report set the stage for new label requirements on cigarette packs and a ban on broadcast media ads the following year. Today, quit lines and cessation programs abound. Commercials and ads featuring cigarettes are profoundly moribund in nature, focusing on the likely outcomes of disease, disfigurement and death.
"I don't think anyone is in denial about the health risks of smoking. Obviously the risks of it are much more well known publicly now, but it's a habit," Marks said. "We get people in the office with a cancer diagnosis that are still smoking. There's a lot of information out there, but quitting has to be an individual decision."
After climbing steadily until the early 2000s, the incidence of lung cancer in both men and women is on the decline. Still, an estimated 2,500 new cases were diagnosed in Colorado in 2013, said Marks. Of those patients, approximately 1,700 are expected to die of the disease.
The overall five-year survival rate for all stages of lung cancer is only 16 percent, Marks said, but with early detection and treatment those odds increase dramatically.
To that end, lung cancer screenings might one day be as standard as mammograms and colonoscopies for those at high risk of developing the disease. In the wake of a major study that found screening and early detection could reduce the risk of dying from lung cancer by 20 percent, the national Community Preventive Services Task Force has recommended screenings be a health care standard for smokers and other high-risk candidates of a certain age.
"The screening piece is so important. That's a really big step. We've never thought that screening for lung cancer helped people live longer," Marks said. "A lot of people think the diagnosis is a death sentence, but if diagnosed with Stage 1 or 2, that's potentially treatable with chemo or surgery. You can still live a long time."
Meantime, America's half-century war on tobacco continues in the halls of government, on streets and in the exam room. "We ask every patient who walks through the door if they need help with smoking cessation or if they're interested in quitting," Marks said. "We've come a long way, but we can still find better ways to help people manage addiction."
Contact Stephanie Earls: 636-0364