Smoking

0 The most important risk factor for the development of lung cancer is smoking. One of the most predictive factors on lung cancer epidemiology is trends in population cigarette smoking. Because lung cancer is a fatal disease in most cases, both incidence and mortality strongly reflect the smoking trends of the population on a 20- to 30-year lag. In other words, decreases in tobacco use now would be expected to affect lung cancer incidence in 2030. With this knowledge, the current expectation is that lung cancer incidence and mortality will decrease steadily until 2020, reflecting decreases in cigarette smoking between 1970 and 1990. Because smoking has continued at a steady rate since 1990, lung cancer incidence is expected to plateau. Correlation between smoking and lung cancer continues to drive antismoking campaigns and should be considered an investment in the future health care of the nation. Furthermore, smoking cessation plays an important role in reducing lung cancer risk on a patient-to-patient basis, and appropriately guiding such therapy is a crucial part of treating at-risk patients.6 Total smoke exposure, as well as current use, correlates with the individual's risk of developing malignancy. The risk of lung cancer decreases to near-normal levels 10 to 15 years following successful smoking cessation. Total smoke exposure is reported as pack-years. One pack-year is the equivalent of smoking

1 pack per day for 1 year. A patient who smokes 40 cigarettes per day (2 packs) for 5 years would have a 10 pack-year history (2 packs/day for 5 years).

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