Smoking's Impact on the Lungs

Smoking's Impact on the Lungs

Joined: 18 Dec 2008, 23:57

20 Dec 2001, 16:58 #1

Joel's Reinforcement Library

Smoking's Impact on the Lungs

Ex-smokers are often tempted when watching others smoke. Spending time with a specific friend and watching them smoke may be a trigger especially if it was the most time you had spend with the friend since you quit smoking. The first time you have any new experiences, even if smoking is not part of the ritual, the thought for a cigarette will seem like a natural part of the ritual.

Another factor is when watching a person smoke, the natural tendency is for the ex-smoker to start to fantasize about how good a cigarette will be at that given moment. A more productive way to handle the situation though is to really watch the person smoke one, and then wait a few minutes as they light another and then another. Soon you will see that they are smoking in a way that you don't want to and probably in a way that they don't want to either. But they have no choice. You do. I am attaching a letter here that addresses this issue. It is a little harder to describe because it is based on a demonstration I do at live seminars.

One demonstration I do at all my live seminars is a little smoking contraption made out of a plastic Palmolive bottle with a mouth piece inserted to hold a cigarette. The simulation shows how much smoke comes in when a person inhales, and how much comes out when they exhale. Smokers often feel they take in smoke and then blow most of it out, when in actuality, a very small percent actually comes out (about 10%). I always use cigarettes given to me by people in the audience, if I used one I brought people would think I was using a loaded cigarette. Anyway, below is a letter I wrote for clinic graduates who have seen this demonstration but the concepts apply to those who haven't also. Viewing smoking as it really looks will minimize the temptation for even a puff.

The letter is as follows ...

Whenever you watch a person smoking, think of the Palmolive bottle demonstration you saw the first day of the Stop Smoking Clinic. Visualize all of the smoke that goes into the bottle that doesn't come out. Also, remember that the smoker is not only going to smoke that one cigarette. He will probably smoke another within a half-hour. Then another after that. In fact, he will probably smoke 20, 40, 60 or even more cigarettes by the end of the day. And tomorrow will be the same. After looking at cigarettes like this, you don't want to smoke a cigarette, do you?

I always suggest that clinic participants follow this simple visualization exercise to help them overcome the urge for a cigarette. When I suggested it to one participant who was off for three days she replied, "I see, you want me to brainwash myself so that I don't want a cigarette."

Somehow I don't consider this technique of visualizing smoking brainwashing. It is not like the ex-smoker is being asked to view smoking in an artificially horrible, nightmarish manner. To the contrary, I am only asking the ex-smoker to view cigarette smoking in its true light.

The Palmolive bottle demonstration accurately portrays the actual amount of smoke that goes in as compared to the small amount that you see the smoker blow out. Most smokers believe they exhale the majority of smoke they inhale into their lungs. But, as you saw by the demonstrations, most of the smoke remains in the lungs. When you visualize all the smoke that remains, it does not paint a pretty picture of what is happening in the smoker. Maybe not a pretty picture, but an accurate one.

When an ex-smoker watches a person smoke a cigarette, he often fantasizes about how much the smoker is enjoying it--how good it must taste and make him feel. It is true he may be enjoying that particular cigarette, but the odds are he is not.

Most smokers enjoy a very small percentage of the cigarettes they smoke. In fact, they are really unaware of most of the cigarettes they smoke. Some are smoked out of simple habit, but most are smoked in order to alleviate withdrawal symptoms experienced by all smokers whose nicotine levels have fallen below minimal requirements. The cigarette may taste horrible, but the smoker has to smoke it. And because the majority of smokers are such addicts, they must smoke many such cigarettes every single day in order to maintain a constant blood nicotine level.

Don't fantasize about cigarettes. Always keep a clear, objective perspective of what it would once again be like to be an addicted smoker. There is no doubt at all that if you relapse to smoking you will be under the control of a very powerful addiction. You will be spending hundreds of dollars a year for thousands of cigarettes. You will smell like cigarettes and be viewed as socially unacceptable in many circles. You will be inhaling thousands of poisons with every puff. These poisons will rob you of your endurance and your health. One day they may eventually rob you of your life.

Consider all these consequences of smoking. Then, when you watch a smoker you will feel pity for them, not envy. Consider the life he or she is living compared to the simpler, happier, and healthier life you have had since you broke free from your addiction. Consider all this and you will - NEVER TAKE ANOTHER PUFF!

A picture of the Palmolive Bottle Demonstration
This looks like it was an exhalation after about 10 previous exhalations, not that much is seen in this particular photo. I normally get a tremendous amount of smoke out of the bottle with every drag, normally we can smoke up a room with one cigarette. If you look at the mouthpiece of the bottle, it is almost solid brown with tar. It used to be clear. I have used this bottle with somewhere between 300 and 400 cigarettes. While that may sound like a lot, most people smokemore than that in any given month. Even the bottle is pretty yellow and I blow out almost all of the smoke used when it inhales. The bottle is dry allowing me to do this, your lungs are moist trapping most of the tars when inhaled. Literally over 90% of the tar that is inhaled stays in the lung, when you see a person exhale they are literally blowing out about 10% of the smoke.
You can see how the smoke had darkened the bottle after about a few hundred cigarettes. You can start to see how the smoker's lungs below became so discolored. Smokers don't just put a total of a few hundred cigarettes in their system; they literally deliver hundreds of thousands of cigarettes over their shortened lifetime. This discoloration effect is more than just aesthetically unpleasant--it is in fact deadly.
Above: Normal city dwellers lung.
Note black specks throughout indicative of carbon deposits from pollution.
Compare this to the lung below.
Smokers lung with cancer. White area on top is the cancer, this is what killed the person. The blackened area is just the deposit of tars that all smokers paint into their lungs with every puff they take.
To add a little more perspective to the demonstration, here is another way to see how much tar actually gets into the lungs from smoking. Below is the picture of a smoking machine.
This machine smokes 2,000 cigarettes a day, mimicking smokers puffing patterns to capture equivalent amounts of tar as would a smoker. In one day the machine captures the amount of smoke in the picture below.
The bottle above with the tar collected from 2,000 cigarettes. If a diluted form (diluted, not concentrated is as often done in animal experimentation to demostrate that chemicals are carcinogens) of this tar is painted on the skin of mice, 60% of the animals developed cancer of the skin within a year.
Many chemicals currently banned for human consumption were removed from usage if they even caused 5% or less cases of cancer in similar experiments. Cigarette tars contain some of the most carcinogenic chemicals known to man. Consider this when watching people smoking and exhaling only 10% of the tars they actually take in. Not only are these chemicals being painted into the lung, but smoker are also constantly painting them up on their lips, tongue, larynx, swallowing some and thus painting it in the esophagus and throughout the digestive tract. Smokers have increased incidents of cancer in all of these exposed sites.
Now that you know what it looks like on a large scale and feels like, lets take a look at the microscopic level of things that happen in the lung from smoking.

The following series of slides illustrate microscopic changes that happen when a person smokes. The first slide is showing an illustrated blow-up of the normal lining of the bronchus.
On the top we see the cilia, labeled (H). They are attached to columnar cells, labeled (I). The cilia sweep the mucous produced in the goblet cells, labeled (J) as well as mucous coming from deeper glands within the lungs and the particulate matter trapped in the mucous. The bottom layer of cells, labeled (L) are the basal cells.

Below we start to see the changes that occur as people begin to smoke. You will see that the columnar cells are starting to be crowded out and displaced by additional layers of basal cells. Not only are fewer cilia present but the ones that are still functioning are doing so at a much lower level of efficiency. Many chemicals in tobacco smoke are toxic to cilia, first slowing them down, soon paralyzing them all together and then destroying them.
As you see with the cilia actions being diminished, mucous starts to build up in the small airways making it harder for the smoker to breath and causing the characteristic smokers cough in order to clear out the airways.

Eventually though, the ciliated columnar cells are totally displaced. As can be seen below ominous changes have taken place. Not only is the smoker more prone to infection from the loss of the cleansing mechanism of the cilia, but these abnormal cells (O) are cancerous squamous cells. These cells will eventually break through the basement membrane wall and invade into underlying lung tissue and often spread throughout the body long before the person even knows they have the disease.
If a smoker quits before cancer actually starts, even if the cells are in a precancerous state, the process is highly reversible. Cilia regeneration starts in about 3 days once smoking stops. Even if cilia has been destroyed and not present for years, the lining tissue of the windpipe will start to repair. Even the precancerous cells will be sloughed off over time, reversing the cellular process to the point where the lining tissue goes back to normal. But if a smoker waits too long and cancer starts, it may be too late to save his or her life.

Following are actual pathological slides showing these same damaging effects.
The little pink hairlike projections on the top is the cilia and if you compare this image with the illustrations above you should be able to see the mucous secreting cells and the separation of the lining tissue from the underlying lung tissue.

Below you can see the same area of tissue from a smoker's lung who has totally destroyed the cilia in this tissue.
Again note, where there used to be two layers of well formed and orginized basal cells, now numerous layers of disorganized squamous cells has replaced the normal defensive tissue. These cells are precancerous and if the continued irritation (cigarette smoke) is not ceased can go to that final stage where they become malignant and invade into the underlying lunng tissue as seen below.
Then it is only a matter of time before it leaves the lung and spreads throughout the body. If the smoker quits smoking before this last cellular change occurs, before a cell turns malignant, the process seen in this last slide can be avoided. In fact much of the damage seen in the second picture here is highly reversible.

In three days cilia start to regenerate and usually within 6 months the normal cilia function is returned. Also over time, the extra layers of cells will be sloughed off and the lining tissue of the bronchus will return to normal.

Unfortunately, if a smoker waits until a malignancy has started, the outlook is grim. The overall 5 year survival rate for lung cancer is only 14%. Lung cancer, is a disease that while once uncommon, is now the leading cancer killer in both sexes.

Cancer is actually many different diseases with many different causes. If we look at cancer trends over the last century we see some amazing changes. While cancer was always around, it was different sites that were primary problems. Lung cancer, at the turn of the century was almost unheard of. If a doctor saw a case he would have easily gotten it printed up in a medical journal. Now, it is the major cause of cancer death in our society, killing more men and women than any other site. The primary difference between now and then is smoking. Before the turn of the century smoking was a limited practice. A very small percentage of people smoked and even the ones who did smoked many fewer cigarettes. Cigarettes were not even mass produced till the very end of the 1900's.

We always hear of a cancer epidemic, how more and more people die of cancer every year. Actually, if you pull the smoking related sites out of the equation, cancer deaths have been on a decline. Some sites, like stomach the incidence dropped dramatically, not fully understood as to why. Other sites, like breast, even though the morbidity rate (number of cases) didn't drop, because we now have better treatments and earlier detection, the mortality (death) rate has dropped.

But the smoking cancers; lung, mouth, lip, tongue, throat, larynx, pancreas, esophagus, pharynx, urinary bladder have all seen marked increases over the 20th century. These cancers have gone from obscurity to some of the major causes of death in our country. Actually, for the first time in a hundred years we are starting to see an early decline of morbidity and mortality because we are seeing fewer smokers now with the drop in the percentages of adult smokers.
You see a dramatic difference in men and women, especially in lung cancer rates. The reason is women started smoking much later than men, about a 30 year time delay before it became socially acceptable for women to smoke. Male smoking rate jumped dramatically between World War I and another big boost during World War II. Free distribution of cigarettes to soldiers was a big factor. Women smoking rates happened much later and the time delay is reflected in the time delay in cancer and otehr diseases going up too.
The above pictures were primarily about how smoking causes cancer of the lung and other sites. But the assault on the lungs from the tars in tobacco are not just limited to causing cancer. Other lung diseases are directly caused by smoking, the most well known are the chronic obstructive lung diseases.
The most well known smoking induced COPD is emphysema. This is another one of those diseases that primarily happen to smokers. Over 90% of the cases are smoking induced. There are cases in some families where there does seem to be a genetic predisposition, where non-smokers get it too. This is from a rare condition, a lack of a blood enzyme called alpha1antitrypsin. This again is rare, but if you do have family members who never smoked a day in their life get emphysema there may be a genetic tendency. But again, over 90% of emphysema cases are simply caused by smoking. Eradicate smoking and you eradicate the risk of the disease.
To get a sense of how a long is altered by smoking to cause emphsema look at the pictures below. The first is a picture of an inflated non-smoker city dweller's lung.
As in the normal picture of a lung above, you can see carbon deposits collected throughout from pollution effects. But when contrasted with a smoker's lung with emphysema...
...there is a very dramatic visible difference. Not only is the discoloration the issue, but the lungs have literally been ripped out of shape making breathing extremely difficult and eventually impossible. To get a sense of what it feels like to breath with emphysema take a deep breath and hold it. Without letting out any air, take another deep breath. Hold that one too. One more time, take one more breath. Okay let it all out.
That second or third breath is what it feels like to breath when you have advanced emphysema. Emphysema is a disease where you cannot exhale air. Everyone thinks that it is a disease where you cannot inhale but in fact it is the opposite. When you smoke you destroy the lungs elasticity by destroying the tissue that pulls your lung back together after using muscles that allow us to inhale air. So when it comes time to take your next breath it is that much more difficult, for your lungs could not get back to their original shape.

Imagine going through life having to struggle to breath like those last two breaths I had you take. Unfortunately, millions of people don't have to imagine it, they live it daily. It is a miserable way to live and a slow painful way to die.

Hopefully when you breath normally today you are not in pain and you are not on oxygen. If you don't smoke you will continue to give yourself the ability to breath longer and feel better. Never lose sight of this fact. To keep your ability to breath better for the rest of your life always remember to - NEVER TAKE ANOTHER PUFF!

© Joel Spitzer 2001

Return to "The Real Cost of Smoking" Index
Last edited by Joel on 13 Apr 2009, 12:55, edited 1 time in total.

Joined: 19 Dec 2008, 00:14

20 Dec 2001, 23:00 #2

Thanks! I needed that. Lately I have been having this little junkie fantasy about how I would just get me a pack of Shermans and smoke just one...yeah right!

How shocking to see that palmolive bottle! YUCK! Thanks Joel for saving me one more time! Here I am almost to silver and I am still having junkie thoughts! When will this stop? I will admit, however, that the thoughts are fleeting and I do not even consider the possibility that I will act upon them but they are still there so I have to admit to myself that the possibility is still there.

Thanks again for reminding me why I quit.

still clean at 5 months, 2 weks, 2 days

kughes (green)
Joined: 09 Jan 2009, 20:45

21 Dec 2001, 11:04 #3

Ohhhhhhhhh My Goodness!! Yuck! Thank you, Joel, for that reinforsement...I thought I read most all of your library..missed that. I am saving that, not only for myself, but to show my smoking family members. VERY SCARY...I think I really needed help me have a more realistic viewpoint of smoking. It helps to fight off the few second urges that sometimes come along putting thoughts like "one cigarette would be great right now" in the mind. OHHH I glad I have not given in to those infrequent but dangerous thoughts. All I can say is THANK YOU ...THANK YOU .THANK YOU, Joel..and I will help fight the battle against this monstrous addiction in any way I can to educate others.
2 wks, 5days..since my lungs, lips, tongue have been clean from nicotine.
(I feel so guilty for the smoke I blew out to the non smokers! Image..want to join in fighting hard as possible to educate, educate, educate....)

Joined: 18 Dec 2008, 23:57

09 Jan 2002, 19:42 #4

Is quitting smoking worth the initial struggle and effort that an addict has to put forth to take back control over nicotine? You bet your life that it is!

Never take another puff!


Joined: 18 Dec 2008, 23:57

12 Mar 2002, 20:32 #5

A question got posed in the Cilia string that asked about the cleansing and healing that goes on after quitting. The lining tissue of the bronchus starts to heal very quickly, within days in fact. Over time this tissue as illustrated here and in the cilia string does return to normal. If a pathologist were to examine scrapings from the lining of the bronchus years after a person quit, he or she would not be able to determine if the patient were ever a smoker. This is quite significant considering that close to 90% of lung cancers that occur in the lung are from this specific region.
Underlying lung tissue doesn't have the same kind of repair capabilities. Once underlying lung tissue is destroyed, it does not regenerate. This is why a person who is diagnosed with emphysema will likely still have the disease after quitting. They may in fact breath better after quitting, not because of healing the destroyed lung tissue which is the cause of the disease, but rather because the healing of the bronchus lining and the subsequent cilia regeneration helps keeps the small airways cleared of mucous obstruction. So while a person doesn't grow new lung, what they have left is able to work more efficiently and with the clearing of the small airways because of the decrease in mucous production and the cleansing action of the restored cilia.
Also, the purpose of the lungs is to oxygenate the blood. When a person smokes they are taking in large amounts of carbon monoxide which is literally poisoning the oxygen carrying capacity of the blood. When a person quits smoking carbon monoxide levels return to normal in less than one week. So again, the lungs are able to function much more efficiently, not having to do the extra workload of getting more oxygen because of carbon monoxide suffocating effects.
Much of the discoloration of the underlying lung tissue may not be cleared out--but the chemicals do lose their potency over time. I wish I could say that when a person quits that their underlying lung tissue which is responsible for breathing returns to normal but it really is not the case. But when a person quits the tissue that is left is much better able to cope with the body's demands. And in the case of cancers of the bronchus, which is where a vast majority of lung cancers occur, this tissue does in fact return to normal if the person just quits before cancer is initiated in this area.
So while it can't be said that quitting smoking returns a person to a state of never smoking, we can say that the risk of initiating future diseases decrease, and the overall efficiency of the remaining healthy tissue increases. The sooner a person quits, the sooner the repairs start and the sooner the assault of the thousands of dangerous chemicals stops. Again, in the case of cancer you just don't know which cigarette would be the one that starts an irreversible and life threatening process. To minimize the risk now is no more complicated than knowing to never take another puff!
Last edited by Joel on 13 Apr 2009, 12:56, edited 1 time in total.

Toast (GOLD )
Joined: 18 Dec 2008, 23:57

28 Apr 2002, 07:26 #6

I was feeling a bit deprived today - craving a smoke, thinking those old silly thoughts that I was somehow better off than I am now when I smoked. Silly. I'm having the antihistamine/allergy/pollen/husband-on-a-plane-to-AZ-for-a-week blues. I'll own that, but I don't have to go and blow over 11 months REALLY HARD work because of it. So, I came here for some inspiration. I've been a member here since last June, shortly after I quit. I've seen this thread come up time and time again. It's a thread I've honestly been afraid to read, having never read it in all my months on the board. Well, I figured I needed a good scaring out of my foolishness.
It worked.
Image Melissa
11 Months 4 Days 20 Hours 26 Minutes 48 Seconds Free
6797 Less
$985.57 More
1 Mo 2 Wks 2 Days 4 Hrs 50 Mins 23 Secs Added


Joined: 18 Dec 2008, 23:57

17 Apr 2003, 19:32 #7

More women dying of lung cancer
Rate up 46% in females; down 17% for men.
Mortality rate reflects smoking patterns, so numbers likely to decline in future


Thursday, April 17, 2003

While the lung cancer death rate for men has decreased in the past 15 years, it has increased alarmingly for women in the same period, the Canadian Cancer Society said yesterday.

Lung cancer remains the leading cause of cancer deaths for men and women, but the death rate for men has dropped 17 per cent since 1988 while it has increased 46 per cent for women.

"What we are seeing now in terms of lung cancer is the result of smoking patterns prior to the late 1980s," said Dr. Barbara Whylie, the society's director of cancer control policy.

She said men started smoking in a big way earlier than women did. By the mid-'60s the number of men smoking started to drop while smoking among women increased until the late '80s.

The good news is that overall cancer death rates for men and women have dropped in the last 15 years, and the society predicts further drops in the future. But the gender divide remains. Death rates dropped by 12 per cent for men and 3.1 per cent for women. The death rate refers to the number of people per 100,000.

The overall cancer rate for men has dropped by 4.2 per cent since 1988, while it has increased 3.5 per cent for women largely due to lung and breast cancer.

As lung cancer rates are linked to smoking, with a lag time of about 25 years, Whylie said the good news is "since women's smoking rates have declined, we can predict that over the next decade we'll start to see lung cancer rates for women decline as well."

Even though smoking rates are declining and lung cancer rates will follow, Garfield Mahood, executive director of the Non-Smokers' Rights Association, believes that isn't good enough.

Especially since teenagers, even though they are armed with the statistics and information about tobacco, are still taking up smoking.

"Why would kids take adults seriously about the risks when they go into the tens of thousands of corner stores across this country and see power walls of cigarettes?" Mahood said yesterday.

"Those power walls are positioned next to the candy. Why would kids think that this is really a product that carries serious risks? Governments don't care about these kids and we aren't holding governments responsible and forcing them to care."

Whylie said lung cancer is particularly serious because it is preventable and those who develop it will die, while the survival rates for other cancers have improved. For example, the rates for breast cancer haven't changed much in 15 years but the death rate has dropped.

"That means 20 per cent more people are surviving breast cancer now than 15 years ago, and you see the same pattern for prostate cancer," Whylie said.

Still the most common types of cancers continue to be breast cancer and prostate cancer.

Stomach cancer death rates decreased in women by 33 per cent and by 43 per cent in men. Colorectal cancer death rates were down by 23 per cent for women, 15 per cent for men.

However, death rates from melanoma increased 23 per cent for women, 41 for men, and from non-Hodgkins lymphoma 28 per cent for women, 26 for men.

The society has been trying to emphasize that at least 50 per cent of cancers can be prevented through healthy living. Despite the public's knowledge about eating healthier and exercising, there is an increasing problem with obesity, particularly in young people.

"There is a real disconnect between what we know can be done (to improve our health) and public policies," said Whylie. "We know high-fat, high-carb diets are damaging to people. Yet what foods are provided to children in schools?

"We know exercise is important yet physical activity programs are withdrawn from schools."

Dr. Terry Sullivan, vice-president of preventive oncology at Cancer Care Ontario, says the message is simple: eat more fruits and vegetables and less fatty meat. But knowing how to make the right choices is not easy.

"There are many things that help to shape that decision. They include labelling and pricing. And all these are under public policy," said Sullivan. "The decline in smoking isn't because everyone got smart. It's because government policies began enacting smoking bylaws."

Add to that a huge aging population and the future may not be all that rosy. The society predicts that individual new cases of cancer will increase by as much as 70 per cent over the next 15 years.

"There's a big challenge for screening and prevention to reduce overall rates of incidence and mortality rate and there's a big challenge for the treatment system to cope with this glacier ... this slow epidemic of cancer that's a function of aging," Sullivan said.

Whylie also sees the future as an uphill battle.

"I don't like the word epidemic but people have likened it to an express train coming down the track. There is going to be an explosion in the number of new cases of cancer occurring among Canadians in the next two decades," she said.

"If the Canadian health care system is going to be prepared to deal with it, we need policy makers to make some changes now, make the investments now, and frankly we have not seen any evidence of that happening."

© Copyright 2003 Montreal Gazette

John (Gold)
Joined: 18 Dec 2008, 23:57

27 Jul 2003, 21:27 #8

Imagine the 4,000+ chemicals in each and every puff destroying a few more of the 800 million air sacs that each of us started with. Why? Is there anything so wonderful about remaining a chemical slave to nicotine that is worth diminishing, damaging and destroying your ability to breathe? If not, forget about quitting FOREVER and instead focus on the only dependency recovery time period that really matters, the next few minutes. They're doable, and so are the moments that follow them! Baby steps to glory. There's only one rule - no nicotine today!
Last edited by John (Gold) on 13 Apr 2009, 13:01, edited 1 time in total.

Joined: 18 Dec 2008, 23:57

05 Sep 2003, 22:36 #9

From: Joel Sent: 7/29/2003 4:57 PM
Hopes dim for cancer cure in near future

By Daniel Q. Haney
The Associated Press

July 28, 2003

Not long ago, the defeat of cancer seemed inevitable. Decades of research would soon pay off with a completely fresh approach, an arsenal of clever new drugs to attack the very forces that make tumors grow and spread and kill.

No more chemotherapy, the thinking went. No more horrid side effects. Just brilliantly designed drugs that stop cancer while leaving everything else untouched.

Those elegant drugs are now here. But so is cancer.

The approach, which appeared so straightforward, has proved disappointingly difficult to turn into broadly useful treatments. Some now wonder if malignancy will ever be reliably and predictably cured.

The dearth of substantial impact so far suggests the fight against cancer will continue to be a tedious slog, and victories will be scored in weeks or months of extra life, not years. The full potential of the new approach may take decades to be realized.

The drugs, called targeted therapies, are intended to arrest cancer by disrupting the internal signals that fuel its unruly growth. Unlike chemo, which attacks all dividing cells, these medicines are crafted with pinpoint accuracy to go after the genetically controlled irregularities that make cancer unique.

Several have made it through testing, but despite their apparent bull's-eye hits, lasting results are rare. Instead, these new drugs turn out to be about as effective - or as powerless - as old-line chemotherapy. Aimed at the major forms of cancer, they work spectacularly for a lucky few and modestly for some.

But for most? Not at all.

Doctors have many theories about what's gone wrong. But it is clear that cancer is a surprisingly robust foe, packed with convoluted backup systems that kick in when threatened by the new drugs.

At best, experts now expect knocking down cancer will require an elaborate mixture of targeted drugs, assembled to match the distinct biology of each person's cancer.

"It's a much more complicated problem than anyone ever appreciated," says Dr. Leonard Saltz, a colon cancer expert at Memorial Sloan-Kettering Cancer Center. "It will, unfortunately, be with us for a long time."

The job is so daunting, especially for advanced cancers propelled by potentially dozens of nefarious genetic mutations, that scientists are even rethinking the goal of cancer research.

"Society as a whole, and most of the medical profession, have it wrong understanding we'll wake up one morning and find out cancer is cured. It won't happen. The public should give it up," says Dr. Craig Henderson, a breast cancer specialist at the University of California, San Francisco, and president of Access Oncology, a drug developer.

"What we have learned by these billions of dollars invested in cancer biology is that cancer are us," he goes on. True, cancer is different. But not different enough. "Identify what makes cancer unique and wipe it out? That won't happen. We cannot wipe out the cancer without wiping out a lot of the rest of us."

Henderson and many others have shifted their sights to something less - converting cancer into a chronic disease, like diabetes or AIDS. Treatments might slow or even stop its worst effects so people survive for years reasonably free of symptoms.

Dr. Andrew von Eschenbach, head of the National Cancer Institute, argues that a cure is not even necessary if this can be done, something he optimistically hopes to see by 2015. But eliminate cancer? "Not in the foreseeable future," he says.

Experts concede there is no firm evidence that targeted treatments will tame cancer to a chronic condition, either. Certainly, the ones tested so far do not often come close to this for the common varieties, such as lung, breast, colon and prostate cancer.

Although targeted therapies have their origins in basic cancer discoveries of the 1980s, the story for many began at a meeting of the American Society of Clinical Oncology in 1998. Researchers were thrilled to hear of the first convincing demonstration that a targeted drug could slow the course of cancer even a little. It was proof that the principle is sound.

Usually wary oncologists rhapsodized about a new era of treatment. "A tidal wave," one of them called it. Even then, no one predicted quick cures. But they clearly felt they at least had the key to getting inside cancer and fixing it.

The drug that caused the euphoria, Herceptin, became a standard treatment for spreading breast cancer, typically delaying progression by a few months in the quarter of victims with a particular genetic profile.

Since Herceptin, targeted drugs have become the prevailing approach in cancer research. Whenever any of these make slight progress, the news is widely and sometimes breathlessly reported.

An estimated two-thirds of the nearly 400 cancer medicines in human study take this tack. Yet researchers do not envision successes any more spectacular from this pipeline than the modest effects of the handful already on the market.

"Right now, in the short run, we can bring an occasional miracle and have an overall small benefit," says Dr. John Glaspy, medical director of UCLA's surgical oncology center. "But there has not been a major improvement on what happens to them ultimately."

Furthermore, the dream of abandoning chemotherapy has largely evaporated. Even the targeted drugs' small benefits are typically seen only when combined with standard chemo.

Cancer doctors facing waiting rooms full of dying cancer patients, with little to offer but easing misery and perhaps a few extra months of survival, clearly had wished for more.

"The hope was that these targeted therapies would be the new magic bullet and would cure cancer," says Dr. David Decker, an oncologist at William Beaumont Hospital outside Detroit. "It's fair to say they haven't panned out the way we thought they would."

The targeted drugs have been most impressive against cancers of the blood and immune system, which are easier to control than the more common organ tumors. For instance, about half of patients getting Rituxan for non-Hodgkin's lymphoma have at least a 50 percent reduction in their cancer.

Side note:|

While there is no magic cure for smoking induced cancers right around the corner, there is a non-magic solution to minimizing your risks of over developing a smoking induced cancer and a host of other diseases caused by cigarettes. It is simply sticking to your commitment to never take another puff!


John (Gold)
Joined: 18 Dec 2008, 23:57

28 Dec 2003, 23:26 #10

He Wanted You to Know