I Remember

This blog was posted 10 years ago. It's been taken down with the website revamp, so I'm re-posting here with refreshed links.

In 2009, my mother was one of 97,247 women who were diagnosed with lung cancer in the United States.

As an epidemiologist I know the numbers. You probably know them too. What cancer kills more people than any other? Lung cancer. How many deaths in the United States are caused by cigarette smoking? 1 in 5. How many people die each year in the United States from cigarette smoking? 443,000. 

It’s one thing to know the numbers and it’s another to KNOW the numbers. My mother is one of the numbers in the dataset that I analyze as part of my daily work. She is one of the numbers in the report published this week in MMWR. The report was actually good news. From 2005–2009 lung cancer incidence rates among women went down from 57 to 54 cases per 100,000 women, decreasing about 1% per year. Lung cancer went down even faster among men, decreasing 2.6% per year, from 87 to 78 cases per 100,000 men.

We know why lung cancer is going down. Many people have worked very hard to tell the story of the dangers of smoking. Tobacco cessation treatments are covered by more health insurance policies. Cigarette advertising is banned from television and radio. It is against the law to sell tobacco to children in all fifty states. State and local laws have been passed to protect non-smokers from deadly tobacco smoke. Today fewer people are smoking cigarettes than ever before. My mother’s grandchildren are growing up in a world where smoking is not the norm.

My mother was 67 years old when she was diagnosed with lung cancer which had spread to her blood, her lymph system, and her brain. She had surgery to remove the largest brain tumor. When the anesthesiologist asked my mother how many years she had smoked cigarettes, she answered fifty. “FIFTY?!” echoed the anesthesiologist. She couldn’t believe her ears. Actually, it was fifty-two because my mother started smoking when she was 15 years old.

In our report we found that lung cancer went down fastest among young adults, 35-44 years old. People are surprised by this. 35 seems so young to be diagnosed with lung cancer. We can’t say exactly what causes lung cancer in one person. We know that lung cancer can be caused by many things like secondhand smoke, radon, asbestos, air pollution, medical radiation, and genetic factors, but cigarette smoking is, by far, the biggest cause of lung cancer. By the time my mother was 35 years old, she had been smoking cigarettes for 20 years. By the time she was 45 years old, she had been smoking cigarettes for 30 years. Twenty to thirty years is a long time to be exposed every day to something that causes cancer.

People are also surprised to hear that tobacco control could be responsible for the decline in lung cancer among young adults. We know that states with stronger tobacco control programs tend to be states where lung cancer has gone down the most among young adults. Something is working. More people are quitting, fewer people are starting, and fewer people are getting lung cancer.

My mother tried to quit smoking cigarettes almost every day of her life. After her diagnosis, she did succeed and stayed smoke-free until her last breath, 14 months later. Quitting is hard. If you smoke, you can ask your doctor for help or visit smokefree.gov, call 1 (800) QUIT-NOW, or text the word QUIT to 47848 from your mobile phone.

At my mother’s funeral, a trumpeter played one of her favorite songs When The Saints Go Marching In. You probably know the words “Oh, when the saints go marching in, Oh, Lord I want to be in that number.” My mother didn’t want to be in MY number, but, unfortunately, she is. I have a quote on my desk from Thomas Glynn, tobacco control scientist, “But, despite these enormous, and even numbing, numbers, we need to remember that every one of these 1 billion, 100 million, 6 million, or 443,000 was a father, mother, brother, sister, son or daughter who, if tobacco had not intervened, would have enjoyed, and shared, a longer, healthier, and more fulfilling life.” I remember.