Blogs by the online BMJ respiratory medicine champion
Smoking, lies and statistics
Last week I gave a short presentation to a group of nurses out in rural Angus. They had asked for a general update on respiratory services within the region, so I was happy to oblige. As ever, part of any update in respiratory services has to include something on lung cancer, and smoking cessation.
You'd think, in 2011, that everyone would accept that smoking causes lung cancer; smoking causes COPD; and is generally "not very good for you". But one of the girls was not convinced.
"My mother smoked until she was 86, and my aunt smoked until she was 90"
This is a standard sort of response to the suggestion that smoking is not the best idea. And we all know someone who smoked until they were xx, or even yyy, and they die from "old age". Of course we do, but as chest physicians we see hundreds of people every year who die from lung cancer, in their 80s, 70s, 60s, 50s, 40s, and even 30s. I've diagnosed lung cancer in two men in their 20s in the past 5 years. Both had strong famliy histories of lung cancer, and both were heavy smokers - they could not quote that their family lived long and happy smoking lives.
So what to say to the person who tells me that their family members lived as smoking octagenarians? It's about statistics, probability, and risk. Every day we're exposed to risk, some risk we can't avoid (background radiation, for example), and other risk we inflict on ourselves. So what risk is acceptable? We can only make reasonable decisions on what is accpetable if we understand what the risk actually is. If all a smoker knows is long lived relatives, their perceived risk is small. As chest doctors we see so much lung cancer/COPD/IHD that we *know* the risk is too great.
I showed a slide, freely available on the Cancer Research website, which show the lifetime risk of lung cancer death by age 75 in a lifelong smoker is 16%, or about 1 in 12. The same risk for a lifelong non smoker is 0.2 %, or about 1 in 500. And stopping smoking at 60 reduces this risk from 16 % to 8 %. It was only when I told them this that the sole smoker in the room accepted that I might be on to something.
Why don't we get this sort of information accross to the public? If nurses don't know this, then how can we expect members of the public to know?
Smoking is prevalent, over 20% of the population smoke, more up here in Scotland.
We don't do enough to dispell the lies they tell themselves to keep them smoking.
And statistics are powerful, so we should share them.
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