Lung Cancer and Tobacco Use - North Dakota Department of Health


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  • Introduce self Identify your representing organization and connection with the North Dakota Cancer Coalition
  • The Lungs are paired organs in the chest that perform respiration. Each human has two lungs. Each lung is between 10 and 12 inches long. Lung function normally peaks in the late teens and early twenties. After the early twenties, lung function declines about 1 percent a year over the rest of a person's lifetime. Lung function decreases about 2 percent a year for people who smoke . What do your Lungs do? Your lungs do a vital job. Each day, you take about 23,000 breaths, which bring almost 10,000 quarts of air into your lungs. The air that you breath in contains several gases, including oxygen, that your cells need to function. With each breath, your lungs add fresh oxygen to your blood, which then carries it to your cells. The lungs are the essential respiration organ in humans. Their principal function is to transport oxygen from the atmosphere into the bloodstream , and to release carbon dioxide from the bloodstream into the atmosphere. Human lungs are located in two cavities on either side of the heart. Though similar in appearance, the two are not identical. Both are separated into lobes , with three lobes on the right and two on the left. Lungs are to a certain extent 'overbuilt' and have a tremendous reserve volume as compared to the oxygen exchange requirements when at rest. This is one of the reasons that individuals can smoke for years without having a noticeable decrease in lung function while still or moving slowly; in situations like these only a small portion of the lungs are actually perfused with blood for gas exchange. As oxygen requirements increase due to exercise , a greater volume of the lungs is perfused, allowing the body to match its carbon dioxide and oxygen exchange requirements. The connective tissue that divides lobules is often blackened in smokers and city dwellers.
  • What is Lung Cancer? Lung cancer is a disease in which the cells of the lung tissues grow uncontrollably and form tumors. Lung Cancer is the leading cause of death from cancer among both men and women in the United States. There are two main types of lung cancer primary and secondary. Primary lung cancer starts in the lung itself. Primary lung cancer is divided into small cell lung cancer and non-small cell lung cancer, depending on how the cells look under the microscope. Each type of Primary lung cancer grows and spreads in different ways. Secondary lung cancer is cancer that starts somewhere else in the body (for example, the breast or colon) and spreads to the lungs.
  • Symptoms of Lung Cancer There are many symptoms and each individual may not experience them all. Some of the symptoms are: a cough that does not go away chest pain shortness of breath persistent hoarseness swelling of the neck and face significant weight loss that is not due to dieting or vigorous exercise fatigue loss of appetite bloody or brown-colored spit or phlegm (sputum) unexplained fever recurrent lung infections, such as bronchitis or pneumonia .
  • Read slides and emphasis the high death rate
  • Most expensive cancer in terms of treatment cost (21.1 million dollars annually for North Dakotans) and has the highest death rate Lung cancer accounts for 29% of cancers in men and 22% of cancers in women.
  • Cancer death rates and incidence rates are going up in ND and down in the United States.
  • More Americans die each year of lung cancer than from breast, prostate and colorectal cancers combined When we look at the difference in lung cancer rates for men and women, we see that the lung cancer rates were much lower for women in the 1980’s and have continuously increased. This is due to the fact that smoking rates for women are also on the rise.
  • We know that our Northern Plain American Indians have the highest smoking prevalence and as a result the highest death rates
  • (read the bullets) If you have symptoms make an appointment with your doctor
  • CT scan - CT imaging combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. These cross-sectional images of the area being studied can then be examined on a computer monitor or printed. CT scans of internal organs, bone, soft tissue and blood vessels provide greater clarity and reveal more details than regular x-ray exams. PET scan - Positron emission tomography, also called PET imaging or a PET scan, is a type of nuclear medicine imaging. Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material to diagnose or treat a variety of diseases, including many types of cancers, heart disease and certain other abnormalities within the body. MRI - Magnetic resonance imaging (MRI) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. MR imaging uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. The images can then be examined on a computer monitor, printed or copied to CD. MRI does not use ionizing radiation (x-rays). Sputum samples - Testing sputum helps clinicians diagnose things like pneumonia, bronchitis, and TB and determine the cause of things like a lung abscess. For the sample to be useful, though, it must come from deep within the lungs. In addition, the specimen must be of sufficient quantity. Bronchoscopy - Bronchoscopy is a procedure that allows your doctor to look at your airway through a thin viewing instrument called a bronchoscope. During a bronchoscopy, your doctor will examine your throat, larynx , trachea , and lower airways.
  • The primary risk factor for developing lung cancer is tobacco smoke.
  • On the left we see a clean healthy lung of a nonsmoker. On the right we have a blackened lung, due to tar and abnormal growths that impact the lung function. The lung on the right is also larger than the lung on left, this is due to loss of elasticity which makes it lose it’s shape and appear larger.
  • The smoke of a cigarette contains about 4,000 chemicals. More than 200 chemicals have been linked to cause cancer. Tobacco smoke contains thousands of dangerous elements and chemicals compounds, including formaldehyde, arsenic, cadmium, benzene, polonium, ammonia, carbon monoxide, methanol, and hydrogen cyanide.
  • Secondhand smoke causes 30 times as many lung cancer deaths as caused by all other air pollutants combined. Hundreds of thousands of other nonsmokers, exposed to secondhand smoke, have developed lung cancer. Studies show that a person breathing secondhand smoke is exposed to the same tar, nicotine, cyanide, formaldehyde, arsenic, ammonia, methane, carbon monoxide and other harmful ingredients as the person smoking a cigarette. The United States Environmental Protection Agency (EPA) ranks secondhand smoke as one of the most dangerous cancer-causing substances. Secondhand smoke promotes genetic changes in your cells that interfere with cell development and increase the risk of some cancers. If you or a member of your household smokes around your children, your children can inhale the equivalent of 102 packs of cigarettes by age 5. Effects on children include: Increased ear infections Increased respiratory infections Increased risk of Sudden Infant Death Syndrome (SIDS) Exposure to secondhand smoke is a serious health risk. It affects everyone—whether they smoke or not.
  • Make a Difference Today You can make a difference, starting today . Here are some things you can do today that will help everyone breathe free in North Dakota: 1. Join the coalition today. 2. Educate friends, relatives and public officials about the issue. 3. Write a letter to the editor for your local newspaper. 4. Call in to talk radio shows when the topic arises. 5. Contact your legislators to let them know how important this issue is for all North Dakotans. Cancer is the second most common cause of death in the US. Among cancer deaths, lung cancer is the number one killer of both men and women. More women die from lung cancer than breast cancer.
  • spit tobacco, smokeless tobacco, snus, chew, pinch, plug or dip – call it what you want, but don’t call it harmless. If you are thinking about switching from cigarettes to smokeless tobacco because you think the smokeless version won’t hurt you, be forewarned – smokeless tobacco also causes serious health problems. Spit tobacco contains 28 cancer-causing agents (carcinogens). It is a known cause of human cancer, as it increases the risk of developing cancer of the oral cavity. It can also cause a number of non-cancerous conditions and can lead to nicotine addiction and dependence. Some of the ingredients in spit tobacco include polonium 210, N-nitrosamines, formaldehyde, nicotine, cadmium, cyanide, arsenic, benzene, and lead.
  • Using spit tobacco products can cause serious health problems, from gum irritation to oral cancer. Use of spit tobacco products can permanently stain teeth and cause bad breath. Spit tobacco also causes tooth decay or cavities. Many smokeless tobacco products contain high amounts of sugar, which contribute to cavities. Spit tobacco also contains coarse particles which can irritate your gums and cause tooth abrasion. The sugar and the irritants can cause your gums to pull away from your teeth (receding gums) in the area of your mouth where the smokeless product is placed, and over time this can lead to gum infection (gingivitis), gum disease and possibly tooth loss. spit tobacco products contain nicotine, and causes nicotine addiction and dependence, similar to the way cigarettes do. People who use spit tobacco are more likely to develop mouth sores and small white patches called leukoplakia where the smokeless product is placed. These lesions are precancerous. The risk or oral cancer is increased for those who use smokeless tobacco products. Oral cancer includes cancers of the mouth, throat, cheek, gums, lips and tongue. Some research has also shown a connection between use of spit tobacco and pancreatic cancer. Spit tobacco increases the heart rate and blood pressure and may trigger irregular heart beats leading to a greater risk of heart attack and stroke.
  • The warning signs of oral cancer include: A sore that bleeds easily and does not heal; A lump of thickening anywhere in the mouth or neck; A red or white patch that does not go away; A prolonged sore throat, or soreness or swelling in the mouth or neck that does not go away; Difficulty chewing or swallowing, or moving the tongue or jaw. Smokeless tobacco users may be unaware of the seriousness of these warning sings as pain is rarely an early symptom.
  • Smokeless tobacco users are more likely to develop small white patches called leukoplakia inside there mouths where the product is most often placed. These patches are precancerous – meaning that one day the sores could develop into cancer. Smokeless tobacco users are at increased risk for oral cancer. Surgery to remove oral cancer can leave the jaw, chin, neck or face disfigured. Oral cancer is one of the most difficult cancers to treat. On average only one-half of those with the disease will survive more than five years. About 30,000 new cases of oral cancer are diagnosed every year. More than 8,000 individuals die from mouth cancer every year.
  • Studies show that asbestos workers are seven times more likely to die from lung cancer and workers from other industries. Asbestos workers who smoke increase their risk of getting lung cancer. Mining industry workers who are exposed to coal products or radioactive substances such as uranium, and workers exposed to chemicals such as arsenic, vinyl chloride, mustard gas, and other carcinogens also have a high risk of contracting lung cancer. High levels of a radioactive gas (radon) that cannot be seen or smelled pose a risk for lung cancer. This gas is produced by the breakdown of uranium, and does not present any problem outdoors. Radon can be found in the basements of some houses that are built over soil containing natural uranium deposits, however, radon may accumulate to dangerous levels. Having one's house inspected for the presence of radon gas when buying or renting is a good idea. You can get test kits from your local public health or the American Lung Association Other forms of environmental pollution (e.g., auto exhaust fumes) may also slightly increase the risk of lung cancer Inflammation and scar tissue are sometimes produced in the lung by diseases such as silicosis and berylliosis , which are caused by inhalation of certain minerals; tuberculosis ; and certain types of pneumonia. This scarring may increase the risk of developing lung cancer. Family history Although the exact cause of lung cancer is not known, people with a family history of lung cancer appear to have a slightly higher risk of contracting the disease
  • Physician/treatment team will choose the most appropriate treatment option Depends on the type and stage of the cancer as well as the general health of the patient Sugery Curative surgery : The removal of a tumor when it appears to be confined to one area. Debulking surgery : Performed when the entire tumor cannot be removed. The remaining portion of the tumor may then be treated with chemotherapy or radiation. Palliative surgery : To remove a portion of the tumor that is causing discomfort or disability for temporary relief. Chemotherapy - Use of strong chemicals or drugs to prevent the reproduction of cancer cells and stop their growth. Can be used in conjunction with radiation therapy and surgery. Drugs are often given in different combinations to more effectively attack the cancer. Drugs may be given intravenously or taken orally in tablet, capsule, or liquid form. The amount of chemotherapy a patient receives depends on the type of cancer, the drugs, and the patient’s overall response to treatment. Radiation Therapy - Use of high-energy X-rays to kill cancer cells or prevent them from growing. X-rays targeted directly at tumors or anywhere cancer is present. Often spaced over a number of weeks or months so that the healthy cells that may be affected have time to rejuvenate. The number of treatments a patient receives depends on the type and extent of the tumor, as well as the radiation dosage and the patient’s tolerance.
  • Point out how quick the body heals once you quit. After 15 years your risk of death returns to nearly the level of people who have never smoked. Benefits of stopping tobacco use are: When you stop tobacco use, you experience immediate health benefits no matter what your age. For example, within 20 minutes of stopping tobacco use, your blood pressure drops to its normal level. After 8 hours without a cigarette, the level of carbon monoxide drops to normal. And after 24 hours without tobacco use, your chance of having a sudden heart attack decreases. After one year without tobacco use, your chance of having a heart attack is cut in half. Even after years of smoking, your lung function increases up to 30% in the first three months after quitting. After 5 years of being tobacco-free, your risk of stroke is reduced to that of a nonsmoker’s. The longer you remain tobacco-free, the more benefits you will enjoy. Stopping smoking also benefits those around you. People who live with smokers are at greater risk for lung cancer, emphysema and other lung problems. Children who are exposed to secondhand smoke get sick more often and suffer more ear infections. How Your Body Changes When You Quit Smoking from ; page 30.
  • The general quit rate for a person is 5%. When you add medications you double that 10%. When you add counseling like the quitline or local tobacco consultation and classes you double that again. (We need to give the percentage of the effectiveness with the quit line and other supports)
  • Special populations include: Spit users Pregnant women American Indians Teens 12-17 years of age People who are low level readers
  • Anyone who participates in the Quitline program is eligible for the 28 day supply of nicotine replacement therapy noted above.
  • To find a program in your area click on the North Dakota Department of Health Website and click on the directory of North Dakota Tobacco Cessation Programs
  • Lung Cancer and Tobacco Use - North Dakota Department of Health

    2. 2. Right lung=3 lobes Left lung=2 lobes Air enters lungs through trachea Trachea divides into bronchi Bronchi divide into bronchioles Alveoli are the air sacs at the end of the bronchioles Pleura = lining of the lungs What is the function of the lungs?
    3. 3. What is lung cancer? <ul><li>Lung cancer is the uncontrolled growth of abnormal cells. </li></ul><ul><li>These cells develop into tumors and the tumors disrupt the proper function of the lung. </li></ul>
    4. 4. <ul><li>Cough that does not go away </li></ul><ul><li>Breathing trouble, such as shortness of breath </li></ul><ul><li>Constant chest pain </li></ul><ul><li>Coughing up blood </li></ul><ul><li>A hoarse voice </li></ul><ul><li>Frequent lung infections </li></ul><ul><li>Feeling tired all the time </li></ul><ul><li>Weight loss with no known cause </li></ul><ul><li>  </li></ul>Symptoms
    5. 5. United States lung cancer facts American Cancer Society, 2007 <ul><li>Estimated new cases and deaths from lung cancer in the United States in 2007: </li></ul><ul><ul><li>New cases: 213,380 </li></ul></ul><ul><ul><li>Deaths: 160,390 (29% of all cancer deaths) </li></ul></ul><ul><li>Lung cancer is the leading cause of cancer death among men and women </li></ul><ul><li>More than 87% of lung cancers are smoking related </li></ul><ul><li>More Americans die each year of lung cancer than from breast, prostate and colorectal cancers combined </li></ul>
    6. 6. About 390 new cases each year in North Dakota. It is estimated that 330 Lung cancer deaths will occur in North Dakota this year. North Dakota lung cancer facts American Cancer Society, Cancer Facts and Figures 2008
    7. 7. Lung/Bronchus cancer rates 1980-2005 Age-adjusted rate per 100,000
    8. 8. North Dakota lung and bronchus cancer by gender, 1980-2005 Age-adjusted rate per 100,000
    9. 9. Lung cancer mortality rates, IHS regions and U.S. all races, 1999-2003
    10. 10. Screening <ul><li>No approved screening test proven to improve survival or detect localized disease </li></ul><ul><li>Clinical studies are under way </li></ul>
    11. 11. Diagnosis <ul><li>Physical exam </li></ul><ul><li>Chest X-ray </li></ul><ul><li>CT Scan </li></ul><ul><li>PET Scan </li></ul><ul><li>MRI </li></ul><ul><li>Sputum sample </li></ul><ul><li>Bronchoscopy </li></ul><ul><li>Biopsy </li></ul>Chest Xray PET Scan CT Scan
    12. 12. Primary Risk Factors Tobacco use & Secondhand Smoke
    13. 13. <ul><li>Lung cancer is the most preventable form of cancer death </li></ul><ul><li>in our society. </li></ul><ul><li>More than 87% of lung cancers are smoking related </li></ul><ul><li>  </li></ul>
    14. 14. Secondhand smoke <ul><li>Each year about 3,000 non-smoking adults die of lung cancer as a result of breathing secondhand smoke. </li></ul>
    15. 15. What about secondhand smoke? Being in a nonsmoking section of a restaurant for 2 hours = Being in a smoky home for one day = Being in a smoky bar = Mayo Clinic
    16. 16. To learn what you can do to make a difference with secondhand smoke? What can you do?
    17. 17. Spit tobacco is not harmless <ul><li>Smokeless (spit) tobacco is not a safe alternative to cigarettes – smokeless tobacco also causes serious health problems! </li></ul><ul><li>Smokeless tobacco contains 28 cancer-causing agents. </li></ul>
    18. 18. Consequences of spit tobacco use <ul><ul><li>Tooth discoloration and staining </li></ul></ul><ul><ul><li>Tooth abrasion/worn teeth </li></ul></ul><ul><ul><li>Cavities </li></ul></ul><ul><ul><li>Stained tongue/bad breath </li></ul></ul><ul><ul><li>Tarter buildup and gingivitis </li></ul></ul><ul><ul><li>Receding gums </li></ul></ul><ul><ul><li>Gum disease </li></ul></ul><ul><ul><li>Addiction </li></ul></ul><ul><ul><li>Precancerous mouth lesions </li></ul></ul><ul><ul><li>Oral cancers and other cancers </li></ul></ul><ul><ul><li>Heart problems </li></ul></ul>
    19. 19. Warning signs of oral cancer <ul><li>A sore in the mouth that bleeds easily and does not heal </li></ul><ul><li>A lump or red/white patch in the mouth </li></ul><ul><li>Prolonged sore throat </li></ul><ul><li>Difficulty chewing or swallowing </li></ul><ul><li>Restricted movement of the tongue or jaw </li></ul><ul><li>Pain is rarely an early symptom! </li></ul>
    20. 20. Oral cancer-deadly to ignore <ul><li>Precancerous lesion </li></ul><ul><li>Oral cancer </li></ul>
    21. 21. Other risk factors <ul><li>Exposure to asbestos and toxic chemicals </li></ul><ul><li>Environmental contamination </li></ul><ul><li>Chronic lung inflammation /scarring </li></ul><ul><li>Family history </li></ul>
    22. 22. Treatment <ul><li>Surgery </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Radiation Therapy </li></ul>
    23. 23. <ul><li>Lung cancer is the most preventable form of cancer death in our society. </li></ul><ul><li>By quitting tobacco use you significantly reduce your risk of all cancers. </li></ul>It is preventable!
    24. 25. Quit tobacco use today <ul><li>Seek help in quitting by: </li></ul><ul><li>Becoming familiar with the medications and combinations of medications available. </li></ul><ul><li>Contacting your local health department </li></ul><ul><li>Contacting your physician </li></ul><ul><li>Calling the North Dakota Tobacco Quitline </li></ul>
    25. 26. <ul><li>Is a resource for: </li></ul><ul><ul><ul><li>Tobacco users </li></ul></ul></ul><ul><ul><ul><li>Family members & friends </li></ul></ul></ul><ul><ul><ul><li>Health care professionals </li></ul></ul></ul>
    26. 27. <ul><li>Supported by North Dakota Department of Health with funding from </li></ul><ul><ul><li>Tobacco Master Settlement Agreement (MSA) funds appropriated by ND legislature </li></ul></ul><ul><ul><li>Centers for Disease Control and Prevention (CDC) grant </li></ul></ul>
    27. 28. <ul><li>Hours that you can speak to someone direct are: </li></ul><ul><li>Monday-Thursday 7:00am – 8:00pm(CT) </li></ul><ul><li>Friday 7:00am – 7:00pm(CT) </li></ul><ul><li>Saturday 10:00am – 4:00pm(CT) </li></ul><ul><ul><ul><ul><li>Voice mail available 24 hours/day </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Quit Tips audio library also available </li></ul></ul></ul></ul>
    28. 29. <ul><li>Every caller receives a thorough initial assessment </li></ul><ul><li>May also receive up to 5 additional counseling sessions </li></ul><ul><li>Special protocols for certain populations </li></ul><ul><li>Will refer callers to local cessation programs if needed </li></ul>
    29. 30. <ul><li>Free nicotine replacement therapy (NRT) </li></ul><ul><li>Free 28 day supply of your choice of nicotine patch, gum or Lozenge to qualified enrollees </li></ul>
    30. 31. <ul><li>For The Directory of North Dakota Tobacco Cessation Programs In Your Area: </li></ul> /tobacco