Tobacco Cessation: Curb the Deadliest Epidemic

1. Tobacco Cessation:Curb the Deadliest Epidemic Keith Bradley, MD Director, Research Associates Program atSt. Vincent’s National Alliance of Research Associates Programs (NARAP)

4. Nicotine-Related Pathology • coronary artery • peripheral vascular disease • hypertension • peptic ulcer disease • fetal mortality and morbidity • cancer

7. Lung Cancer All lung cancers begin as small focus of uncontrolled cell division → thickening/piling up of bronchial mucosa.

9. Lung Cancer • Small cell • Adenocarcinoma • Squamous carcinoma • Large cell carcinoma

10. Small Cell Carcinoma

11. Small Cell Carcinoma • 20% of all lung cancers

12. Small Cell Carcinoma • 20% of all lung cancers • highly aggressive, metastasizing early.

13. Small Cell Carcinoma • 20% of all lung cancers • highly aggressive, metastasizing early. • only 1% of cases occur in non-smokers

14. Small Cell Carcinoma • 20% of all lung cancers • highly aggressive, metastasizing early. • only 1% of cases occur in non-smokers • incurable by surgery

15. Small Cell Carcinoma • 90% of small cell carcinomas begin in central airways

16. Small Cell Carcinoma • 90% of small cell carcinomas begin in central airways • consistent with smoking association

17. Small Cell Carcinoma • 90% of small cell carcinomas begin in central airways • consistent with smoking association • Small cell staged as limited or extensive (spread outside chest)

18. Small Cell Carcinoma • 90% of small cell carcinomas begin in central airways • consistent with smoking association • Small cell staged as limited or extensive (spread outside chest) • 70% are extensive at diagnosis

20. Adenocarcinoma

21. Adenocarcinoma • About 40% of lung cancer cases in the US

22. Adenocarcinoma • About 40% of lung cancer cases in the US • The most common lung cancer among women

23. Adenocarcinoma • About 40% of lung cancer cases in the US • The most common lung cancer among women • number of new cases is increasing

24. Adenocarcinoma • About 40% of lung cancer cases in the US • The most common lung cancer among women • number of new cases is increasing • Usually starts near the outer edges of the lungs

25. Adenocarcinoma • About 40% of lung cancer cases in the US • The most common lung cancer among women, • number of new cases is increasing • Usually starts near the outer edges of the lungs • Often metastasized at diagnosis

28. Squamous Carcinoma

29. Squamous Carcinoma • 25-30% of lung cancer cases in the US

30. Squamous Carcinoma • 25-30% of lung cancer cases in the US • Occurs most frequently in men and the elderly

31. Squamous Carcinoma • 25-30% of lung cancer cases in the US • Occurs most frequently in men and the elderly • Usually starts in one of the larger breathing tubes

32. Squamous Carcinoma • 25-30% of lung cancer cases in the US • Occurs most frequently in men and the elderly • Usually starts in one of the larger breathing tubes • Tends to grow relatively slowly

33. Squamous Carcinoma • 25-30% of lung cancer cases in the US • Occurs most frequently in men and the elderly • Usually starts in one of the larger breathing tubes • Tends to grow relatively slowly • Tends to remain localized in the chest longer than other types of lung cancer

34. Squamous Carcinoma • 25-30% of lung cancer cases in the US • Occurs most frequently in men and the elderly • Usually starts in one of the larger breathing tubes • Tends to grow relatively slowly • Tends to remain localized in the chest longer than other types of lung cancer • Does not metastasize early

37. Large Cell Carcinoma

38. Large Cell Carcinoma • “Other” • tend to have larger cells than other types of lung cancer

39. Large Cell Carcinoma • “Other” • tend to have larger cells than other types of lung cancer • Incidence appears to be decreasing • may be due to improvements in determining the types of lung cancer

40. Large Cell Carcinoma • “Other” • tend to have larger cells than other types of lung cancer • Incidence appears to be decreasing • may be due to improvements in determining the types of lung cancer • 10-15% of lung cancer cases in the US

41. Large Cell Carcinoma • “Other” • tend to have larger cells than other types of lung cancer • Incidence appears to be decreasing • may be due to improvements in determining the types of lung cancer. • 10-15% of lung cancer cases in the US • Usually starts in the smaller breathing tubes

42. Large Cell Carcinoma • “Other” • tend to have larger cells than other types of lung cancer • Incidence appears to be decreasing • may be due to improvements in determining the types of lung cancer • 10-15% of lung cancer cases in the US • Usually starts in the smaller breathing tubes • May occur in any part of the lung

43. Large Cell Carcinoma • “Other” • tend to have larger cells than other types of lung cancer • Incidence appears to be decreasing • may be due to improvements in determining the types of lung cancer. • 10-15% of lung cancer cases in the US • Usually starts in the smaller breathing tubes • May occur in any part of the lung • Tumors are usually large at diagnosis

44. Large Cell Carcinoma • “Other” • tend to have larger cells than other types of lung cancer • Incidence appears to be decreasing • may be due to improvements in determining the types of lung cancer. • 10-15% of lung cancer cases in the US • Usually starts in the smaller breathing tubes • May occur in any part of the lung • Tumors are usually large at diagnosis • Tends to invade the mediastinum (chest area behind the breastbone)

45. Large Cell Carcinoma • “Other” • tend to have larger cells than other types of lung cancer • Incidence appears to be decreasing • may be due to improvements in determining the types of lung cancer. • 10-15% of lung cancer cases in the US • Usually starts in the smaller breathing tubes • May occur in any part of the lung • Tumors are usually large at diagnosis • Tends to invade the mediastinum (chest area behind the breastbone) • Metastasizes to the central nervous system

47. Nicotine Addiction

48. Nicotine Addiction • Psychoactive

49. Nicotine Addiction • Psychoactive • dose-related changes in mood and feeling

50. Nicotine Addiction • Psychoactive • dose-related changes in mood and feeling • transient