Tennessee women see rise in lung cancer deaths
Tom Wilemon for The Tennessean
Tennessee women who lit up Virginia Slims and other cigarette brands in the 1960s and 1970s as acts of liberation are dying of lung cancer more often than women of earlier generations.
A new study shows a spike in lung cancer deaths among Tennessee women who
started the habit when it became more socially acceptable to smoke and tobacco
companies targeted them in marketing campaigns.
However, the same study shows women were able to largely avoid this death cycle in California and other states that imposed strict anti-smoking policies and higher tobacco taxes.
Women in those states quit smoking earlier and lit up less often than Southern women, according to the study, which was recently published in the Journal of Clinical Oncology. It used white women born in 1933 as a baseline. The Tennessee death rate increased by more than 50 percent over that baseline for women born in the 1950s and 1960s.
Gloria Massie of Donelson started smoking as a teenager, puffed her way up to a three-pack-a-day habit and didn’t quit until 2007, when she was 60. A year later, she was diagnosed with lung cancer.
She considers herself lucky because a doctor noticed something on a chest X-ray when she went to an emergency room for an unrelated health issue. “They caught it just in time before it spread everywhere,” Massie said.
She had the top third of her right lung removed in January 2008 at TriStar Centennial Medical Center and did not require chemotherapy or radiation. Massie, whose mother had died of lung cancer at age 60, has been cancer-free for four years.
But she looks in the mirror and wonders how much younger she might look. “I know from squinting your eyes because of the smoke and from inhaling you get all those lines around your mouth,” Massie said. “You have little lines around your eyes. I think how many of those wouldn’t have been there if I had not smoked.”
Her physician, Dr. Eric Raefsky, a medical oncologist with Tennessee Oncology, said he sees too many women with lung cancer. “It is worse than breast cancer in terms of cancer-related deaths,” Raefsky said. “It is now actually the No. 1 cause of cancer deaths among women.”
Both state and national studies show that lung cancer is about twice as deadly as breast cancer, the second-most common cancer killer among women.
Today, about as many female high school students smoke as male students in the United States (19.1 percent compared with 19.8 percent), according to the U.S. Centers for Disease Control and Prevention. In Tennessee, 13 percent of youths between the ages of 12 and 17 smoke. Twenty-three percent of adults do.
One-fifth of all women in the state smoke. Raefsky fears history may be repeating itself.
“There is obviously a lag between when people start smoking and when there is a higher incidence of lung cancer because it takes many years of smoking to increase the risk,” Raefsky said.
The study was limited to white women because there was not adequate data to include other ethnic groups in the 23 states for which lung cancer deaths were analyzed, said Dr. Ahmedin Jemal, its lead author and vice president of surveillance research for the American Cancer Society.
“The dramatic rise in lung cancer rates in young and middle-aged white women in several Southern states points to a lack of effective policies or interventions, like excise taxes and comprehensive smoking bans, that deter initiation of smoking among teenagers and promote smoking cessation among adults,” Jemal said.
Higher tax pushed
California was the first state to increase tobacco excise taxes in 1988 as part of an initiative to discourage smoking and began instituting smoking bans in public places as early as the mid-1970s. Tennessee did not ban smoking in restaurants and other public places until the Non-Smoker Protection Act of 2007. The state still allows smoking in many bars as well as private businesses that employ fewer than three people.
Tennessee’s cigarette tax is 62 cents a pack, which is below the national average of $1.46 a pack. The American Cancer Society is pushing for Tennessee to raise that tax by $1.
Dr. Jonathan Metzl, director of the Vanderbilt University Center for Medicine, Health and Society, said the “slam-dunk point of the article” is the effectiveness of public policies to curb smoking.
“If we are going to use California, as this study does, as the gold standard for smoking cessation efforts, certainly it is easier to smoke in a public setting in Tennessee than it is in California,” Metzl said. “Still in Tennessee, you can smoke in bars. I realize this is a deep issue, a kind of personal liberty for people that people feel strongly about.” Under Tennessee law, bars can allow smoking if they restrict admittance to people 21 and older.
More calls for help
Bill Pressly of Crossville is a volunteer with the American Cancer Society who supports higher tobacco taxes in Tennessee. He said the state, which provides free assistance to help people quit smoking, is making progress. Calls to Tennessee’s quit-smoking hotline nearly tripled from the last six months of 2011 to the first six months of 2012, thanks to a national media campaign, the state health department said. The Tennessee Tobacco Quitline got more than 13,000 calls over the past 12 months.
“The Tennessee Non-Smoker Protection Act has helped,” said Pressly, the son of a mother who smoked and died at age 59 of emphysema and himself a former smoker who is a throat cancer survivor. “I think raising the tobacco tax has helped reduce the number of smokers. I think weare on the right track, but our train is moving too slow.”