The harmful effects of smoking have been known since the mid-1950s when the link between smoking and lung cancer was statistically proven. Dr. Morton L. Levin of the Roswell Park Memorial Institute in Buffalo, NY a state cancer research-treatment center, made this connection. Subsequently, he boldly wrote to the presidents of seven leading tobacco companies suggesting that they voluntarily label all cigarette packaging with a warning that excessive smoking is dangerous to health. At that time, it created a firestorm of controversy, with the tobacco companies defending their positions. I had the good fortune to work under Dr. Levin during the summer of 1965 in a National Summer Science program. Packages were finally labeled in 1964.

Researchers over the following decades have been searching for the noxious chemicals in tobacco which cause disease. Some early thoughts were to find the offending chemicals so these agents could be removed. More recently, finding these compounds in the urine of smokers has resulted in being able to determine who is at higher risk to develop lung cancer.

Interestingly only one in ten smokers will get lung cancer. Determining who the “10th” person could be an important motivator for the 10% at risk to stop smoking if they wanted to live. “Urinary levels of tobacco-specific nitrosamine metabolites in relation to lung cancer development in two prospective cohorts of cigarette smokers” was an abstract shared recently at the proceedings of the 100^th Annual Meeting for the American Association for Cancer Research by Dr. J. M. Yuan.

Dr. Yuan and his associates developed a test for a known carcinogen (cancer causing chemical) called 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol also known by the much easier to say moniker, NNAL. The researchers took blood and urine samples from over 80,000 Chinese and Singapore citizens from 1986 to 1999 and measured the levels of NNAL. These patient researchers then followed the smokers over the ensuing years to see which 10% of the smokers developed lung cancer.

The conclusions are interesting and again support the facts that smoking causes cancer. The risk of lung cancer was 8.5 times higher in those who had the highest levels of this chemical, NNAL, and the highest nicotine levels. The challenge now is to make the test inexpensive and easy to obtain so that smokers can be screened. The researchers say this test is still not ready for general clinical use.

Why do some smokers have a higher level of NNAL and get lung cancer while other smokers survive? The scientists are still searching for the answer to this question with the current leading theory being that some smokers have a genetic makeup which breaks down the toxins in tobacco differently that other smokers. If a smoker can get rid of the toxins quickly, the overall exposure is less and presumably the chances of survival are better.

Bottom line: Don’t smoke. However, if you do or if you have smoked in the past, knowing whether you have or have had a high level of NNAL will help you predict whether you are at higher risk for lung cancer. Knowing you are at risk should make you more vigilant for early detection of lung cancer and ultimately improve your chances of survival.

Here are ten interesting facts about smoking:

1. About 8.6 million people in the US have at least 1 serious illness that’s caused by smoking.
2. Smoking is the cause of 1 in 5 deaths in the US annually. And tobacco use is the leading preventable cause of death.
3. About 1.69 billion pounds of butts end up as toxic trash each year, making cigarettes the most littered item on Earth.
4. For every person that dies from a smoking-related disease, there are 20 more who suffer from at least 1 serious illness associated with smoking.
5. The CDC estimates that adult male smokers lose an average of 13.2 years of life and female smokers lose 14.5 years of life because of smoking. And given the diseases that smoking can cause, it can steal your quality of life long before you die.
6. In 2020, 12.5% of Americans, 18 and older, were current smokers.
7. A single cigarette contains over 4,800 chemicals, 69 of which are known to cause cancer. Secondhand smoke contains over 7,000 chemicals, including 70 cancer-causing chemicals.
8. Smoking cessation works but early education to discourage smoking in the first place is even more cost effective.
9. Every year, there are approximately 46,000 deaths from heart disease in people who are current non-smokers but formerly smoked.
10. Smoking increases your risk of getting lung diseases like pneumonia, emphysema, and chronic bronchitis.