Listen to the Special Cancer.Net Podcast: Questions and Myths About Quitting Smoking, with Michael Cummings, PhD, MPH, adapted from this feature.
Michael Cummings, PhD, MPH	Carolyn Dresler, MD, MPA

Quitting smoking is the single most important thing a person can do to lower his or her risk of cancer. Yet many smokers (and nonsmokers) hold myths about the value of quitting or staying quit, even after a diagnosis of cancer. To discuss the most common myths and questions asked about smoking and cancer, Cancer.Net welcomes Michael Cummings, PhD, MPH, director of the New York State Smokers’ Quitline, and Carolyn Dresler, MD, MPA, chief of the tobacco prevention and cessation program at the Arkansas Department of Health.

Q: I already have cancer. Why should I quit smoking now?

A: If you have cancer, it is especially important for you to stop smoking immediately. Smoking can adversely impact how the cancer will respond to treatment. It also impairs wound healing for those who have surgery. Sometimes, these wounds are internal, such as the closure to your airways when you have lung surgery. If proper healing in these internal areas is at risk, your life may also be at risk. Similarly, with radiation therapy, continued smoking increases the risks of complications. The risk of infection, which is an important source of illness and even death in people with cancer, is higher in those who continue to smoke. Furthermore, in people who continue to smoke, the cancer doesn’t respond as well to certain types of chemotherapy. Recent studies of lung cancer have shown that nicotine induces resistance to chemotherapy. The risk of the cancer spreading to other parts of the body and of a second primary cancer is also higher in those who continue to smoke. You are more likely to survive longer after your cancer treatment if you stop smoking.

Q: Does it matter if I quit smoking now? I have a friend who quit smoking 20 years ago and he still got cancer.

A: Yes, it does matter. The benefits of quitting smoking start immediately. When you quit, your cells get more oxygen and wound healing is improved. The nicotine levels in your blood begin to drop rapidly, and the nicotine is cleared out of your system a few days after you quit. Getting rid of nicotine is especially important because research shows that nicotine can speed up the growth of cancer cells. While it has been suggested that it may not be wise to use nicotine medications, such as the patch or gum, as the initial treatment to stop smoking for people with cancer because of evidence that nicotine promotes tumor growth by stimulating angiogenesis (growth of new blood vessels for tumors to grow), these medications rarely produce nicotine levels as high as those associated with continued cigarette smoking. Also, the continued use of tobacco with all the other chemicals in tobacco represents a far greater health risk compared with using nicotine medications. Fortunately, there are alternative non-nicotine medications such as bupropion (Zyban) and varenicline (Chantix) that doctors can offer to patients with cancer to help them stop smoking.

Q: My cancer diagnosis is stressful. Why should I add to this stress by quitting smoking?

A: Actually, people who smoke often misunderstand this issue of stress! Studies have shown that people who smoke have higher levels of stress than nonsmokers. And, right now, you have the stress of cancer treatment, which is much more stressful than continuing to smoke. If you’ve been diagnosed with cancer, you need to recognize that quitting smoking is not an option—it is now an essential part of your cancer treatment, just like having surgery, chemotherapy, or radiation therapy. Sometimes surgery, chemotherapy, and radiation therapy don’t work as planned, so adjustments are needed. The same is true for quitting smoking. It is not always easy to quit, but just because you might relapse back to smoking doesn’t mean you can’t stop. Take it one day at a time and tell yourself, “I choose not to smoke.” There are medications that your doctor can give you to help you fight the urges to smoke. Some people benefit from combining different medications to get relief. First-line medications to support a quit attempt include nicotine replacement (gum, patch, lozenge, nasal spray, or inhaler), bupropion, or varenicline. Use of these agents can increase quit rates by 1.5 to 3 fold. Several studies have shown that combining the nicotine patch with either gum or nasal spray can increase quit rates over a single type of treatment. Going to a support group to stop smoking, calling a telephone quitline (1-800-QUIT-NOW [1-800-784-8669]), or even going online to get support for your quitting effort can also help increase your odds of quitting.

Q: Would it help to cut back on smoking?

A: Not if cutting back is an excuse to keep smoking. Every single puff on a cigarette damages your body. However, sometimes it does help to cut back on the amount you smoke every day in preparation for quitting completely rather than just quitting “cold turkey.” Several studies have found that using stop smoking medications a week or two in advance of quitting smoking can improve longer-term quit rates. Sometimes, it is useful just to write down each and every cigarette smoked as a strategy to cut back. The simple process of recording when and where you are smoking can help you find ways to forgo lighting up and may convince you that you can control your smoking urges.

Q: What about “light” cigarettes? Are they safe?

A: No, these cigarettes are not safer and do not help you quit smoking. In fact, studies reveal that the tar extracted from a light cigarette is more damaging to your body’s cells than the tar from a high-tar cigarette because the filter allows more oxygen to mix with the cancer-causing chemicals. The vent holes in the filters of light cigarettes make it easier for smokers to take bigger, deeper puffs on the cigarette, allowing the tiny smoke particles to go deeper into the lungs, which makes these cigarettes MORE dangerous, not less dangerous. Most people smoke a filtered cigarette thinking that it makes the cigarette safer. Unfortunately, that is not true either. There is not much evidence that smoking a filtered cigarette is any better than smoking one without a filter. Research also has shown that smokers can inhale the tiny, plastic, fiber filaments that break off the filter tip end when they smoke. These tiny fibers coated with tar can be inhaled in the mouth and airways where they can cause tissue inflammation. The bottom line is filters, low-tar cigarettes, and so-called “light cigarettes” are a marketing scheme to make smokers feel better about continuing to smoke.

Q: I tried to quit smoking, but nothing works. What can I do?

A: Ask for help and don’t give up. Nicotine dependence is an addiction and should be considered a chronic health condition. The risk of relapse back to smoking is always a concern. In other words, struggling to quit is part of the process. The goal is to extend the periods when you don’t smoke. Most people think they should be able to quit without assistance or “cold turkey.” But, the reality is few people succeed this way. When you were diagnosed with cancer, you went to see a specialist for treatment; you should do the same for your smoking. Ask your doctor for help or for a referral to a specialized program that can develop a treatment plan tailored to your needs. Quitting smoking is like riding a bike—you’re going to have to practice to learn how to do it well. In every state of the United States is a free program to help you stop—1-800-QUIT- NOW— call them right now!

Q: I quit smoking. How can I convince my partner to quit, too?

A: You can’t make someone quit, which you probably already knew since you used to smoke. But, the good news is actions always speak louder than words. So, if you want a family member or friend to stop smoking, show them that it can be done by remaining smoke-free yourself. Tell your partner how important it is to you for him or her to be as healthy as possible to help you with your cancer treatment.

Q: Why do I still think about smoking, even though I quit years ago?

A: Most people start smoking when they are teenagers. It turns out nicotine is a very potent stimulant to the central nervous system, especially in the developing brain, which is likely the reason why those who start smoking at an earlier age tend to find it hard to quit later in life. Nicotine binds to and stimulates neural nicotinic acetylcholine receptors (nAChRs), which influence the release of dopamine and other signaling substances that produce feelings of reward, which motivates the smoker to smoke again. The drug-induced associations of smoking, such as a cup of coffee, seeing another person smoking, or just waking up in the morning, are typically associated with the urge to smoke even in those who have quit for some time. So, if you occasionally feel the urge to smoke after you’ve quit, you’re not crazy—it’s normal. The good news is the urges to smoke, although sometimes very intense, become less frequent the longer you stay off cigarettes. When the urge to smoke strikes, remember the five “D’s”: Delay a minute or two and the urge will pass; Drink water to fight off the cravings; Do something else to distract yourself, take a walk, call a friend, or clean a closet; Deep breathing—it will help relax you— close your eyes and take 10 slow deep breaths; and finally, Discuss your thoughts and feelings with someone close to you.

Dr. Cummings is Chair, Department of Health Behavior, Division of Cancer Prevention and Population Sciences at Roswell Park Cancer Institute in Buffalo, New York. He is a member of ASCO’s Cancer Prevention Committee. Dr. Dresler is a thoracic surgical oncologist and Branch Chief of the Tobacco Prevention and Cessation Program at the Arkansas Department of Health.

More Information

Tobacco

Additional Resources

National Alliance for Tobacco Cessation: BecomeAnEx.org

Smokefree.gov

Last Updated: January 05, 2009