The Evaluation and Treatment of Tobacco Use Disorder
Prognosis
Smoking cessation significantly reduces most of the increased morbidity and mortality from smoking.59 The degree of improvement, however, depends on the disease process involved, the amount of damage produced, and the reversibility of this damage at the time of cessation. Former smokers reduce their risk of developing coronary heart disease by 50% within 1 year of quitting.59 After 4 years, this risk becomes equal to that of people who have never smoked. Improvement in cancer risk varies with the type of cancer involved. The risk of lung cancer in former smokers, for example, always remains higher than that for those who have never smoked. However, this risk decreases progressively and considerably with the number of years of abstinence.59
In addition to reduction in morbidity and mortality, smoking cessation is among the most cost-effective measures in primary care. Studies have shown that the cost-effectiveness of physician smoking cessation counseling is similar to the treatment of mild to moderate hypertension or hypercholesterolemia.60 The estimated cost per year of life saved is $2000 for smoking cessation compared with $50,000 for screening mammography for breast cancer.61 Given the proven effectiveness of available smoking cessation interventions and the ready access primary care physicians have to smokers, effectively addressing tobacco use in primary care settings has a great potential of reducing tobacco-related morbidity and mortality.
Acknowledgments
Our work was supported by a grant from the Cancer Research Foundation of America (Dr Okuyemi) and a Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Award (Dr Ahluwalia, #032586). Dr Wadland has received funding in the past from SmithKline-Beecham and Glaxo-Wellcome for nicotine replacement in community clinical trials. Dr Ahluwalia has received honoraria for presentations from Glaxo-Wellcome, Inc and Pharmacia Upjohn, Inc. Dr Okuyemi has received an honorarium for educational purposes from SmithKline Beecham.
