Head and Neck Cancer Specialist Fears New Anti-Smoking Images May Fall Short

Photo of Yash Patil, MD, by Cindy Starr / Mayfield Clinic

A picture may pack the punch of a thousand words, but Yash Patil, MD, doesn’t think the graphic images scheduled to appear on cigarette packs in 2012 will be strong enough to slay the dragon of nicotine addiction. In Dr. Patil’s experience, a diagnosis of cancer may not even be enough.

“In a decade of treating patients with head and neck cancers, I’ve never met an addict who didn’t want to stop the day they received a cancer diagnosis,” says Dr. Patil, an otolaryngologist with the University of Cincinnati Gardner Neuroscience Institute and UC Health and an Assistant Professor of Otolaryngology at UC.

But not all can free themselves from the vice-grip of addiction. At least one-third of the patients Dr. Patil treats for head and neck cancers are not able to stop smoking. That fact is borne out by one of the FDA’s most graphic images, which depicts a man exhaling smoke through a tracheotomy hole in his neck.

“The addiction is very real,” Dr. Patil says, “and the greatest mistake we can make is to blame patients for their addiction and pass judgment. If they had heart disease, we wouldn’t pass judgment.”

Robert Anthenelli, MD, Professor of Psychiatry and Psychology at UC and Director of the Tri-State Tobacco and Alcohol Research Center, says it is “the hallmark of addiction” that some patients with serious tobacco-related medical conditions, including head and neck cancers, continue to smoke despite knowledge that the smoking caused their cancer and continues to harm them. “This is a sign of the loss of control and continued use despite serious medical consequences that are symptoms of all addictive disorders, including nicotine dependence,” he says.

The Food and Drug Administration is hopeful that the ads will help reduce the number of smokers, which stands at 20 percent of adults in the United States. On its Web site, the FDA describes the warnings as “a significant advancement in communicating the dangers of smoking.”

Dr. Anthenelli believes the harsher warning labels on cigarette packs sold in the United States are long overdue. “The U.S. lags behind other developed countries in issuing such graphic warnings, which have been found to have some positive effects in motivating smokers to quit and preventing youth smokers from trying smoking.”

Dr. Patil agrees that the ramped-up cigarette warnings, which will cover half the front and back of each pack, are likely to help dissuade some younger people from starting to smoke. He remains skeptical, however, because the allure of smoking has long been dispelled and that virtually everyone is aware of the harm that cigarettes cause.

The most “bang for the buck,” Dr. Patil believes, involves educating very young children about the dangers of smoking. Dr. Patil recently delivered such a message himself in a 15-minute presentation to his son’s first-grade class.

People who continue to smoke following a cancer diagnosis often suffer from what Dr. Patil calls “refractory addiction,” or treatment-resistant addiction. At the same time, these individuals are not expecting to develop cancer, he says. “Just because someone is addicted to something doesn’t make the diagnosis any less painful. It’s a common misconception that someone who smokes is expecting to develop cancer. They’re not expecting it. It is an absolute jolt and tragic turn of events.”

Patients who develop head and neck cancer are treated at the UC Gardner Neuroscience Institute whether they are able to quit smoking or not. “If they’re actively smoking or drinking alcohol, we beg them to stop,” Dr. Patil says. “But once they have developed cancer, it has to be treated. We can’t simply wait the months and months it might take for them to stop.”

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Anyone who smokes or who drinks heavily should see a specialist immediately if he or she experiences a change in voice or swallowing that persists for more than three to four weeks.

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A new support group is available to patients at UCNI who are treated for head and neck cancer. To reserve a space in the group, please contact Angie Keith at (513) 475-7366 or angie.keith@ucphysicians.com

For information about smoking cessation, please visit:

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The pain of oral cancer: Photograph of healthy mouth and (warning!) graphic photograph of mouth cancer. Click to view >>

— Cindy Starr

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