Can the physician contribute to the decrease in prevalence of lung cancer?

Abstracts and increased lung cancer risk, was found (OR: 2.09, CI:0.88-5.02). Further data will be collected to confirm these results. The interferon system in lung cancer patients and new therapeutic approaches JL Ambrus, Sr., MD, PhD, FACP, CM Ambrus, MD, PhD, FACP, D Sykes, PhD, W Dembinski, PhD, TJ Bardos, PhD, JL Ambrus, Jr., MD, D Lilie, MD, J Aradi, PhD. The Department of Medicine State University of NY at Buffalo, Buffalo General Hospital/Kaleida Health System, USA, and the Department of Biomedicine, University of Debrecen, Hungary. Supported by the Oishei Foundation, the Troup Foundation and the National Institutes of Health, USA. We studied the interferon (INF) system in 100 cancer patients. In all advanced cases, INF inhibitory activity was observed. This was due to 4 factors: (1) free-floating soluable INF alpha/beta receptors appearing in the circulation and neutralizing INF alpha/beta; (2) increased production of PgE2 which we have shown to inhibit INF production (3) increased production of cAMP phosphodiesterase which decreases second-messenger effect for INF production; (4) appearance of a protein which inhibits INF alpha>beta>gamma. This protein was partly purified and identified. In order to offset the effect of INF inhibitors in cancer patients, a series of compounds were synthesized which increase INF production and antagonize INF inhibitory activity. They have been explored in tissue culture systems. We will select compounds for in vivo animal experiments and eventual clinical exploration. Can the physician contribute to the decrease in prevalence of lung cancer ? Jean-Pierre Zellweger, University Medical Policlinic, Lausanne, Switzerland The only way to influence the prevalence of lung cancer is by modifying the smoking habits of the population. If all smokers would quit, the incidence of lung cancer would start decreasing after 15 to 20 years, as has been demonstrated in countries where the prevalence of smoking has markedly decreased. On the contrary, among population groups where the prevalence of smoking is stable or progredient, the incidence of lung cancer is still increasing. Minimal intervention, i.e. brief but consistent counseling to quit by the practicizing physician, has been demonstrated to be a cost-effective method to help smokers to quit and is widely recommended as a routine activity in medical practice. The problem is that not all physicians advise their patients to quit and that the intervention will be successful in only a minority of smokers, usually those who have a low level of dependence. Heavy smokers, who have the highest risk of developing lung cancer and who are more dependent to nicotine, are less successful in quitting. Therefore, the current policy of minimal intervention will frequently fall to influence the behaviour of patients at highest risk. In order to help more efficiently the patients at risk, a new policy of harm reduction is now seriously considered in selected cases, consisting in offering to the heavy smokers unable or unwilling to quit a help to decrease their consumption, compensating if necessary the withdrawal symptoms by long-term nicotine replacement therapy. If widely applied, smoking reduction may significantly contribute to the decrease in incidence of lung cancer. It has been demonstrated that long-term reduction in smoking, with or without the simultaneous use of nicotine replacement therapy, is possible, safe, and does not decrease the motivation to quit. The risk of dependence to the nico-

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tine substitute is small and not linked with any increase in cardiovascular or respiratory disease. The development of new pharmacological compounds influencing the nicotine dependence may offer new perspectives of decreasing the frequency of lung cancer among smokers. Smoking cessation: a study of respiratory in- and out-patients KM Skwarski, J Barr, W Boland, W MacNee. Unit of Respiratory Medicine, Royal Infirmary of Edinburgh, Scotland, UK. Lung cancer is the most common fatal malignancy in the developed world. Cigarette smoking is the major aetiological factor in the development of respiratory diseases including lung cancer. Respiratory physicians are in an advantageous position to promote smoking cessation. The aim of this study was to assess smoking prevalence, motivation factors to smoke and to give it up, the demand amongst respiratory patients for the introduction of a specialised smoking cessation programs and the potential level of success that could achieve. The study population included respiratory patients who attended for the treatment in the Royal Infirmary of Edinburgh between Oct - Dec 1998 (6, Weeks). Group 1 consisted of 181 inpatients, Group 2 of 88 randomly selected outpatients. Patients were asked to complete the self-administered smoking questionnaire to assess pre-hospital smoking rate, nicotine dependence, motivation to smoke, to quit smoking and a brief assessment of type of professional intervention the subject would prefer. Both study groups were of similar age (61 and 57 yrs), smoking prevalence (32 and 33%) and sex distribution. Fagerstroms Test for Nicotine Dependance score >7 was reported more frequently in Group 1 (27.5%) than in Group 2 (17%). Motivation to smoke was similar in both groups but motivation to give up smoking appeared to be significantly higher in Group 1 (p<0.001). Comparing our results with those obtained by Foulds and Jarvis (COPD) 1995:373390) we found that successful smoking cessation could be achieved in 13% of our hospitalised patients and in 18% outpatients in any 12 month. It appears to be growing evidence that smoking cessation in respiratory patients could influence their morbidity. We believe that developing adequate smoking cessation programs may prove to be cost effective strategy. Interactive preventing method against smoking G. Kov‡cs1, T. DemjŽn2, National Kor‡nyi Inst. for TB and Pulmonology1, National Inst. for Health Promotion2, Budapest, Hungary In Hungary the young people's smoking is especially alarming. 40% of 13 year-old and 76% of 18% year-old have tried smoking already. On the other hand 3% of the 13 year-old do smoke regularly and 12% occasionally. The critical age is the next two years, because 14% of the 15 year-old people are regular and 23% are occasionally smokers. We organised Preventive lectures among 13 and 14 year-old elementary school students, We have met with the students twice. On the first occasion we gave a 40-minute long lecture illustrated with slides. During the second session on the following week, we discussed the topics and issues of the previous lecture (breathing, smoking, motivation of smoking and diseases). On the second session we use the interactive method (TOTO-game, situation game about the motivation, questions and answers about smoking). This method needs good cooperation between the teachers, the doctors and the health education. We like to decrease the number of adolescent smokers. The goal is the aim of WHO: 20% decrease of the number of smokers.