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Smoking less might help, but still best not to light up at all

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Two new studies demonstrate that smokers who consume fewer cigarettes can reduce their risk of lung cancer, but they still face a much larger risk of premature death or disability compared with people who quit smoking or never start.

Smoking even one to four cigarettes a day nearly triples the risk of death from heart disease, according to a study published last week in Tobacco Control. Light smoking appears to pose an even greater risk to women, who have five times the risk of dying of lung cancer as people who have never smoked.

Those who cut back, however, might lower their odds of getting lung cancer, says Nina Godtfredsen, a doctor at Copenhagen University Hospital in Denmark and lead author of a study in today's Journal of the American Medical Association. Previous studies have shown that cutting back does not reduce the risk of dying prematurely or having a heart attack, she says.

In the Danish study, which followed nearly 20,000 people for up to 31 years, those who cut their daily cigarette use from 20 to less than 10 cut their risk of lung cancer by 27%. Those who quit smoking cut their risk of lung cancer in half.

About 70% of smokers want to quit, the American Cancer Society says, but fewer than 5% a year succeed. Many smokers are lighting up fewer cigarettes each day, however, because bans in offices, bars and restaurants leave smokers with fewer opportunities to smoke, says Thomas Glynn, the society's director of cancer science and trends, who was not involved in the study.

Researchers have found that sharp decreases in daily cigarette consumption lead to relatively modest improvements in health, probably because smokers try to get as many drags as possible out of each one, according to an editorial by Lawrence Dacey and David Johnstone of Dartmouth-Hitchcock Medical Center that accompanied the JAMA study.

People who try to smoke less or who smoke light or low-tar cigarettes often end up sucking harder on each cigarette to get more nicotine, Glynn says.

But such "compensatory smoking" just pulls carcinogens deeper into the lungs.

Even small levels of carbon monoxide -- one of the many carcinogens found in cigarette smoke -- can cause heart disease, Glynn says. That's probably why smoking fewer cigarettes fails to reduce the risk of heart attacks or death.

"It doesn't take much to trigger a heart attack," Glynn says. "There is no such thing as a safe level of smoking."

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