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Ex-smoker Discovers His Risk Lingers On

Estimated read time: 5-6 minutes

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WASHINGTON -- The cheerless basement hallway-cum-waiting-area with the no-nonsense furniture befits the mood. Anyone sitting here, waiting to be summoned, feels a little anxious -- as if maybe you're about to be punished for something foolish you did a long time ago.

And, in a way, you are.

That long-ago foolishness, for me, was smoking. Now it has brought me here, to the bowels of a sprawling medical center at Georgetown University, as a sort of human guinea pig to see whether there's a better, earlier way to detect lung cancer.

I'm not alone. Nearly 50,000 of us have been split into two groups for tests at more than 30 lung-screening sites nationwide. One group is getting traditional chest X-rays. The other is getting spiral CT scans, a newer technology that can detect tumors that are much smaller and, at least to most people, would seem a better way of spotting trouble before it's too late.

But doctors are far from sure about that -- or even that early detection of lung cancer saves lives. Hence, the National Cancer Institute's National Lung Screening Trial.

I'm in the CT scan group.

In just a few minutes, I'll be summoned from the hallway into a dimly lit room, then asked to lie perfectly still, hands behind my head, on a flat table and hold my breath while we (the table and I) pass through the center of a large doughnut-shaped scanner. The scanner makes a whirling sound similar to that of a clothes dryer. What's happening here, though, is a bit more sophisticated: A computer is creating 3-D images of my lungs from the X-ray information coming from the scanner.

This is my second year in the trial (I have one more screening to go, then follow-up chats until 2009). From the images created by my first CT scan, I learned I had ''moderate apical pleural fibrosis.'' Not lung cancer, the letter assured me, though ''you may want to discuss the abnormality with your health care provider.''

Good advice, I thought.

Presuming that it's better not to have ''moderate apical pleural fibrosis'' than to have it, I trudged off to the doctor's office to see what this ''abnormality'' was all about.

''It means you were exposed to TB or some sort of infection in the past that left a little scarring,'' explained my physician, Dr. Elliot Aleskow. Then, before I could launch into my usual litany of questions, he added: ''It means, 'Don't worry about it.' ''

Through the years, I had never worried much about smoking -- best evidenced by the fact that I picked up the habit in the mid '60s, precisely when the surgeon general began warning everyone that it might kill them.

By the time the letter inviting me to participate in the survey arrived just before Christmas 2002, I was even less worried because I had quit smoking more than a decade earlier. But what happened in those long-ago years was, as I would soon learn, still a cause for concern.

The letter, mailed to targeted households in selected ZIP codes, said I should contact the Georgetown University screening site if I thought I might qualify for the study, and someone would get back to me.

Several weeks passed before a young woman called to ask whether we could talk. That was the just the first of many questions.

''How old are you?'' (58.)

''Are you a current smoker?'' (No.)

''Former smoker?'' (Yes.)

''How long ago did you quit?'' (10 or 11 years ago.)

''At what age did you begin to smoke?'' (20 or 21.)

''How many cigarettes did you usually smoke a day?'' (Too many.)

''Can you be more specific?'' (At least two packs a day, probably more.)

''In the years you smoked, was there ever a period of one or more years in which you did not smoke?'' (Yes; five years.)

The questions went on like that for a while before she asked to put me on hold so she could figure out my score.

The score, it turns out, was a measure of whether I was still at risk and still worth the researchers' trouble -- a calculation based on when I started smoking, when I quit and the extent of my habit. To qualify, I needed a score of at least 30 ''pack years'' (the equivalent of a person smoking a pack a day for 30 years).

I got a 42.

Astonished, I asked, ''After all these years of not smoking, I still scored that high?! Hell, if I'd have done this well on my SATs . . . ''

She asked when I wanted to make my appointment to come in.

What no one asked is why I had ever started smoking in the first place. Just as well, because I never really figured it out myself. Maybe it was because, back then, it was the drug of choice in Brookings, S.D., where I went to college. Berkeley had pot; Brookings had nicotine.

No one in my family ever smoked. Nor has anyone in my family ever died of lung cancer or, for that matter, any other kind of cancer.

Maybe the good genes will carry me through. Anyway, so far, so good. Georgetown called the other day with my latest results. Still no sign of lung cancer. But the pleural fibrosis persists, and now there's evidence of something called ''coronary artery calcification.''

If the cigarettes don't get you . . . probably time to call Dr. Aleskow again for a little reassurance.

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