24-30 January 2014 #691

Live long, look good

Dhanvantari by Buddha Basnyat, MD

A question that is frequently asked to doctors during medical exams is: which one preventive intervention leads to the largest average increase in life expectancy in a target population?

a) A regular exercise program

b) Quit smoking

c) Mammogram (breast cancer prevention screening) for women

d) Pap smear (cervical cancer prevention screening) for women

e) Prostate gland cancer screening for men

The answer is B. For a targeted population, more than all the other choices listed above, quitting smoking will add three to five years. Regular exercise program will add one to two years and the rest will each add a couple of months. This question illustrates the importance of quitting cigarettes and exercising. Does this mean that options C, D, and E are not worth pursuing? Possibly not.

Predicted increases in life expectancy are average numbers that apply to populations and not individuals. For example, mammograms may increase the overall life expectancy by only two to three months, but for an individual at risk of breast cancer (patients with a family history of breast cancer, smoking etc), the screening may add many years by detecting the disease earlier. This holds true for those at risk of cervical and prostate cancer too.

Importantly, many of us do not know if we are at risk for common diseases because they may not be obvious, like family history. So while carrying out recommended screening tests like the ones in the question above, it is important to assume that we are average Joes (or Ram Bahadurs and Sita Devis if you wish) who may be at risk.

In a country like Nepal where day to day existence is so difficult for so many people, it may be hard to understand the concept of ‘wellness’, which the above medical question evokes. But this idea of wellness is in our interest because prevention is better than cure. And crucially, cure is more expensive. Therefore, not only quitting smoking and exercise, but tests like breast and cervical cancer screening may help a great deal in promoting wellness. So raising awareness about the importance of some screening tests (not all) in the community is a very good public health practice.

And for those looking to quit smoking, there is another reason to do so right away: smoking ages you prematurely. A study published in the Journal of the American Society of Plastic Surgeons in January this year. ccorroborates this statement.

For the study, 79 pairs of adult identical twins were categorised in three groups: a group in which one was a smoker and the other a non-smoker; another group consisted of pairs in which both were smokers; a third group consisted of pairs of smokers with at least five years difference in the duration of their smoking. The researchers photographed them and had an independent panel of judges, who were oblivious to the smoking history of the individuals, rate the pictures which were arranged side by side.

The rating was done on the basis of elements like wrinkles, crow’s feet, jowls, bags under the eyes, creases around the nose, and lines around the lips and other general appearance of skin aging. It was important to ‘control’ for other confounding or misleading factors such as stress at work, alcohol consumption which could be invoked for premature skin aging. Indeed, the differences between the twins regarding these confounding factors were found to be insignificant.

Amazingly, the panel’s decision on which twin looked older completely matched their smoking histories; that is, the longer you smoked the worse you looked. So clearly smoking affects not only your longevity, but also how you look while you live.

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