YOU HAVE A CHOICE!

Dr S Andaz MD, FACS, FRCS

Director

Center for Minimally Invasive Thoracic Surgery and Thoracic Surgical Oncology

South Nassau Hospital

New York

Heart Disease Statistics

Every 20 seconds has a heart attack.

Every 34 seconds a person dies from heart disease.

More than 2,500 deaths from heart disease each day

“Symptoms - COSTLY mistakes”

• “I feel great.”

• “ I just had a check up and I am just fine”

• SILENT KILLERS – Cadiovascular– Cancer

Anatomy

Plaques

Major Risk Factors• Smoking

• Cholesterol - LDL( < 70) HDL (>40)

• Hypertension

• Family history

• Obesity

• Diabetes

Warning Signs

Chest discomfort.

Discomfort in other areas of the upper body.

Shortness of breath.

Other signs: cold sweat, nausea or lightheadedness

Angina v/s “heart attack”

Investigations

• EKG

• CXR

• Blood work

• Stress Test

• Ultrafast CT and Total Body Scanners

• Cardiac Cath

Management• Medical

• Aspirin

• BP control

• Statins - Liver and muscle damage

• Diabetes control

• Lifestyle changes!!!!– smoking

– exercise

– diet changes

Coronary Stents

S/P Agioplasty stenting

S/P angioplasty

Surgical - CABG

Surgical - CABG

Cardiac Surgery - New Frontiers

Cancer Statistics

2004 Estimated US Cancer Cases

Men699,560

Women668,470

•32% Breast

•12% Lung & bronchus

•11% Colon & rectum

•6% Uterine corpus

• 4% Ovary

• 4% Non-Hodgkin lymphoma

•4% Melanomaof skin

•3% Thyroid

•2% Pancreas

•2% Urinary bladder

•20% All Other Sites

Prostate 33%

Lung & bronchus 13%

Colon & rectum 11%

Urinary bladder 6%

Melanoma of skin 4%

Non-Hodgkin lymphoma 4%

Kidney 3%

Oral Cavity 3%

Leukemia 3%

Pancreas 2%

All Other Sites 18%

2004 Estimated US Cancer Deaths

Men290,890

Women272,810

•25% Lung & bronchus

•15% Breast

•10% Colon & rectum

• 6% Ovary

• 6% Pancreas

• 4% Leukemia

• 3% Non-Hodgkin lymphoma

• 3% Uterine corpus

• 2% Multiple myeloma

• 2% Brain/ONS

•24% All other sites

Lung & bronchus 32%

Prostate 10%

Colon & rectum 10%

Pancreas 5%

Leukemia 5%

Non-Hodgkin 4%lymphoma

Esophagus 4%

Liver & intrahepatic 3%bile duct

Urinary bladder 3%

Kidney 3%

All other sites 21%

Lifetime Probability of Developing Cancer, by Site, Men, US, 1998-2000

Site Risk

All sites ??????

Prostate 1 in 6

Lung & bronchus 1 in 13

Colon & rectum 1 in 17

Urinary bladder 1 in 29

Non-Hodgkin lymphoma 1 in 48

Melanoma 1 in 55

Leukemia 1 in 70

Oral cavity 1 in 72

Kidney 1 in 69

Stomach 1 in 81

Lifetime Probability of Developing Cancer, by Site, Men, US, 1998-2000

Site Risk

All sites 1 in 2Prostate 1 in 6

Lung & bronchus 1 in 13

Colon & rectum 1 in 17

Urinary bladder 1 in 29

Non-Hodgkin lymphoma 1 in 48

Melanoma 1 in 55

Leukemia 1 in 70

Oral cavity 1 in 72

Kidney 1 in 69

Stomach 1 in 81

Lifetime Probability of Developing Cancer, by Site, Women, US, 1998-2000

Site Risk

All sites ?????

Breast 1 in 7

Lung & bronchus 1 in 17

Colon & rectum 1 in 18

Uterine corpus 1 in 38

Non-Hodgkin lymphoma 1 in 57

Ovary 1 in 59

Pancreas 1 in 83

Melanoma 1 in 82

Urinary bladder 1 in 91

Uterine cervix 1 in 128

Lifetime Probability of Developing Cancer, by Site, Women, US, 1998-2000

Site Risk

All sites 1 in 3

Breast 1 in 7

Lung & bronchus 1 in 17

Colon & rectum 1 in 18

Uterine corpus 1 in 38

Non-Hodgkin lymphoma 1 in 57

Ovary 1 in 59

Pancreas 1 in 83

Melanoma 1 in 82

Urinary bladder 1 in 91

Uterine cervix 1 in 128

Smoking kills more people than

alcohol, AIDS, car accidents, illegal drugs, murders suicides

combined.

There is a funeral

1150 times every day

48 times every hour

Because somebody was addicted to cigarettes

SYSTEMS AFFECTED

CARDIOVASCULAR

LUNG

Cardiovascular Disease• Stroke

• Sudden Death

• Heart Attack

• Peripheral Vascular Disease

• Aortic Aneurysm

180,000 Deaths per Year

LUNG DISEASE• Pneumonia

• Influenza

• Bronchitis

• Emphysema

90,000 Deaths per Year

Healthy Lung Advanced Emphysema

ONLY LUNG CANCER???????

Smoking causes other cancers!

• Laryngeal cancer• Oral cancers• Esophageal cancer• Stomach cancer• Pancreatic cancer• Kidney cancer• Bladder cancer• Cervical cancer• Leukemia

When does it all START?

KIDS

Lighting the FIRST cigarette !!!!

Protecting our children and grandchildren

• More than 3 million kids age 12-17 are current smokers.

• More than 5 million children under age 18 alive today will eventually die from smoking-related disease.

• More than 40% of high school boys report tobacco use.

HOW SEVERE IS

SECOND HAND SMOKING????

SECONDHAND SMOKE

Secondhand smoke contains over 4000 chemicals and 43 known carcinogens.

Among the chemicals are formaldehyde, cyanide, arsenic, carbon monoxide, methane and benzene.

Smoke filled rooms have up to 6 times the air pollution of a busy highway.

“PRIDE IN TOBACCO”Winston-Salem, NC – the home of R.J. Reynolds Tobacco Co.

This town depends on the tobacco dollar: 8200 factory workers produced 142 billion cigarettes last year.

Winston-Salem is a company town.

Smoking is allowed almost everywhere.

There is one place where smoking is banned……..

smoking is banned at the R.J. Reynolds Tobacco Plant

-that’s for the benefit of the machines.

-One delicate machine makes 2000 filters a minute, while another produces 400 packs a minute

•ONLY 1/3!!!!

LUNG CANCER

HOW MANY CAN BE SAVED?

ONLY 1/3 PRESENT AS EARLY LUNG

CANCER!!!

Stage I

Stage II

2/3 PRESENT AS ADVANCED LUNG

CANCER!!!

Stage III

Stage IV

Stage IV

Incurable.

Most die within 12 months

Note: Data from participating states and the District of Columbia were aggregated to represent the United States.Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape (2000), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2001.

24.2 24.4 24.1 24.4 24.5

0

5

10

15

20

25

30

35

1994 1996 1998 2000 2002

Year

Pre

vale

nce

(%)

Trends in Consumption of Five or More Recommended Vegetable and Fruit Servings for Cancer Prevention, Adults 18 and Older, US, 1994-2002

Trends in Overweight* Prevalence, Children and Adolescents, by Age Group (%), US, 1971-2000

*Overweight is defined as at or above the 95th percentile for body mass index by age and sex based on reference data. Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2000, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002.

54

55

7 67

11

5

10

15

11

0

5

10

15

20

2 to 5 years 6 to 11 years 12 to 19 years

Pre

va

len

ce

(%

)

NHANES I (1971-74) NHANES II (1976-80) NHANES III (1988-94) NHANES 1999-2000

Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20 to 74, US, 1960-2000

*Obesity is defined as a body mass index of 30 kg/m2 or greater. Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2000, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002.

1311

1615

12

1715

13

17

2321

26

31

28

34

0

5

10

15

20

25

30

35

40

45

Both sexes Men Women

Pre

vale

nce

(%)

NHES I (1960-62) NHANES I (1971-74) NHANES II (1976-80)

NHANES III (1988-94) NHANES 1999-2000

No one gets itIn a survey of 21,500 people, not a single person consumed a 100% of RDA for the 10 most important nutrients!

*as recommended by the National Cancer Institute

The Constant BattleFree Radicals are unstable molecules that

cause cell and DNA damage;

They are a by-product of metabolism.

Free RadicalsSources:

Sunlight, Stress, Toxins, Pollution,

X-rays, Radioactivity, Airline travel,

Medications

Metabolism – Calories & Oxygen (75K)

Smoking = 10 Billion

free radicals per cigarette!

“The amount of antioxidants that you maintain in your

body is directly proportional to how long you will live.”

Dr. Richard Cutler, Director of the Anti-Aging Research Department of the National Institute of Health(NIH), Wash D.C.

American Cancer Society

Recommendation

• Cancer-related Checkup

• every 3 years for people aged 20-40 and

• every year for people age 40 and older.

American Cancer Society• Prostate

• The ACS recommends that both the prostate-specific antigen (PSA) blood test and the digital rectal examination be offered annually, beginning at age 50,

• Men in high-risk groups, such as those with a strong familial predisposition (i.e., two or more affected first-degree relatives)

Cancer Screening

• The 5-year relative survival rate for these cancers is about 80%.

• If we participated in regular cancer screenings, this rate could increase to 95%.

• Don’t have time - lame excuse!

• yourself

• and the family

• life style changes

• Don’t BLAME the GENES

• YOUR FAMILY DESERVES IT

• THEY GET HURT IF YOU FALL SICK

MARLBORO COUNTRY

THE MARLBORO MAN

YOU HAVE A CHOICE