Despite all the warnings, we keep on smoking

How truly obscene that lung cancer has overtaken breast cancer as the most dangerous form of the disease for British women.
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Here is a perfect metaphor for the idea that in success, failure can lie.

Here is a perfect metaphor for the idea that in success, failure can lie.

What is happening here? How can a great leap in preventative health care be so closely accompanied by such a cavalier disregard for the same disease in a different part of the body? How sick it is that, while millions of pounds are spent on driving the killer cancer out of one part of our bodies, we wantonly invite it back in through another avenue.

One half of the news, of course, is tremendous. While more women than ever - around 35,000, or one in 10, last year - are diagnosed with breast cancer, the number of women dying from the disease has fallen by a third in the past decade. That represents the most marked reduction in breast-cancer deaths in the world.

Three out of four women in this country now survive breast cancer. That is partly because of advances in treatment, but crucially because of breast-cancer awareness. The early diagnosis of breast cancer increases the chance of survival by 90 per cent, and more than 150 breast-cancer charities in Britain continue to chivvy women to be vigilant. Meanwhile, breast-cancer research receives about £4.3m every year in funding.

There is no doubt that women have themselves to thank for this happy state of affairs. For decades, women campaigned to break down the taboos around the disease and gain decent preventative care programmes.

The difference that these crusading attitudes made can be seen only too starkly when comparisons are made with the disease that kills more than one British man every hour, or around 10,000 each year: prostate cancer has only one charity dedicated to it and attracts a 100th of the funding spent on breast cancer. Survival rates run at a good deal less than half, and the number of sufferers is predicted to triple over the next 20 years.

It is agreed that prostate cancer is neglected because men are more likely to bury their heads in the sand when it comes to health. That may well, in part, be true. But it also makes it all the more odd that while men are now giving up smoking more and taking up smoking less, women are doing the reverse.

As breast-cancer deaths have decreased, lung-cancer deaths have increased. Yesterday's figures from the Cancer Research Campaign suggested that deaths had risen by a third in the past 20 years and were set to rise further. Last year, 12,700 women died of lung cancer.

Most pathetically, the Commons health select committee warned, a few months ago, of a sharp rise in a particular form of lung cancer in women that was once rare and is believed to be the result of deep inhalation of low-tar cigarettes. Almost all cases of this cancer - which affects one in four patients - are inoperable.

Many more men die each year of lung cancer than women - although a higher proportion of men than of women survive it - but for men the death rate is going down. And while, in 1996, 28 per cent of women smoked and 29 per cent of men, all surveys show that there is an increasing trend among women.

How bizarre it is that we so strongly court the disease we most dread, while at the same time campaigning so vociferously against it. Perhaps part of the blind spot is to do with age. While those at the highest risk of breast cancer are old women, with a third of all breast cancer being found in women aged between 70 and 85, it is also still the most common form of death in women aged 35 to 54.

Sometimes women die of it even younger. I knew one such young woman, whose cancer was treated too late because of a series of hospital bungles, while another friend, in her mid-thirties, is undergoing chemotherapy and should make a full recovery, as her cancer was discovered extremely early. Another friend had a sister who died of the disease.

But I know of no young women who have died of lung cancer, even though it took the lives of my aunt and my mother-in-law. Lung cancer is in my family, but breast cancer is in my peer group. Illogical though it may be, I smoke on, while monitoring my breasts with concerned interest.

And, as the statistics prove, it's not just me; it's in the culture. We all know lung cancer is a huge killer, but somehow it doesn't have the drama and pathos of breast cancer. Perhaps it is just too nasty and untelegenic a death. If you want proof, look at the soaps.

Barbara Windsor was recently given an award by a breast-cancer charity for her contribution to breast-cancer awareness as Peggy Mitchell in EastEnders, even though the storyline was not in the least new to soap-land. Patricia had a mastectomy in Brookside years ago and has recovered so fully that she is now Debs in Coronation Street.

By contrast, though, Ethel recently died in EastEnders of a barely named cancer, bumped off in a mercy killing by her fag-puffing buddy Dot. In the entire history of television soap, I cannot remember a soul who died specifically of lung cancer, or even of a smoking-related disease.

Likewise, in the fashion industry, models will cavort about happily in breast-cancer awareness T-shirts before nipping off the catwalk for a quick fag. It could be that smoking is somehow connected to eating for women, and that women smoke as part of the huge pressure they feel generally to keep down their weight. Certainly I know plenty of women who've stopped smoking for a while, then started up again when they put on the pounds. Look to popular culture again and Big Brother. All the women smoked, except Claire, who was the only female who looked like she might sometimes eat things.

As for why it is that women are now more likely to smoke than men, well, one can't help falling back on the ridiculous but oft-repeated mantra that men are the new women, and women are the new men. Maybe women simply feel more stressed now than ever, and more in need of a psychological prop as they attempt to balance the multiplying demands on them, while men are becoming more calm, responsible and sensible.

The odd thing about smoking is that it is embraced most enthusiastically by those with least to gain from it - the poor smoke more, even though it's prohibitively expensive; the unhealthy smoke more, even though it makes them even less fit; women smoke more, even though it plays havoc with that skin regimen, those perfumes and that lung disease. There's some kind of law of diminishing returns at work here, and it's a particularly noxious one.

In my household, the pattern is the same. My husband and I both smoke, but he is the one most keen for us to give up. We have a date for the great event - 26 October - although as it comes closer and closer I find myself wondering if I have enough commitment to the task. Even in pregnancy I struggled to stop smoking and couldn't. Now, it is not the idea of my early, painful death that motivates me to stop, but the idea that my son may have to cope with my early, painful death when he's at a tender age.

Not that I'm relying on that alone. Allen Carr's splendid rant about how easy it all is will once again be consulted, the blob of nicotine chewing gum will have all the pocket lint scraped off it, and a Zyban prescription will be duly surrendered at the local chemist. [Please note: Allen Carr is in fact alive and well.]

The last time I attempted to stop, the bid collapsed in a fit of telephone-booth rage against a Japanese tourist. Goodness knows which unfortunate will provide me with my excuse to light up next time. But if any Independent reader wishes to berate me in the street during the final months of this year, my advice is to e-mail instead.

d.orr@independent.co.uk

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