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DrRussMD
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64947
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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I smoke 20 cigarettes a day and have been for 12 years and

Resolved Question:

I smoke 20 cigarettes a day and have been for 12 years and smoked crack cocaine for 3 years but have stopped smoking crack cocaine now. I am worried about how much damage I have done to my lungs and if I have a increased risk of lung cancer.
Submitted: 3 years ago.
Category: Medical
Expert:  DrRussMD replied 3 years ago.
Hello
I am Dr. Thomas, double board certified doctor in internal medicine, and in integrative medicine. I have advanced training in other fields as well. I will give you an initial answer or ask you a question. Use reply to expert for continuing our conversation.
From the cigarettes you are at increased risk of lung cancer.
The amount of lung damage per se can be assessed with pulmonary function testing. And high resolution CT scan. Otherwise it is impossible to say how much damage, or if you have early cancer or not.
Stop smoking.
See a pulmonologist.
If you stop smoking, and you do that for 10 years, your risk decreases almost to that of a non smoker at that point.
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 3 years ago.
Relist: Answer quality.
Customer: replied 3 years ago.
Relist: Answer quality.
Expert:  DrRussMD replied 3 years ago.
Hello
The answer is exact.
And accurate.
I see nothing wrong with the quality.
If you notice my instructions, it says use reply to expert for more information or concerns.
I have not seen any post from you
Further questions?
Further concerns?
Customer: replied 3 years ago.

I understand what you saying. But was looking for an opinion on my situation and what you think rather than just a referral.

Expert:  DrRussMD replied 3 years ago.
I think you need to read my above post again. I covered a lot of points.
In no way can we say how much lung damage you have at that point.
Without testing, ti could be a little to a lot.
Symptoms are not a reliable indicator, so you could have no symptoms and still have early cancer.
Your number of years is significant as is 20 cigarettes a day. You are now medium risk, at least, for lung damage and for lung cancer.
Pulmonary function testing assesses how your current lung function is.
High resolution CT will detect early cancer that x ray will not, and is now a say to save lives.
My opinion is that, statistically, if you stop smoking now, you can probably get back to a near normal risk.
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 3 years ago.

I understand but I am looking for someone to put things in perspective for me. I would like a second opinion.

Expert:  DrRussMD replied 3 years ago.
There is a two opinion question format, you did not use it here.
Let me ask you....what do you mean put in perspective.
I gave you exact risk estimates....did you read those?
What other perspective exactly...some detail please....are you referring to? Then I can finish an opinion for you
Customer: replied 3 years ago.

I want to know what is my risk of lung cancer giving the information I have given you. And does smoking crack cocaine increase that risk dramatically as I was doing it for three years.

Expert:  DrRussMD replied 3 years ago.
OK
The three years of crack does not change the over all picture.
Your risk right now, given the number of pack/years of smoking , is moderate to high.
As a male smoking more than 5 cigarettes a day, your current risk of getting lung cancer at some point is 25%.
Your risk is currently somewhat lower since it is only 12 years that you have been smoking, but you also started smoking very early, so this adds an increased risk.
I would say your risks of having lung cancer right now are minimal.
Less that 5 to 10 %, just based on what you are telling me.
However, with any symptoms, with increased years, this goes up substantially, so, in other words, to continue smoking, even for a year, can substantially increase your current risk.
Cutting down has no benefit on these numbers.
Please use reply to expert if you have further questions.
When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 3 years ago.

I like your reply. Why do you say the three years of smoking crack cocaine does not change the overall picture? Is that not worse than smoking cigarettes?

Expert:  DrRussMD replied 3 years ago.
No data on that.
It certainly can add lung damage, but the tars and other toxins of cigarettes, for which we have a lot of data, are there.
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Customer: replied 3 years ago.

Could you tell me some data on that please as I am very anxious because I'm thinking that because I smoked crack cocaine for three years it added more damage/more increased risk of lung cancer.

Expert:  DrRussMD replied 3 years ago.
No good data on the carcinogenicity of crack.
However, the main negative effects are known to be due to blood vessel damage...so in effect the cocaine can augment problems in micro circulation.
The effects on promoting cancer are not known.
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Customer: replied 3 years ago.

Ok thank you for your answer. Is this not known anywhere?

Would my risk of lung cancer as it stands would of been the same if I never smoked crack cocaine?

Expert:  DrRussMD replied 3 years ago.
It would increase your risk to some extent but that extent is not known.
My best estimate is that if you don't already have damage, you probably are OK.
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 3 years ago.

would the extent of the damage from smoking crack cocaine be worse than smoking cigarettes?

Expert:  DrRussMD replied 3 years ago.
No
No evidence of that at all.
In fact, 12 years v. 3 years is going to be a lot worse on the part of the cigarettes.
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Customer: replied 3 years ago.

What I'm thinking is that smoking I have been smoking 20 cigarettes a day for 12 years and in them 12 years the 3 years of smoking crack cocaine has added significant risk of lung cancer?

Expert:  DrRussMD replied 3 years ago.
No way to say.
No data.
But, from the mechanisms involved, no, I don't think it has increased the risk you already have significantly.
What we do know is that if you put no smoke of any sort into your lungs, then in 10 years your risk will be reduced 80 % or more.
And you can get a high resolution CT now to rule out cancer.
That is what I would suggest.
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Customer: replied 3 years ago.

Do you think a CT scan is really necessary from the information I have given you?

Expert:  DrRussMD replied 3 years ago.
If you want to be certain, but I think the likelihood of finding anything, if you have a normal chest x ray, is less than 5%.
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Customer: replied 3 years ago.

Ok so you don't feel its necessary to have a CT scan from the information I have provided?

Expert:  DrRussMD replied 3 years ago.
If you are going to quite smoking, and your chest x ray is clear.
No.
That decision also has to be based on physical exam, and that has to be clear.
So your doctor has to decide this.
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Customer: replied 3 years ago.

if I continue smoking you still think my CT scan will be fine?

Expert:  DrRussMD replied 3 years ago.
No
If you continue smoking I think you will eventually have a problem.
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Customer: replied 3 years ago.

Could you give me percentages please. You did say that my risk is not great.

Expert:  DrRussMD replied 3 years ago.
If you keep smoking your risk of getting cancer is 25%.
I told you that quite a few posts ago.
Your risk could even be that high right now, if you are unlucky.
I suspect it is lower since you don't have symptoms and have not been smoking longer than 12 years.
But, if you were my patient, and I sensed anything out of whack on exam, I would recommended the CT.
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Customer: replied 3 years ago.

what's a whack

Expert:  DrRussMD replied 3 years ago.
Out of whack
Any exam findings.
I am guessing that your risk is between 1 and 5% now, but will increase with every day you smoke.
That is the bot***** *****ne.
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 3 years ago.

Thanks for your time. I still want a second opinion so I am going to ask this question again, but thank you for your answer.

Expert:  DrRussMD replied 3 years ago.
Please don't forget a positive rating.
That is the only way we are paid by ja, per post.
That is the only way we can spend this type of time with you....please rate at least one post positive.
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