A Lung Cancer Survivor's Story
What that pack of cigarettes almost cost one former NNMC Sailor

by OS2 Wendy Kahn
Journal Staff Writer

In the early part of the 20th century, Hollywood legends like Rudolph Valentino, Humphrey Bogart and Frank Sinatra defined America's culture with smoking. Smoking became the hallmark associated with the "macho man" image that would attract many followers. Likewise, actresses like Bette Davis and Joan Crawford glamorized the use of tobacco on screen, and women wanted to imitate their role models. As more stars began to "puff away" on screen, faithful fans believed that cigarette smoking was "cool" and were convinced it was the sexy thing to do.

However, smokers would discover years later that they couldn't stop smoking and, eventually, many would develop lung cancer.

One such smoker wanting to project a macho image who would later regret his decision is Cmdr. Rudolph Brewington, former public affairs officer at the National Naval Medical Center (NNMC). Now at LIFELines Services Network, Washington, DC, Brewington, was a smoker for nearly 38 years until he was diagnosed with lung cancer earlier this year.

On Sept. 11, he underwent surgery where NNMC's doctors removed the top lobe of his right lung.

Brewington began smoking as a teenager in the 1960s, a decade when it was considered "hip," "chic" and "right on" in society. He enlisted in the Marine Corps at age 17 and then enlisted in the Army Reserve at age 32. He earned his commission in the Naval Reserve at age 33.

"Smoking was the thing one was supposed to do in the 60s," he says. "Society enabled it and the Navy's adage, 'the smoking lamp is lit' on board ships meant that smoking was not considered dangerous to one's health.

"Furthermore, while on deployment, we received free packs of cigarettes in our sea rations. The Navy believed they were rewarding their Sailors based on society's attitudes toward smoking -- uninformed that smoking was becoming an addiction."

The consumption of cigarettes was a shared responsibility between the tobacco companies and the consumers, in Brewington's opinion. From his perspective, the enjoyment aspect from smoking had disappeared years ago. The problem, however, was that as a smoker, he was already addicted and couldn't stop the habit until he was diagnosed with lung cancer.

By that time, the Navy's attitude toward smoking had changed when they realized its dangerous effects.

"I smoked a pack of cigarettes a day," says Brewington. "The Navy tried to help me with its smoking cessation programs, which have become more aggressive over the last 10 years by offering nicotine patches and Zyban, which didn't work for me."

According to statistics, an estimated 47 million adults in the United States currently smoke, and approximately half will die prematurely from smoking. Lung cancer is the leading cause of cancer death for men and women, and in 2002, there will be about 169,400 new cases diagnosed in the United States. More than 80 percent of lung cancers are thought to result from smoking.

Not until 1977, when the Great American Smokeout began, did society change its attitude about smoking. Within a 25-year period, researchers, scientists and heath care professionals have raised public awareness as to the health dangers from smoking through seminars, support groups and literature.

State and federal laws were established based on efforts of non-smokers calling for a smoke-free environment. As a result, cigarette manufacturers were forced to issue warning labels on cigarette packs stating the dangers of smoking.

"Before the Smokeout campaign began, tobacco companies didn't inform consumers about the amount of nicotine in cigarettes," explains Brewington. "Cigarette manufacturers have already proved themselves as being 'less than candid' about the risks of smoking, which caused consumers and federal agencies to file lawsuits against these manufacturers."

Brewington's purpose for publicizing his surgery is his concern for Sailors who are addicted to smoking.

"I want them to understand that lung cancer is real," he adds. "These pictures are the reality from smoking. The surgery, even with pain medications, is a painful process. If we can get people to stop smoking, we can reduce the number of lung cancer cases."

The first diagnosis of Brewington's lung cancer was suspected at NNMC's Pulmonary Clinic. The most general symptoms of lung cancer are a bloody sputum (spit), weight loss and feeling lethargic. The clinic found a 3-cm. solitary pulmonary nodule which appeared to be malignant. Once the mass was revealed, Brewington was then referred to the Cardiothoracic Clinic.

Cmdr. Donald Bennett, MC, a thoracic surgeon at NNMC who treated Brewington, explains the events that led to the surgery.

"After the preliminary screening is completed, a conference is set up with an oncologist, pulmonologist, clinical physician, thoracic surgeon, and a radiologist," says Bennett. "Because of his smoking history, his age, and the appearance of the mass, there was a 60 percent probability that he had lung cancer.

"The plan was to do a standard thoracotomy (surgical incision of the wall of the chest), which I refer to as a 'shark bite.' We made a semicircular incision starting from the back of the chest around to the front and removed the upper lobe of his right lung to include the lesion. The surrounding lymph nodes were also removed."

Bennett emphasizes the importance for a patient to know what type of surgery he can tolerate before he makes a decision to have surgery. The stage of the cancer is based on the size of the tumor, where it's located, the nodes, and any distant disease in the liver, other lung, or the brain. In Brewington's case, he was diagnosed as Stage 1A, or cancer at an early stage. As a result, no chemotherapy or radiation treatment is required and the survival rate is good.

Because smoking is a significant factor of lung cancer, the possibility of developing other cancers exists for those people with lung cancer, explains Bennett. Even though Brewington did not require chemotherapy or radiation treatment, he is still at a higher risk of having another cancer. However, the risk can be significantly reduced, if he stops smoking.

Bennett wants smokers to understand that it takes 20 years to reduce the risk factor for lung cancer down to normal population. In other words, if a person refrains from smoking for 10 years, he or she is still at risk for lung cancer.

For Brewington, the surgery was a "wake up call" as he realized he nearly died because of smoking. Now that he is cancer free, he says he literally wakes up every day blessed because he was given a second chance at life.

"When the surgery was over, I felt relieved that I was still here," says Brewington. "The cancer was out of my body and didn't spread to any other area. I quit 'cold turkey' after realizing that this object [cigarette] almost killed me."

Although the Navy smoking rate is declining, it is still at 36 percent and still exceeds the national average of 31 percent, according to the Navy Public Affairs Library. The Navy's policy is to reduce tobacco use and protect nonsmokers from involuntary exposure to ETS [Environmental Tobacco Smoke]. It states, "Where conflicts arise between the rights of nonsmokers and the rights of smokers, the rights of nonsmokers to a smoke-free air space shall prevail."

Brewington emphasizes to Sailors who smoke that they have free access to medical care while in the Navy. Of course, if they develop cancer, the Navy will help. They can also take advantage of other options, like smoking cessation programs.

Brewington now admits he was wrong. People do not have to "light up" to be macho, as he once believed.

He reiterates, "Do not smoke! Smoking is a killer. It may take years, or it may not, but it will cause bronchitis, emphysema and, eventually, death. There is nothing cool about it. It's a walk to death. Nothing beats looking at these pictures of me.

"If one Sailor, or one Marine, would stop smoking as a result of what happened to me, and to many of our fellow shipmates, that would be wonderful for both themselves and the Navy."

Source: www.dcmilitary.com/dcmilitary_archives/stories/112002/20324-1.shtml

More HOOAH 4 HEALTH information on lung cancer and quitting smoking:
Lung Cancer Resources
Tips to Help You Quit Smoking