By Dr Ang Peng Tiam

Since the start of the year, the smoking ban in Singapore has been extended to include all indoor public places and some outdoor places.

Singapore probably has the most rigorous laws among countries that protect the rights of those who do not smoke and dislike the smell of cigarette smoke.

Two good friends and I just came back from a long weekend holiday in Shenzhen, China. There, we had great difficulty having meals without being overwhelmed by cigarette fumes. Whenever we asked for seats in a non-smoking area, the waitresses gave us incredulous looks. We found out there were very few such provisions.

Yet there ought to be, because this is not just a matter of personal preference but of public health.

There is no doubt that smoking increases the risk of developing cancer. Yet smokers continue to burn money and poison themselves with the carcinogens found in burning tobacco.

With graphic pictures of diseased body parts on cigarette packs and with anti-smoking posters displayed at void decks, bus stops and other public places, smokers cannot say they are unaware of such harmful effects.

So why do smokers continue to smoke? I suspect that the two main reasons are habit and addiction.

Some admit it and say that they have smoked for so long that they have difficulty giving it up. Others, denying they are addicted, defend their indulgence as a personal vice.

I often tell my patients - and anyone else who cares to listen - that we will see a drop in the cancer figures by up to one-third if everyone stopped puffing away.

Smoking is a major factor in the development of cancer of the lung, oral cavity, voice box and oesophagus, and it is linked to cancer of the stomach, bladder, pancreas, kidney, anus, cervix and penis.

Besides causing cancer, the harmful effects of smoking include damage to the vessels of the heart (leading to heart attacks) and brain (leading to strokes). It can also damage the lungs, leading to chronic bronchitis and emphysema.

The good news is that it is never too late to give up smoking. Once a smoker joins the ranks of non-smokers, his risk of developing smoking-related cancers will drop from year to year. It is said that by year 10, his risk of developing cancer will return to that of a non-smoker.

Is it difficult to give up smoking? I have never smoked so it is difficult for me to answer this but I suspect that it depends a great deal on the smoker's motivation.

All too often, once cancer has been diagnosed, the majority will give up smoking right away. For most, when faced with the reality of cancer and possibly premature death, self-preservation gives them the willpower to stop smoking immediately.

Initially, there might be an almost irresistible urge to smoke but the desire to live helps them to beat the habit. And, of course, any parent who smokes near his or her young child is just completely irresponsible.

Mr Lim, a 70-year-old man from Kuala Lumpur, came to see me when he was diagnosed with small cell cancer of the lung three years ago. There are several types of lung cancer and this particular one is almost always associated with smoking.

He has an amazing family - very loving and supportive, especially his wife.

Over the few years of looking after him, I have learnt that he is a fun-loving man who has lived life to the fullest - smoking, drinking, gambling and womanising.

'He has done every naughty thing you can think of,' Mrs Lim once said as he sat sheepishly next to her. As she described his misdeeds, he would try to interrupt her: 'My dear, Dr Ang is very busy and has lots of patients. Let's go so that he can see the other patients.'

When he was first diagnosed with lung cancer, the whole family rallied around him. His three children took turns to accompany him for the chemotherapy and radiotherapy. His wife would come for every visit.

Then, suddenly, all his children stopped coming.

I subsequently found out that he had promised to stop smoking when he was diagnosed with lung cancer. He did, for a while.

Then they caught him smoking in a back alley after dinner. His children were so angry that they refused to talk to him or have anything to do with him for months.

They decided to practise tough love on dad. He learnt his lesson and, to the best of my knowledge, he has not smoked for the past year.

I see many cancer patients in my clinic every day and the question 'Why me?' hangs in the air at almost every consultation. For most, there appears to be no good reason why they should get cancer. Some blame it on fate, others on bad luck. For smokers with lung cancer, I know the reason. Most of the time, to their regret, so do they.

angpt@parkwaycancercentre.com

Dr Ang, the medical director of Parkway Cancer Centre, has been treating cancer patients for nearly 20 years. In 1996, he was awarded Singapore's National Science Award for his outstanding contributions to medical research.

This article was first published in Mind Your Body, The Straits Times.

For more The Straits Times stories, click here.

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Photos: "No smoking" areas extended