Recently I received a serious letter from Prof. Dr. HJ de Koning, Professor of Public Health & Evaluation of Early Detection of Diseases at Erasmus MC Rotterdam. Anyone who has a position with so many capital letters must write serious letters. When I saw that he also turned to me personally, I realized that I could not ignore this letter.
“Dear Mr. Abrahams,” he writes, “lung cancer is a serious health problem. In the Netherlands, 14,000 people are diagnosed with lung cancer every year. It often takes a long time before lung cancer leads to complaints. The lung cancer is often difficult to treat. Lung cancer screening is the detection of lung cancer before symptoms arise. […] Why are you getting this letter? We are looking for people between the ages of 60 and 79 to participate in this lung cancer trial population.”
He then explains for whom the research is intended: people who have smoked for a long time. “Even after people have stopped smoking, the risk of lung cancer remains high for a long time. For example, have you smoked at least 1 pack a day for 25 years? Or maybe 15 years at least 2 packs? And if you stopped smoking, did you stop after 2005? Then we would like to ask you to consider whether you would like to participate in the study.”
Would Prof. Dr. HJ de Koning realize what he stirs up with the unsuspecting letter reader with such questions? I immediately felt an old smoker’s cough coming on and became so nervous that I would have lit a cigarette if I had had one nearby. Exactly how much had I smoked and how long had it been? In conversation with other ex-addicts you tend to be light-hearted about it. “Yes, heavily smoked, but that must have all worn out by now.”
After a thorough examination of my conscience, one more or less reassuring certainty surfaced: in any case, I had definitely stopped before 2005, after a period in which I had half-heartedly smoked cigars, “but not in the lungs”, as I always proudly added. . And before that? I hadn’t been a real pack-a-day smoker, you only had to hear WF Hermans cough once to know what to expect.
It is only in the fourth paragraph of his letter that Prof. HJ de Koning adopts a slightly more reassuring tone. “Have you not smoked or smoked less? Then you cannot participate in this study.” If you want to tear up the letter at that moment, you should still read the connecting sentences: “This does not mean that you cannot get lung cancer. That is why you should always go to your doctor in case of complaints.”
In de Volkskrant Another professor, Yolanda van der Graaf (clinical epidemiology UMC Utrecht), called her colleague’s research “a pure screening lobby of the medical industry”. It is much better to invest the money in smoking cessation programmes, she believes.
I will leave that discussion to the expert professors. For now, I’ve had enough of the mortality of all of us again. Especially since I just heard about a lonely elderly woman who was found dead in her home and whose family was unwilling to provide for her funeral. Sometimes quitting life is preferable to quitting smoking.
A version of this article also appeared in the newspaper of August 24, 2022