Given the harmful effects of cigarette smoking and its potential to cause cancer, how do many people manage to survive even after smoking for 45 to 65 years?

The wisdom behind the impact of smoking was imparted to me years ago by a wise physician. He clarified that smoking’s peril lies not merely in its direct causation of ailments, notably cancer, but in its exacerbation of existing vulnerabilities in individuals predisposed to such conditions.

It’s plausible that one’s susceptibility to these maladies lies deep within their genetic makeup, encoded within their DNA. Some individuals lack any genetic inclination towards cancer, for instance. Among these individuals, some may smoke for years without suffering significant consequences.

However, genetic predisposition alone doesn’t seal one’s fate with cancer. But if a smoker carries a genetic predisposition towards it, the odds of contracting the disease skyrocket.

Beyond cancer, smoking is entwined with a myriad of health issues, spanning from emphysema to heart disease. For those genetically inclined towards these ailments, smoking amplifies their likelihood of manifestation.

As the adage goes, the only certainties in life are death and taxes. Yet, to stave off the former for as long as possible, steering clear of cigarettes remains paramount.

In the realm of causality, clarity is key. Take the example of the smallpox virus: it’s a clear-cut case where the virus is undeniably linked to the disease. Virtually everyone with smallpox carries the virus, and almost all those with the virus exhibit symptoms. The rare instances where individuals with the virus don’t fall ill underscore the rule rather than challenge it.

Contrast this with smoking and its association with lung cancer. Statistics reveal that only a minority, around 8-10%, of lifelong smokers develop lung cancer, leaving the majority unaffected. This complexity blurs the label of “cause,” though “risk factor” fits snugly; smokers indeed face a higher likelihood of contracting the disease compared to nonsmokers.

Yet, recent research injects nuance into this narrative. Surprisingly, lung cancer rates among nonsmokers have surged in recent years, divorcing the disease from its traditional association with smoking. Moreover, a groundbreaking study suggests that many cancers arise not from identifiable causes, but from random chance—a disconcerting notion, akin to a skier tumbling down a slope due to a misplaced step rather than a deliberate action.

In essence, while skiing may elevate the risk of leg fractures, it doesn’t directly cause them. Similarly, smoking heightens the odds of lung cancer, but it’s not a singular cause. Instead, it’s a tangled web where probabilities intersect with happenstance, where even the most cautious skiers and health-conscious nonsmokers can find themselves at the mercy of fate.