Recommendations for Smokers & Ex-Smokers

The human body has a remarkable ability to heal itself. Take smoking, for example. If you quit at 50, you may have reduced your likelihood of dying from smoking-related illnesses by about half. Still, there's no guarantee that past smoking habits won't show some effects on your health long after you've quit.

Ask your doctor whether you should consider screening for any of the following smoking-related health problems to look for possible residual damage. But keep in mind that screenings put you at risk for false-positive results (indicating the presence of disease when there's none), which could lead to unnecessary diagnostic procedures. Also, your insurance or Medicare may not cover all of these screenings.

Lung cancer

Most major medical associations, including the American Lung Association, base their lung cancer screening guidelines on findings from the National Lung Screening Trial (NLST), in which screening with low-density computed tomography (CT) resulted in a 20 percent relative risk reduction in lung cancer death. They recommend CT scanning for current or former smokers ages 55 to 74 with a smoking history of 30 pack years (a pack a day for 30 years, two packs a day for 15 and so on) and no history of lung cancer. The American Thoracic Society expands the age range to 79 and includes lung cancer survivors.

CT screenings aren't foolproof though: They have a high rate of false-positive results. Only about 1 percent of participants in the NLST with positive results actually had lung cancer. Most lung nodules are found to be noncancerous after further testing, often with more radiation or invasive procedures. That's why all guidelines stress that CT scanning be done in medical facilities with radiologists, oncologists and surgeons who have expertise in interpreting scans and treating cancer.

Abdominal aortic aneurysm

The largest blood vessel in your body, the aorta, runs from your heart into your abdomen. When the aorta walls weaken or become damaged—often caused by smoking—it can lead to an abdominal aortic aneurysm (AAA), a ballooning or bulging of the artery wall that can rupture and prove fatal. But if screening finds an AAA early it can be treated, and the odds of dying drop significantly.

The U.S. Preventive Services Task Force recommends a one-time AAA screening by ultrasonography for men ages 65 to 75 who have ever smoked. They recommend against screening for women in most cases because of their lower risk of developing an AAA and evidence that surgery to treat an AAA in women may do more harm than good. However, they do recommend that healthy older female smokers with a strong family history of AAA consider the screening, since in this case benefits may outweigh harms.


Chronic obstructive pulmonary disease (COPD) is a respiratory disorder that encompasses both emphysema and bronchitis. Cigarette smoking causes most COPD cases. Its symptoms include wheezing, a chronic cough that produces phlegm and shortness of breath. You should be tested if you have any respiratory symptoms, say the American Thoracic Society and the American College of Chest Physicians.

Screening involves blowing into a spirometer, which measures the volume and rate of air you forcefully exhale.


Studies have linked smoking to osteoporosis, a condition in which bones weaken and fracture easily. The American College of Obstetricians and Gynecologists recommends that postmenopausal women who currently smoke be screened for osteoporosis with a dual-energy x-ray absorptiometry (DEXA) scan. The Endocrine Society recommends that men over 50 who smoke be screened using DEXA.

For the general population, including past smokers, the groups recommend, respectively, women over 65 and men over 70 be screened.

Eye diseases

Smokers have two to three times the risk of developing cataracts than nonsmokers. They have twice the risk of age-related macular degeneration, which causes vision loss. There are no specific recommendations for smokers or past smokers, but the American Academy of Ophthalmology recommends all adults have a comprehensive eye exam at age 40 and regular exams every one to two years after age 60.

Doctor's Viewpoint

Peter B. Terry, MD, MA, Professor, Dept. of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine

Quitting smoking is one of the most difficult things to do, and anyone who successfully does so should be commended for taking such a big step toward better health. Nevertheless, ex-smokers may still be at risk for smoking-related illnesses.

If you smoke or have a history of heavy smoking, you should weigh the pros and cons of undergoing an annual lung CT scan with your doctor and talk about other types of screenings that may be advisable for you.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Publication Review By: the Editorial Staff at

Published: 20 Jul 2013

Last Modified: 01 Oct 2015