Smoking Still a Major Cause of Cancer Death: A Call to Action on Tobacco Control

Charles Bankhead

June 2014, Vol 5, No 5 - Health Policy

San Diego, CA—Tobacco researchers and regulators lauded progress in tobacco control, but they emphasized that the health burden of tobacco use continues, reflecting the expanding list of diseases caused or exacerbated by tobacco.

At the 2014 American Association for Cancer Research (AACR) meeting, speakers continually pointed to tobacco control efforts that have led to a 60% reduction in smoking prevalence since the 1964 Surgeon General’s report on the health consequences of smoking.

Even so, 480,000 Americans continue to die annually from causes related to tobacco use, including 130,000 cancer deaths.

“Smoking prevalence has decreased from 42% of adults in 1964 to 18% today,” said Roy S. Herbst, MD, PhD, MS, Chief, Medical Oncology, Yale Cancer Center, New Haven, CT, and Chair of the AACR tobacco control council. “In that time, an estimated 8 million lives have been saved.”

Main Cause of Preventable Death
“But we still have a long way to go. Tobacco remains the largest preventable cause of death in the United States. It contributes to 18 different types of cancer and up to 30% of all cancer-related deaths. Eliminating the scourge of tobacco is one of the most effective things we can do in the area of cancer control,” Dr Herbst said.

The AACR recently published a collection of articles that have played a role in reducing smoking and other forms of tobacco use. Titled 50 Years of Tobacco Control, the publication includes reprints of articles that originally appeared in the AACR’s 7 peer-reviewed journals.

Since 1964, a “remarkable denormalization of smoking has occurred,” marked by “stunning progress” in tobacco control. The 1964 Surgeon General’s report was “a critical building block in reducing the death and disease toll from tobacco,” said Mitchell Zeller, JD, Director, US Food and Drug Administration (FDA)’s Center for Tobacco Products, Rockville, MD.

Jonathan M. Samet, MD, MS, Director, Institute for Global Health, University of Southern California, Los Angeles, and Senior Editor of 50 Years of Tobacco Control noted that 31 reports from the Surgeon General have followed the 1964 publication.

The 2014 report further lengthens the list of diseases caused by smoking, said Dr Samet. Notable additions include liver and colon cancers. The report “drives home the need for action, citing this large burden of smoking-attributable death and morbidity. The burden has not decreased, although we are making progress in some areas,” said Dr Samet.

The report ends with a call for more action and more collaboration among various stakeholders to bring about change more rapidly, “to end this epidemic as quickly as possible,” said Dr Samet.

“The report did not say what should be done; it simply said the problem was big enough that something should be done,” said Dr Samet. “The reports are about what the scientific evidence shows. It provides a framework for decision making.”

Smoking has remained a major public health problem, said Robert T. Croyle, PhD, Director, Division of Cancer Control and Population Sciences, National Cancer Institute (NCI), Bethesda, MD.

“We’re in a bizarre situation where we have a legal product on the market which is responsible for about a half a million deaths each year. In any other circumstance, without this long, strange history, there would be a lot more engagement by the scientific community, by clinicians, and organizations, really marshaling every effort to address the problem,” Dr Croyle stated.

One of the key challenges to increased control of tobacco use involves finding ways to engage with today’s “typical” smoker.

“The subpopulations which are the highest users are often those of lower income, lower levels of education, and in some regions of the country,” said Dr Croyle. “If you are a college-educated, wealthy individual living in the state of California, you may assume or believe that the smoking problem is one of the past. Clearly, for many of us, we see that, across the United States, this is an overwhelming problem.”

The FDA and e-Cigarettes
The AACR meeting concluded only a couple of weeks before the FDA announced proposed rules to bring e-cigarettes under its regulatory authority, which was hinted to by Mr Zeller during the meeting.

After the FDA tried to ban the importation of e-cigarettes, an importer sued the agency, claiming it had no regulatory authority because e-cigarettes do not contain tobacco. The argument held up in federal district and appellate courts.

Mr Zeller pointed out that the 2009 Family Smoking Prevention and Tobacco Control Act gave the FDA “authority and unprecedented opportunity to reduce the death and disease toll through use of science-based product regulation.”

“For the first time, the federal government is able to regulate the manufacturing, marketing, and distribution of tobacco products,” Mr Zeller said. “Until now, it was the tobacco industry that decided which products reached the market and which ones did not, which claims and descriptors appeared in labeling and advertising. FDA now plays a vital gate-keeping role in protecting the public by reviewing products and health-related claims for tobacco products we regulate.”

That apparently will include e-cigarettes. The 2009 legislation included a so-called deeming provision, allowing the FDA to extend its regulatory reach to products the agency deems to meet the statutory definition of tobacco products.

“The statutory definition of tobacco product includes anything ‘made or derived from tobacco,’” said Mr Zeller. “The nicotine in e-cigarettes is derived from tobacco.”

Aside from exercising its regulatory authority over tobacco products, the FDA has made youth tobacco use a priority. The NCI plans to ramp up efforts to address tobacco-related health problems at a global level, said Dr Croyle.

As the United States has become more restrictive toward tobacco use, the tobacco industry has shifted more of its focus on global markets. Several institutes with the National Institutes of Health have planned a collaborative research program, some of which may be funded by the FDA, which can fund research as part of its expanded authority over tobacco products.