OncoLink

More Reasons to Quit

Julia Draznin Maltzman, MD
The Abramson Cancer Center of the University of Pennsylvania

The New Five

November is national lung cancer month and smoking awareness month. Just in case heart disease, peripheral vascular disease, emphysema, and lung and head and neck cancers were not good enough reasons to quit smoking, the US Surgeon General's office added five more cancers to the risk of diseases caused by cigarettes. The 2004 report follows the first Surgeon General report on smoking and health published forty years ago. These reports document evidence that cigarettes can in fact cause heart disease, lung diseases, and cancer. The new report estimates that there are 440,000 smoking related deaths in the US per year. Furthermore, male smokers shorten their life expectancy by 14.5 years and women smokers by 13.2 years.

Take Home Messages

The three main points that the report tries to get across are:

  1. Cigarettes ruin good health and are responsible for many diseases including cancer.
  2. Cigarettes can harm almost every organ system in the body  cardiac, pulmonary, vascular, genitourinary, gastrointestinal, endocrine, and hematologic, just to name a few.
  3. Quitting smoking has both immediate and long-term benefits to all organ systems.

The report also notes that smoking cigarettes with lower percentage of nicotine as advertised by some companies, has no protective effect on the body and has no proven benefit to health.

How Bad is Bad?

In this report, the Surgeon General has indicated how strong the evidence is to support these accusations. There are four categories in which all diseases will fall into. These include:

  1. Sufficient to infer a causal relationship
  2. Suggestive but not sufficient to infer a causal relationship
  3. Inadequate to infer either a causal or an absence of a relationship
  4. Suggestive of no causal relationship

In addition to the well known lung cancer, laryngeal, pharyngeal, esophageal and oral cavity cancers that are caused by cigarette smoking, the five new additions include: kidney cancer, cervical cancer, gastric cancer, pancreatic cancer, and acute myeloid leukemia. The diseases that fall into the second category of suggestive but not sufficient evidence include colorectal and liver (hepatic) cancer. The Surgeon General deemed ovarian cancer as one for which there is not enough data to prove or disprove a causal relationship.

The Good News

The report also noted changes in American smoking habits and general attitudes toward cigarettes since the publication of the first report forty years ago. In 1963 American consumption of cigarettes peaked at 4,345 per capita adult. In 2002 the annual per capita adult consumption dropped to 1,979. The latest poles note that there are now more former smokers in the US than current smokers. Furthermore, there is a greater recognition of the dangers of smoking and as a consequence a greater intolerance to it. Still, more needs to be done, since one in four of high school seniors are current smokers.