Prevention and cessation of cigarette smoking

Tobacco is the leading avoidable cause of cancer and has been estimated to account for about 30% of cancer deaths in the United States. Smoking increases the risk of many types of cancer including cancers of the lung, throat, mouth, pancreas, kidney, bladder, cervix, and others. Depending on how long and how much a person has smoked, the smoker's risk of cancer can be 2 times to 10 times greater than a nonsmoker's risk.

Smoking is also causally associated with many other diseases besides cancer, including coronary heart disease, stroke, emphysema, and bronchitis, as well as adverse outcomes of pregnancy. Well over 400,000 premature deaths in the United States each year are attributable to cigarette smoking.

Smoking can also affect the health of nonsmokers. The same cancer-causing chemicals found in inhaled tobacco smoke have been found in second-hand tobacco smoke but in lower concentrations. Nonsmokers exposed to second-hand smoke are at increased risk for lung cancer and coronary heart disease, and children exposed to tobacco smoke have elevated risks of sudden infant death syndrome (SIDS), ear infections and respiratory infections.

In 2004, 23% of adult men and 18% of adult women were current smokers. Cigarette smoking is more common in American Indians/Alaska Natives. Rates of smoking are highest in adults with the least education, and fall as the level of education rises. Lung cancer is now the leading cause of cancer death in both men and women. In the last 30 years, the number of smokers has decreased, especially among men. Since the 1980s, the lung cancer death rate among men has been decreasing and appears to be staying level now.

Most of the health problems related to cigarette smoking, including cancer and cardiovascular and respiratory disease, can be reduced by stopping smoking. Quitting smoking is beneficial at all ages, and the earlier in life one quits, the greater the benefits. People who quit smoking cut their risk of lung cancer by 30% to 50% after 10 years compared to continuing smokers, and cut their risk of oral and esophageal cancer in half within 5 years after quitting.

The damaging effects of smoking are even greater for cancer survivors, who have an increased risk of cancer recurrence, new cancers, and long-term side effects from cancer treatment. Stopping behaviors that are harmful to the body, such as smoking, can improve long-term health and quality of life.

Many methods of quitting smoking have been studied. The following are the more common methods used to help smokers quit.

Counseling Methods: People who have even a brief counseling session with a health care professional are more likely to quit smoking. The ASK, ADVISE, ASSESS, ASSIST, and ARRANGE model was developed to help health care professionals with their patients who smoke. Using this model, the physician asks the patient about their smoking status at every visit; advises the patient to stop smoking; assesses the patient’s willingness to quit; assists the patient by setting a date to quit smoking, provides self-help materials, and recommends use of nicotine replacement therapy (such as the nicotine patch); and arranges for follow-up visits.

Childhood cancer survivors who smoke may be more likely to quit when they take part in peer-counseling smoking cessation programs. In these programs, trained childhood cancer survivors offer support to other childhood cancer survivors who smoke. More people have been able to quit with peer-counseling than with self-help programs. Childhood cancer survivors who smoke can speak with their doctors about peer-counseling programs.

Drug Treatment: Various drug treatments are successful in helping people quit smoking. These include nicotine replacement products such as nicotine gum, the nicotine patch, nicotine nasal spray, nicotine inhalers, and nicotine lozenges. Nonnicotine medications such as bupropion, an antidepressant, and varenicline, a drug that mimics the way nicotine acts in the body, have also been studied and approved as aids to help people quit smoking. People who use drug treatments, no matter which kind, are more likely to be successful in their effort to quit smoking after 6 months and 12 months than those who use a placebo or no replacement at all.

Smoking Reduction: When smokers fail to completely quit smoking, they may still benefit from reducing the number of cigarettes they smoke. The more a person smokes, the higher his risk of developing lung cancer and other smoking-related cancers. Therefore, using medications or other means to smoke less may reduce smoking-related harms. Studies show that smokers who cut back are more likely to stop smoking in the future. However, smoking less should not be seen as a substitute for quitting smoking altogether, and is harmful if the smoker inhales more deeply or smokes more of each cigarette to try to control nicotine cravings. Nicotine replacement products have been shown to help smokers reduce the number of cigarettes smoked, but this effect does not appear to last over a period of years.

Consumer information about quitting smoking is available at the Agency for Healthcare Research and Quality Web site.

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