Overview of Prevention

Prevention Purposes of this summary

Control of Tobacco Use

Prevention and cessation of cigarette smoking

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Changes to This Summary (02/22/2008)
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Overview of Prevention

Prevention

Doctors cannot always explain why one person gets cancer and another does not. However, scientists have studied general patterns of cancer in the population to learn what things around us and what things we do in our lives may increase our chance of developing cancer.

Anything that increases a person’s chance of developing a disease is called a risk factor; anything that decreases a person’s chance of developing a disease is called a protective factor. Some of the risk factors for cancer can be avoided, but many cannot. For example, although you can choose to quit smoking, you cannot choose which genes you have inherited from your parents. Both smoking and inheriting specific genes could be considered risk factors for certain kinds of cancer, but only smoking can be avoided. Prevention means avoiding the risk factors and increasing the protective factors that can be controlled so that the chance of developing cancer decreases.

Although many risk factors can be avoided, it is important to keep in mind that avoiding risk factors does not guarantee that you will not get cancer. Also, most people with a particular risk factor for cancer do not actually get the disease. Some people are more sensitive than others are to factors that can cause cancer. Talk to your doctor about methods of preventing cancer that might be effective for you.

The purposes of this summary on prevention and cessation (stopping) of cigarette smoking are to:

• Give information on counseling methods used by health professionals to improve quit rates of smokers.
• Describe various drug treatments used to improve quit rates of smokers.

You can talk to your doctor or health care professional about prevention and cessation methods and whether they would be likely to help you.

Control of Tobacco Use

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 ¹ Web site.

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There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

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The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator ⁴. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Changes to This Summary (02/22/2008)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

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If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form ⁵. We can respond only to email messages written in English.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ³. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether a certain drug or nutrient can prevent cancer. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients and those who are at risk for cancer. During prevention clinical trials, information is collected about the effects of a new prevention method and how well it works. If a clinical trial shows that a new method is better than one currently being used, the new method may become "standard." People who are at high risk for a certain type of cancer may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ⁶. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Glossary Terms

A drug used to treat depression.

The organ that stores urine.

Inflammation (swelling and reddening) of the bronchi.

A substance that is used to treat depression, and to help people quit smoking. It belongs to the family of drugs called antidepressants.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

Having to do with the heart and blood vessels.

The lower, narrow end of the uterus that forms a canal between the uterus and vagina.

A disease in which there is a narrowing or blockage of the coronary arteries (blood vessels that carry blood and oxygen to the heart). Coronary heart disease is usually caused by atherosclerosis (a build up of fatty material and plaque inside the coronary arteries). The disease may cause chest pain, shortness of breath during exercise, and heart attacks. The risk of coronary heart disease is increased by having a family history of coronary heart disease before age 50, older age, smoking tobacco, high blood pressure, high cholesterol, diabetes, lack of exercise, and obesity. Also called coronary artery disease and CAD.

The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

Pulmonary emphysema is a disorder affecting the alveoli (tiny air sacs) of the lungs. The transfer of oxygen and carbon dioxide in the lungs takes place in the walls of the alveoli. In emphysema, the alveoli become abnormally inflated, damaging their walls and making it harder to breathe. People who smoke or have chronic bronchitis have an increased risk of emphysema.

Smoke that comes from the burning of a tobacco product and smoke that is exhaled by smokers. Inhaling environmental tobacco smoke is called involuntary or passive smoking. Also called secondhand smoke and ETS.

Cancer that forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to the stomach). Two types of esophageal cancer are squamous cell carcinoma (cancer that begins in flat cells lining the esophagus) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).

Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.

The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

In medicine, refers to the act of taking a substance into the body by breathing.

Transmitted through genes that have been passed from parents to their offspring (children).

One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.

A chewing gum that contains a small dose of nicotine, which enters the blood by being absorbed through the lining of the mouth. This helps stop nicotine cravings and relieves symptoms that occur when a person is trying to quit smoking. A prescription is not needed for nicotine gum.

A device used to inhale (breathe in) small doses of nicotine through the mouth. The nicotine is absorbed through the lining of the mouth and goes into the blood. This helps stop nicotine cravings, and relieves symptoms that occur when a person is trying to quit smoking. A prescription is needed for nicotine inhalers.

A hard candy-like tablet that contains a small dose of nicotine. The nicotine is absorbed through the lining of the mouth and goes into the blood. This helps stop nicotine cravings, and relieves symptoms that occur when a person is trying to quit smoking. A prescription is not needed for nicotine lozenges.

A nose spray that contains a small dose of nicotine, which enters the blood by being absorbed through the lining of the nose. This helps stop nicotine cravings and relieves symptoms that occur when a person is trying to quit smoking. A prescription is needed for nicotine nasal spray.

A patch that sticks on the skin and contains a small dose of nicotine, which enters the blood by being absorbed through the skin. This helps stop nicotine cravings and relieves symptoms that occur when a person is trying to quit smoking. A prescription is not needed for nicotine patches.

A type of treatment that uses special products to give small, steady doses of nicotine to help stop cravings and relieve symptoms that occur when a person is trying to quit smoking. These products include nicotine gum, nicotine inhaler, nicotine nasal spray, nicotine lozenges, and nicotine patch. They do not contain any of the other chemicals found in tobacco products.

Cancer that forms in tissues of the lip or mouth. This includes the front two thirds of the tongue, the upper and lower gums, the lining inside the cheeks and lips, the bottom of the mouth under the tongue, the bony top of the mouth, and the small area behind the wisdom teeth.

A glandular organ located in the abdomen. It makes pancreatic juices, which contain enzymes that aid in digestion, and it produces several hormones, including insulin. The pancreas is surrounded by the stomach, intestines, and other organs.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

Medical doctor.

An inactive substance or treatment that looks the same as, and is given the same way as, an active drug or treatment being tested. The effects of the active drug or treatment are compared to the effects of the placebo.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrent cancer.

The organs that are involved in breathing. These include the nose, throat, larynx, trachea, bronchi, and lungs. Also called respiratory tract.

The organs that are involved in breathing. These include the nose, throat, larynx, trachea, bronchi, and lungs. Also called respiratory system.

Something that may increase the chance of developing a disease. Some examples of risk factors for cancer include age, a family history of certain cancers, use of tobacco products, certain eating habits, obesity, lack of exercise, exposure to radiation or other cancer-causing agents, and certain genetic changes.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

In medicine, a loss of blood flow to part of the brain, which damages brain tissue. Strokes are caused by blood clots and broken blood vessels in the brain. Symptoms include dizziness, numbness, weakness on one side of the body, and problems with talking, writing, or understanding language. The risk of stroke is increased by high blood pressure, older age, smoking, diabetes, high cholesterol, heart disease, atherosclerosis (a build-up of fatty material and plaque inside the coronary arteries), and a family history of stroke.

The sudden and unexpected death of a healthy child who is younger than one year old, usually during sleep. The cause of sudden infant death syndrome is not known. Also called SIDS and crib death.

A plant with leaves that have high levels of the addictive chemical nicotine. The leaves may be smoked (in cigarettes, cigars, and pipes), applied to the gums (as dipping and chewing tobacco), or inhaled (as snuff). Tobacco leaves also contain many cancer-causing chemicals, and tobacco use and exposure to secondhand tobacco smoke have been linked to many types of cancer and other diseases. The scientific name is Nicotiana tabacum.