Director's Update: November 25, 2003
Last week, the Great American Smokeout provided the more than 46 million smokers in this country the opportunity and the motivation to stop smoking - for a day and hopefully for a lifetime. More than 22 percent of adults and more than 28 percent of high school students in this country are current smokers. Because of their smoking, they are at increased risk for a host of cancers - lung, mouth, pharynx, larynx, esophagus, pancreas, cervix, kidney, and bladder - as well as chronic lung disease, heart disease, and stroke. And every year more than 440,000 people in this country die prematurely as a result of such tobacco-related diseases. Cigarette smoking alone is directly responsible for about 30 percent of all cancer deaths annually in the United States and 87 percent of lung cancer deaths, making tobacco use the single most preventable cause of premature death in our nation. The National Cancer Institute (NCI) cannot achieve its challenge goal to eliminate the suffering and death due to cancer without effectively reducing and treating tobacco use and tobacco-related cancers.
For years, we have made research on tobacco use prevention a priority. Because approximately 90 percent of smokers begin using tobacco before the age of 18, understanding why young people start smoking - and using this knowledge to design more effective prevention strategies - is a central part of our research. Through NCI-funded studies, we are gaining important insights into why young people start to smoke. For example, recent studies suggest that viewing smoking in popular movies is associated with an increased risk for smoking initiation in youth.
We also are partnering with the National Institute on Drug Abuse, another institute within the National Institutes of Health, to better understand youth tobacco use. Research funded through this effort has provided valuable information, such as demonstrating that the brains of adolescent smokers show signs of addiction, and experience withdrawal symptoms, even before regular smoking occurs. In fact, adolescent smokers can experience withdrawal symptoms within one month of starting to smoke. These findings indicate that adolescents who are not daily smokers might encounter extreme difficulty in quitting smoking, a concern that can have considerable implications for smoking cessation strategies.
While prevention research remains a vital part of our program, we know that helping smokers - of any age - to quit will have the greatest impact on reducing lung and other tobacco-caused cancers. Smokers who quit before age 50 reduce, by half, their risk of dying over the next 16 years from a tobacco-associated disease. Yet, getting smokers to stop smoking - and not return to cigarettes - has proven to be very difficult. Because of tobacco's addictive nature, only 3 to 6 percent of those who try to quit smoking each year remain abstinent.
Nevertheless, some studies show that smokers who receive state-of-the-science help, for example a combination of pharmacotherapy and behavioral counseling, can achieve quit rates as high as 15 to 25 percent. And recent research suggests telephone-based counseling is a promising cost-effective population-based approach for intervening with smokers on an individual basis. NCI offers assistance for those trying to quit smoking via the Cancer Information Service's telephone quitline, 1-877-44U-QUIT, and NCI's smoking cessation Web site, Smokefree.gov.
NCI has also provided a solid scientific foundation for the creation and support of state and community tobacco control programs. One such program is the American Stop Smoking Intervention Study (ASSIST), funded jointly by NCI and the American Cancer Society. The ASSIST program aimed to change the social, cultural, economic, and environmental factors that promote smoking. A research evaluation of this program, which appeared in last week's Journal of the National Cancer Institute, reports that states participating in the ASSIST program showed a greater reduction in smoking prevalence than non-ASSIST states. Moreover, among states with stronger tobacco control policies and a greater ability to implement tobacco control activities, the reductions in smoking were even greater. This study demonstrated that investing in state tobacco control programs can lead to a reduction in smoking rates among adults. Recently, state tobacco control programs have experienced large budget cuts. NCI, the Centers for Disease Control and Prevention, and other partners are working to evaluate the effects of state funding cuts on smoking prevalence, with special attention to youth smoking.
Fortunately, these science-based public health efforts have helped millions of smokers to quit since the groundbreaking 1964 Surgeon General's Report on the health consequences of tobacco use. However, former smokers remain at increased risk for developing lung and other cancers, despite having stopped smoking. As the population of former smokers expands each year, NCI research is exploring new early detection and chemoprevention strategies. For example, we are collaborating with two NCI-funded research networks to conduct the National Lung Screening Trial (NLST), to determine if screening people with either spiral computed tomography (CT) or chest X-ray before they have symptoms can reduce deaths from lung cancer. NLST is enrolling current and former smokers.
We remain committed to research on the discovery, development, and delivery of interventions to reduce tobacco use among youth and adults as part of our overall effort to prevent and control cancer. Our efforts in this area have revealed that tobacco use and tobacco-related cancers occur because of a complex interplay among genetic, physiologic, behavioral, and social factors. In light of these multiple contributing factors, we recognize the importance of pursuing transdisciplinary studies - bringing together scientists from multiple disciplines to effectively address this major public health problem. To guide the Institute in these efforts, NCI established the Tobacco Control Research Branch in 1998 to lead and collaborate on research and to disseminate
evidence-based findings to prevent, treat, and control tobacco use. NCI also has created a central source for the Institute's online information about tobacco research and control. This Smoking and Cancer page offers information about NCI's tobacco-related research; information on tobacco products, environmental tobacco smoke, and tobacco use by special populations; tobacco-related information in Spanish; tobacco-related statistics and clinical trials information; and information about smoking cessation.
Given the number of people in our country who are at risk for tobacco-related cancers, a victory against suffering and death due to cancer cannot come without a victory against tobacco use.
Andrew C. von Eschenbach, M.D.
Director, National Cancer Institute
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