I started smoking when I was 16 and quit in my early 30s. I was shocked when the doctor told me that my bladder cancer may well have been caused by smoking. So far it's cost me the misery of four surgeries and the loss of my bladder. If only I had known . . . |
For every woman who smoked in 1950, 600 women smoke today. And as more women smoke, more suffer and die from smoking-related disease. Many American women are unaware of just how dangerous smoking can be. Here are the facts:
- Lung cancer has now replaced breast cancer as the number-one cancer killer of women.
- Tobacco use is a major cause of cancers of the bladder, mouth, larynx, and esophagus.
- Tobacco use is a contributing cause of cervical cancer, myeloid leukemia, and kidney, colon, stomach, and pancreatic cancers.
- Nearly 20 million women have successfully quit smoking but remain at risk for many cancers.
NCI-supported research has shown that:
- Fourteen percent of Hispanic women and 22 percent of White women smoke.
- Smoking rates are higher yet among African American women (about 24 percent) and much higher among Native American and Alaskan Native women (about 35 percent).
- Poor and less educated women are more likely to smoke.
A better grasp of the underlying causes of these disparities is critical to developing effective interventions to help all women.
Lots of my friends smoke - me, too. It's social and relaxing. And it's not a problem; I could quit anytime. |
Tobacco industry marketing frequently targets young and minority women, and studies have revealed the effectiveness of this technique, especially for youths. Most women smokers begin as teenagers, before high school graduation. Of the millions of women who try to quit smoking each year, only a small percentage succeeds. African American, Hispanic, younger, and less educated women have the lowest quit rates.
In February 2003, NCI took the lead with other federal and non-federal partners to convene a meeting of experts to assess the state of knowledge about tobacco use and tobacco-related cancers among women. They identified priorities for research, evidence-based interventions, and the application of new and proven interventions across several key areas:
- Toxicology, cancer susceptibility, and biologic gender differences related to tobacco and cancer.
- The biology and behavior of addiction.
- National surveillance of tobacco use and control efforts.
- Prevention of tobacco use and treatment of addiction in women.
- Public knowledge of tobacco addiction, health and addiction risks, and control interventions targeting women.
- Community, policy, legal, and regulatory interventions.
- International issues in tobacco use and control.
Recommendations are being developed to serve as the basis for an action plan.
NCI supports research to help the nearly 20 million women who have successfully quit but who remain at risk for many cancers. Researchers are examining how genetic differences and additional environmental exposures influence cancer risk in former smokers.
Other investigators are working to develop and deliver effective interventions for prevention and treatment of tobacco-related cancers. For example:
- In partnership with the National Institute on Drug Abuse and the Robert Wood Johnson Foundation, NCI funds seven Transdisciplinary Tobacco Use Research Centers, which conduct studies on topics such as culturally tailored tobacco-use prevention methods, and determinants of relapse.
- NCI supports more than 50 projects related to youth smoking prevention and cessation.
- NCI recently established the Tobacco Intervention Research Clinic, a state-of-the-science center for genetic, epidemiologic, basic, and behavioral tobacco research studies.
- Ongoing clinical trials are exploring the interplay of tobacco and other environmental exposures on cancer risk.
This People's Story is an amalgam of individual experiences.
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I've struggled with my weight since I was about 13. I gain, I lose, I gain again. . . . I know the extra weight makes me more likely to have heart disease and diabetes, but now the scientists are saying I'm also at higher risk for many cancers.
I try to eat right and exercise regularly, but it's really hard for me to build new habits. |
The evidence is now clear that obesity is a significant risk factor in many cancers, including cancers of the colon, prostate, postmenopausal breast, uterine, and renal cell. It has been estimated that overweight and obesity in the United States may account for 14 percent of all cancer deaths in men and 20 percent in women, adding up to more than 94,000 deaths each year.
- In women, increased body mass also is associated with higher rates of cancers of the breast, endometrium, cervix, and ovary.
- In men, excess weight also increases stomach and prostate cancer risk.
Researchers suspect that many of the mechanisms responsible for this increased risk are systemic in nature, simultaneously increasing the risk of cancer in many parts of the body. For example:
- Overweight and inactivity have been shown to cause the body to secrete increasingly higher amounts of insulin and other growth factors.
- Cells exposed to high levels of these substances over an extended period are more prone to accelerated growth. This rapid growth increases the likelihood of random genetic mutations which, in turn, elevates the risk of cancer.
Other mechanisms related to energy balance appear to be specific to certain cancer types. For example:
- Investigators have demonstrated that exercise decreases colon cancer risk, possibly by increasing the rate at which harmful waste products move through and exit the colon.
- Epidemiologic researchers have shown that overweight or obese women, especially those who gain weight throughout adulthood, experience increased risk for breast cancer after menopause. Even moderate regular exercise may help reduce this risk by decreasing estrogen levels in the breast tissue.
Scientists have identified obesity and sedentary lifestyle as two important and modifiable risk factors for cancer. Experts believe that it is particularly important to reach children with information about healthy eating and regular exercise while their lifestyle patterns are developing and before they experience excess weight gain.
NCI is working to accelerate our understanding of the many aspects of energy balance and specific cancers and cancer in general, and to devise ways to communicate this information to all populations. Investigators are examining the relationship between cancer and the independent and combined effects of reduced energy intake (caloric restriction), various components of diet (e.g., carbohydrates, protein, fat), specific foods, micronutrients, food preparation methods, and types and intensity of physical activity.
To further this research, NCI is hoping to support more transdisciplinary research dedicated to:
- Improving our understanding of how energy balance affects risk across the cancer continuum, from causation through survival.
- Developing innovative approaches to obesity prevention, especially among children and in diverse populations.
This People's Story is an amalgam of individual experiences.
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Each time my colon cancer comes back, it seems to hit me harder. The pain is worse, I have more trouble sleeping, and I just get so tired. The pain is the biggest problem. I get depressed because I can't control it. When the doctors and nurses ask me how the pain is, I don't know how to describe it, except that it's worse than it was the week before. I'm afraid to say too much, because they might stop the chemo, and then the cancer would get even worse.
My husband has been battling cancer for a year and a half. I know he's in a great deal of pain because I can see it in his face. The doctor gave him pain medication, but I wonder if he's taking the full dose - he's told me before he doesn't like how "out of it" he feels when he takes it. It seems like it's a never ending cycle - as the pain gets worse, he gets more tired, he can't eat or sleep, which makes the pain even harder to take. I wish I knew what to do to help him be more comfortable. |
Symptoms of cancer and side effects of related treatments can be severe in patients with advanced-stage disease, especially in those receiving aggressive and experimental therapies. We know that:
- Symptoms affect patients' overall quality of life, including their ability to do many of the things most people take for granted such as caring for themselves, doing household chores, sleeping, or going to work.
- Intense and uncontrolled symptoms lead to poor emotional and physical health.
- Patients are sometimes hesitant to report they have bothersome symptoms for fear their therapy will be slowed or stopped.
More symptom management research is needed to ensure that patients receive quality, effective cancer care that does not disrupt their quality of life. NCI-supported investigators are currently:
- Determining which symptoms occur most frequently according to tumor type and treatment choice
- Developing new methods for assessing symptoms
- Working to improve communication about symptoms between patients and their health care teams
- Developing and comparing strategies of symptom management
- Finding ways to better integrate symptom management as a vital part of all cancer care
NCI-supported researchers are exploring ways to help patients and their families better manage symptoms and improve their quality of life. For example:
- Investigators are seeking a better understanding of the interaction between common symptoms of advanced cancer. For example, when patients experience pain, are they more likely to have fatigue? And which symptoms are particularly troubling to caregivers and patients?
- Other NCI-supported researchers are investigating which symptom management techniques are helpful for various groups of caregivers -- for example, older versus younger or male versus female caregivers.
Millions of Americans are providing care for a family member with cancer. These caregivers are partners in care, part of the patient's team, and a vital resource to the patient. They are often responsible for accessing information, communicating with the patient's healthcare team, and providing hands-on care to alleviate troublesome symptoms.
For many caregivers, managing patient symptoms is one of the toughest challenges. Caregivers are more likely to feel a greater sense of burden and to be depressed, frustrated, and overwhelmed in their role when patients' symptoms are out of control, particularly when the patient has severe pain or fatigue. Through symptom management research, we will be able to better prepare caregivers to manage patients at home and ultimately improve caregivers' emotional and physical health as they continue to help their family members live with cancer.
This People's Story is an amalgam of individual experiences
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