Journal Highlights 40th Anniversary of Surgeon General's Report
A special report in the January 15, 2004, New England Journal of Medicine (NEJM) titled "Tobacco Control
in the Wake of the 1998 Master Settlement Agreement" marks the 40th anniversary of the first Surgeon
General's report, Smoking and Health. The 1964 Surgeon General's report was America's first widely
publicized official recognition that cigarette smoking is a cause of cancer and other serious diseases.
In this NEJM report, Dr. Steven Schroeder, past president of the Robert Wood Johnson Foundation
and current director and chair of the board of directors of the American Legacy Foundation, reviews and
evaluates the 1998 Master Settlement Agreement (MSA) and summarizes the effectiveness of current tobacco
control policies, including cigarette taxation, clean-indoor-air initiatives, smoking cessation programs, and
international trade policies. The special report demonstrates that while the MSA was a landmark event for tobacco control, it was far from
a panacea.
In 1998, the attorneys general of 46
states and five U.S. territories reached
an agreement with four tobacco
companies to recover the costs of the
states' Medicaid programs for treating
tobacco-related illnesses and to
settle other types of lawsuits, such as
consumer protection and antitrust
litigation. The MSA awarded the
states $206 billion, to be paid over
25 years. The MSA also required the
elimination of youth-targeted advertising
and increased the public disclosure
of internal industry documents,
among other provisions.
In general, the MSA did not specify
how states must spend their funds.
Schroeder explores how states have
chosen to use their funds - most of
which have not gone toward tobacco
control-related programs. The only
MSA funds specifically earmarked
were for the creation of the American
Legacy Foundation, to develop
national programs that address the
health effects of tobacco use. Legacy
is responsible for the "truth" campaign,
which Schroeder calls "the
most important national counter-marketing
effort in 30 years."
It now has been 40 years since the
first Surgeon General's report on
smoking and health and over five
years since the MSA. Although much
progress has been made, there are
still 46 million current smokers in the
United States, and 440,000 of them
die each year from smoking, making
it the single largest preventable cause
of death. Another 8.6 million people
suffer from tobacco-related diseases
such as emphysema and heart disease.
Smoking is currently the leading
cause of cancers of the lung, bladder,
larynx, esophagus, and mouth and
is highly associated with the development
of cancers of the pancreas,
cervix, and kidney. And smoking is
increasingly concentrated in populations
with low incomes and relatively
little education, further increasing
the health disparities gap that NCI - and the Department of Health
and Human Services as a whole - seek to eliminate.
"While overall U.S. smoking-rates have slightly declined in recent years, substantial work remains in
order to reach the department's health goals for the nation," said Dr. Cathy Backinger, acting branch chief
of NCI's Tobacco Control Research Branch (TCRB).
For more information on smoking-related research and findings, visit
TCRB's Web page at http://tobaccocontrol.cancer.gov. For
more information on the MSA, go to http://www.naag.org/issues/tobacco/index.php?sdpid=919.
For help with smoking cessation,please go to http://smokefree.gov or call the NCI's Smoking Quitline at
1-877-44U-QUIT (1-877-448-7848).
Mouse Models Closely Mimic Human Pancreatic Cancer
NCI's Mouse Models of Human
Cancers Consortium (MMHCC) has
provided support for the following
studies of mouse models that may
provide insight into pancreatic cancer
in humans. (See this week's Director's
Update for more information on pancreatic
cancer research.)
In the December 17, 2003, Genes
& Development, scientists led by Dr.
Ronald DePinho at the Dana-Farber
Cancer Institute, reported that they
had developed a bioengineered mouse
model containing two "signature
mutations": an activated form of the
Kras gene and a deletion of the Ink4a
tumor suppressor gene. The resulting
mice develop very aggressive PDA
that is lethal in about three months.
Because the two genetic changes are
so common in human PDA, these
researchers are now using the mice to
try combinations of available therapies
and to identify and test novel
interventions.
Meanwhile, in the December 2003
Cancer Cell, researchers led by Dr.
David Tuveson, from the Abramson
Cancer Center of the University
of Pennsylvania, describe a mouse
model they developed by engineering
a mutation in the Kras gene.
This mutation "recapitulates the
cardinal features" of PDA, the scientists
report. These researchers have
already examined blood serum from
the mice with initial stages of PDA
for reproducible patterns of protein
changes that may herald the presence
of very early disease. Studies are
under way to identify the proteins
and determine if they are informative
for detection of human PDA, said Dr.
Cheryl Marks, NCI program director
for the MMHCC.
Study Examines Breast Cancer Screening Techniques
NCI's Clinical Genetics Branch is
conducting the Breast Imaging Study,
which evaluates the use of several
new and promising breast cancer
screening techniques in women at
high genetic risk of breast cancer. The
study is critical to improve screening
for breast cancer among women
who have mutations in breast cancer
susceptibility gene BRCA1 or BRCA2.
New techniques being evaluated include
breast scanning using magnetic
resonance imaging (MRI), positron
emission tomography (PET), and
breast ductal lavage. Women who
carry BRCA1 or BRCA2 mutations
are eligible to join the study, as well as
women who have a first- or second-degree
relative with breast or ovarian
cancer related to BRCA mutations.
More information can be found at
http://breastimaging.cancer.gov.
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