Anti-Smoking Efforts Cut Lung Cancer Deaths
Lung cancer death rates among adults age 30-39 are lower and are falling in most states that have strong anti-tobacco programs, according to a study published in Cancer Causes and Control (Vol. 14, No. 6: 579-585).
Lung cancer rates in this age group reflect smoking behavior over the preceding 5-25 years, when communities first began to control and discourage tobacco use. The findings suggest that efforts to prevent smoking are having a positive effect, said lead researcher Ahmedin Jemal, DVM, PhD, program director for cancer occurrence at the American Cancer Society (news - web sites).
"Where you have high tobacco control efforts you have low lung cancer death rates," he said, "but what's most interesting is that the death rates decreased in most states with strong tobacco control programs, but increased in states with low tobacco control efforts."
But many anti-smoking programs are in jeopardy, said study coauthor Michael Thun, MD, who directs epidemiological research for ACS. "Unfortunately, because of tight budgets, many states are currently cutting their expenditures on tobacco control," he said. "Now is the time to point out that these programs are working and must be sustained if the progress seen in this study is to continue."
Targeting a Killer
Lung cancer is the No. 1 cancer killer in the United States among both men and women. Roughly 171,900 people will get lung cancer in 2003, and 157,200 will die from it, according to American Cancer Society estimates.
Cigarette smoking causes about 82% of these deaths, as well as deaths from several other types of cancer, other lung diseases, and heart disease. Smoking is responsible for more than 400,000 deaths each year in the United States, according to the Centers for Disease Control and Prevention (news - web sites). Worldwide, tobacco use is responsible for nearly 5 million deaths each year, according to the World Health Organization (news - web sites).
Because of the immense health problems caused by smoking and other forms of tobacco use, US and global health advocates have spearheaded a campaign to encourage current smokers to quit, and discourage young people from beginning to smoke. The World Health Organization's 190 member nations recently approved the Framework Convention on Tobacco Control. Countries that ratify the treaty would be required to take steps to reduce tobacco use, such as restricting tobacco advertising, raising tobacco taxes and putting more explicit health warnings on tobacco packages.
A New Way to Measure Success
Similar anti-smoking measures are already in place in many US cities and states. Throughout the late 1980s and 1990s, many states enacted laws banning smoking in workplaces, restaurants, and public buildings, raising taxes on cigarettes, or limiting advertising, especially to teenagers.
But how effective have these programs been? Researchers generally look at smoking rates among adults and high school students to make that determination. Jemal and his colleagues took a different approach.
They examined lung cancer trends in adults age 30-39. They reasoned that people who got lung cancer at younger ages - generally smokers who are genetically more susceptible - would provide an early indication of the benefit of tobacco-control policies.
"Monitoring trends in young adults is really important for measuring the effectiveness of tobacco control activities," Jemal said. Most lung cancers take decades to develop; the average age for people who develop lung cancer is close to 70, though most smokers start the habit in their teenage years. However, a decrease in lung cancer among younger people now predicts a future decrease in lung cancer among older people.
Tobacco Control Works
Jemal and the other ACS researchers looked at smoking patterns and lung cancer deaths between 1990 and 1994, and between 1995 and 1999. Then they compared these rates with an index of anti-tobacco programs in each state. Only 33 states were included in the analysis because the others had too few deaths from lung cancer in the 30-39 age group.
The lung cancer death rate in both time periods was lowest in states like Arizona and California, which had strong anti-tobacco programs. It was highest in states such as Mississippi, Arkansas and Kentucky, which had weak anti-smoking programs.
The death rate also dropped the most between the two time periods in states with strong anti-smoking programs. California's rate fell almost 19%, while Oregon's fell 28%. But 11 states with weak anti-tobacco programs saw the lung cancer death rate among 30-39 year-olds increase in the same interval. The rate in Kentucky, the state with the weakest anti-tobacco measures, rose the most -- more than 34%. Missouri's rate rose more than 29%, and West Virginia's rose 25%.
States that had strong anti-tobacco programs also had fewer current smokers and more people who had quit in the 30-39 age group.
These findings are in line with previous studies that found more rapidly declining rates of heart disease deaths and lung cancer incidence in California after that state adopted anti-tobacco programs in 1989.
Overall, Jemal said, his findings indicate that anti-smoking measures are working.
"There is no question about that," he said. "Where you have stronger tobacco control activities you're going to have lower lung cancer death rates."
He said future evaluations of the effectiveness of state anti-tobacco programs should look at lung cancer in young people, as well as other indicators of tobacco usage.