A comprehensive new report on smoking and cancer, released on the 50th anniversary of the Surgeon General's first such report, highlights successes of the resulting anti-tobacco movement and expands the long list of smoking-related health problems. It also offers evidence documenting the harms of continued smoking for people with cancer.
Fifty years ago, the landmark 1964 report Smoking and Health, issued by U.S. Surgeon General Luther Terry, MD, first linked smoking to lung cancer. The latest report, issued in January by Acting Surgeon General Boris Lushniak, MD, MPH, and available at www.surgeongeneral.gov, highlights successes of the resulting anti-tobacco movement and expands the long list of smoking-related health problems to include colorectal and liver cancers, diabetes, and rheumatoid arthritis, among others.
The comprehensive new report—the 32nd such document—is also the first to offer evidence documenting the harms of continued smoking for people with cancer. It notes that smoking increases all-cause mortality by at least 50% and cancer-specific mortality by 61% in cancer patients. Cancer survivors who smoke are also at increased risk for second cancers caused by smoking—especially lung cancer, for which the risk is up to 24 times greater in current smokers compared with never smokers.
That information isn't new to most oncologists, says Benjamin Toll, PhD, director of the smoking cessation program at Yale Cancer Center and associate professor of psychiatry at Yale School of Medicine in New Haven, CT. What they may not be aware of are the strong data showing that radiation therapy does not work as well for current smokers.
“If you're a radiation oncologist, it's really important to strongly encourage your patients who smoke to quit,” says Toll, adding that research shows smoking can hamper surgery and chemotherapy outcomes as well. Smoking may also increase the risk for treatment-related toxicities, according to the Surgeon General's report.
Yet, it is not routine for oncologists to discuss these risks with patients who smoke, says Toll, who helped review the report's chapter on cancer. Toll hopes evidence from the 472 prospective studies summarized in the adverse health outcomes section prompts more oncologists to pay attention to their patients' tobacco use.
Many cancer patients stand to benefit from cessation assistance, considering more than a third of cancer patients continue to smoke after diagnosis. For cancer patients who quit at diagnosis, the report suggests the risk of dying could drop by 30% to 40%.
Even so, few prospective studies have assessed the impact of smoking cessation at diagnosis compared to remaining a smoker, says Toll, noting that most of the research done so far has looked only at how continued smoking adversely affects cancer patients. “Rigorous studies are still needed to determine whether quitting smoking before treatment leads to a better outcome.”
For more news on cancer research, visit Cancer Discovery online at http://CDnews.aacrjournals.org.