[C-U Smokefree] Scientific Evidence about Secondhand Smoke

[Alan and Anita Cohen]

There is a fine editorial associated with an article on secondhand smoke in 
The American Journal of Medicine of 2/1/04 which I don't have full text web 
access to at the moment, but which says in part, "smoke-free environments 
lead to a 3.8% decrease in the absolute prevalence of smoking and a three 
cigarette per day decrease among continuing smokers--a 29% drop in total 
cigarette consumption."  There follows a paragraph about the tobacco 
industry and it's effort "generate a false controversy about the fact that 
secondhand smoke is dangerous."  It is worth getting a copy.  Also see below:

CA Cancer J Clin 2004; 54:6-7
© 2004 American Cancer Society
GUEST EDITORIAL
The Marriage of Cancer Control and Advocacy
Ralph B. Vance, MD


Dr. Vance is President, American Cancer Society, and Professor of Medicine, 
University of Mississippi School of Medicine, Jackson, MS.

Cancer is the nation’s leading health concern and its second leading cause 
of death. During the next 12 months, approximately 1.3 million Americans 
will hear the words, "You have cancer," and more than 550,000 will die of 
the disease.1 Although cancer continues to take an enormous toll on our 
country, we have an unparalleled opportunity to reduce suffering and death 
from malignant diseases, as reflected in the article by Jemal and 
colleagues in this issue of CA. For progress in research to have a 
substantial impact on this cancer burden, it must be translated to public 
health and clinical interventions that reach all members of our society. 
This will require continued federal and state support of cancer research 
and control programs, as well as sustained efforts to ensure that the 
health care system provides access to diagnosis and treatment for all. 
Thus, we must wed cancer control to advocacy to achieve our mission of 
diminishing suffering and saving lives.

The American Cancer Society (ACS) has established necessarily ambitious 
goals to advance the nation’s progress against cancer by 2015. In 
collaboration with the federal government and other public, private, and 
voluntary health organizations, we hope to achieve a 50% reduction in the 
age-adjusted cancer mortality rate, a 25% reduction in the age-adjusted 
cancer incidence rate, and a measurable improvement in quality of life (in 
physical, psychological, social, and spiritual domains) from the time of 
diagnosis throughout cancer survivors’ lives.

To achieve these ambitious goals, the nation must reaffirm its commitment 
to the fight against cancer. By applying our existing knowledge of cancer 
control more fully—including effective prevention and early detection 
programs—we can make significant strides toward the 2015 goals. The last 
decade has seen major advances in comprehensive cancer control efforts at 
the state level. Federal efforts are also making a difference, such as the 
recently completed doubling of the National Institutes of Health (NIH) 
budget. However, cuts in federal funding, diversion of state tobacco 
settlement funds, increasing poverty, and declining health insurance 
coverage impede states’ efforts and pose new challenges.

Many believe that recent advances in biotechnology will help us surmount 
these challenges. We may be on the brink of being able to interrupt or 
reverse the biological processes by which cancer occurs. According to Dr. 
Andrew von Eschenbach, Director of the National Cancer Institute, "Today, 
we still may not be able to ‘cure’ cancer, but we can now implement a 
comprehensive strategy to preempt the onset and progression of the disease. 
The exponential advances in cancer research are defining with ever-greater 
specificity the many genetic, molecular, and cellular events that determine 
the disease process of susceptibility, disease initiation, and fatal 
progression. And this new knowledge can be translated into innovative and 
more effective strategies of prevention, elimination, and modulation."2 We 
have indeed made significant advances in cancer prevention, but we can 
fully realize this potential only with continued support of basic, 
clinical, and applied research.

This support will continue only through the successful marriage of cancer 
control and advocacy. Many people tend to think of cancer as a purely 
medical or scientific issue, but it is also a political one. Every day 
legislators introduce bills, pass laws, and allocate funds that profoundly 
affect persons with cancer and their families. Health insurance coverage, 
clinical trial participation, the development of new treatments, and the 
delivery of quality care all involve legislation. I share the belief of 
many Society volunteers and staff that advocacy on behalf of cancer control 
is critical to reaching our 2015 goals. It is a force multiplier in the 
fight against cancer.

One example of the synergy between cancer control and advocacy is tobacco 
control. Cigarette smoking alone causes approximately 30% of cancer deaths 
in the United States and a total of 440,000 premature deaths annually. Most 
of the deaths are from lung and other cancers, ischemic heart disease, 
stroke, and chronic obstructive pulmonary disease. An estimated $157 
billion in annual health-related economic losses are also attributed to 
smoking.3

Advocacy can accelerate the goal of ending the epidemic of deaths caused by 
tobacco. At the federal level, we can work to enact legislation supported 
by the public health community that grants the Food and Drug Administration 
meaningful regulatory authority over tobacco products. In addition, 
increasing federal and state excise taxes on tobacco is a proven means of 
reducing tobacco use, especially among young people. In fact, a 10% 
cigarette price increase decreases overall consumption by approximately 4%. 
Funding state programs that help people quit smoking and that prevent kids 
from starting is another avenue, as is providing health care coverage for 
tobacco cessation services to patients in the Medicare, Medicaid, and 
Maternal and Child Health Block Grants. The last piece of this tobacco 
puzzle is enacting effective state and local smoke-free laws in every 
state. Smoke-free environments are becoming the norm rather than the 
exception in some states, but the number of smoke-free communities is still 
far too small.

As a community-based organization, the Society unites millions of people 
nationwide in the fight against cancer. We have a presence in more than 
3,000 communities across the country. Just more than one year ago, we made 
that presence felt in Washington, DC with the Relay for Life® Celebration 
on the Hill. Thousands of volunteers from every state and congressional 
district came together to insist that Congress make cancer a priority. This 
unprecedented and extraordinary event delivered a powerful message, within 
the organization and beyond, about the unique power of advocacy in the 
fight against cancer.

Activities such as the Relay for Life Celebration, combined with the 
ongoing efforts of advocacy volunteers, are helping the Society build and 
flex its grassroots muscle. Working together, dedicated volunteers, staff, 
and coalition partners have restored $1 billion in NIH funding in 2003. We 
have secured coverage for cancer screenings and clinical trials in Medicare 
and through private insurance in many states. The Society worked to ensure 
that women can obtain treatment for breast or cervical cancer no matter 
what their socioeconomic level. Tobacco excise taxes increased in 30 states 
in just two years, and five states and more than 1,600 communities are now 
completely smoke-free.

Clearly, the public policy arena can be as powerful a tool against cancer 
as clinical and laboratory research. But we still have much work to do. 
That is why the Society created the Cancer Action Network (Society CAN), a 
sister organization that will empower the Society to take our advocacy 
efforts even further. A nonprofit, nonpartisan issue advocacy group, ACS 
CAN is dedicated to eliminating cancer as a major health problem through 
voter education and issue campaigns that ensure politicians and policy 
makers are held accountable for their votes on cancer issues through our 
votes at the ballot box.

As the new volunteer president of the Society, I ask you to join me in 
affirming the marriage of cancer control and advocacy, which is now at 
hand. This marriage has had an appropriate interval of engagement. The 
effective tools for the wedding are already in place. Let the ceremony begin.


	   Footnotes

This article is available online at: http://CAonline.AmCancerSoc.org

	

    1. Smith RA, Cokkinides V, Eyre HJ. Cancer statistics, 2004. CA Cancer 
J Clin 2004; 54: 41–52.[Abstract/Free Full Text]
    2. von Eschenbach A. Director’s update: August 27, 2003. Available at: 
http://www.nci.nih.gov/directorscorner/directorsupdate-archives
    3. Annual smoking-attributable mortality, years of potential life lost, 
and economic costs—United States, 1995–1999. MMWR Morb Mortal Wkly Rep 
2002; 51: 300–303.[Medline]