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 While the largest proportion of deaths associated with smoking were
for cancers of the lung, bronchus, trachea and larynx, about half of
fatalities from tumors of the oral cavity, esophagus and bladder
were also tied to cigarettes, the study found.
“The bottom line is that while we’ve made a lot of progress against
the tobacco epidemic in the United States, there’s still much work
to do,” lead study author Rebecca Siegel, a researcher at the
American Cancer Society in Atlanta, said by email.
Siegel and colleagues estimated that out of 345,962 cancer deaths in
2011 among U.S. adults 35 and older, 167,805 were associated with
smoking.
To estimate the proportion of cancer deaths attributable to smoking,
the researchers used a standard formula to calculate the fraction of
cases of specific cancer types that would not have occurred if there
were no smoking.
Then they analyzed data from national surveys and in-person
interviews asking people about their health history and tobacco
habits. They adjusted their estimates to account for age, race,
education level and alcohol use.
Based on smoking habits in the population and the proportion of
cancer cases attributable to smoking, the researchers estimated that
125,799 lung, bronchus and trachea cancer deaths, representing 80
percent of the total, were linked to smoking. So were 50 percent of
deaths from esophagus tumors and 45 percent of deaths from bladder
malignancies.
The researchers also credit smoking with 17 percent of kidney cancer
deaths, 20 percent of stomach cancer deaths, 22 percent of cervical
cancer deaths and 24 percent of liver and bile duct cancer deaths in
2011.
One limitation of the study is that the survey and interview
participants were generally more educated and less racially diverse
than the U.S. population as a whole, the researchers acknowledge in
JAMA Internal Medicine.
It’s also possible, however, that they underestimated cancer deaths
tied to smoking because they didn’t have data on second-hand smoke
exposure, which may cause an additional 5 percent of lung cancer
deaths, or on use of cigars, pipes, or smokeless tobacco.
“While smoking prevalence continues to slowly decline, the use of
alternative tobacco products is on the rise,” Siegel said.
Use of combustible forms of tobacco other than cigarettes, such as
cigars and hookahs, doubled from the equivalent of 15.2 billion
cigarettes in 2000 to the equivalent of 33.8 billion cigarettes in
2011, Siegel said.
“Although we can’t know exactly how many people are not starting to
smoke cigarettes because they are using other tobacco products,
e-cigarettes are now the most common form of tobacco use among high
school students,” Siegel said.
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Evidence doesn’t suggest that people who use alternative tobacco
products are more likely to quit smoking or avoid starting on
cigarettes, Dr. Michael Ong, author of a tobacco cessation editorial
accompanying the study, said by email.
If there’s an upside to alternatives, though, it may be seen in the
declining proportion of lung cancer deaths attributable to
cigarettes, said Ong, a researcher at the University of California,
Los Angeles and the Veterans Affairs Greater Los Angeles HealthCare
System.
“But most of all lung cancer deaths are still attributable to
smoking, and lung cancer makes up the largest cause of
cancer-related mortality,” he said.
In an indication of the uphill battle smoking cessation can be,
another study also published in JAMA Internal Medicine found that
clinicians simply asking patients to quit and advising them of the
lung cancer risks isn’t enough motivation to make it more likely
that patients successfully quit.
Researchers followed more than 3,000 smokers for one year after lung
cancer screenings to see if the amount of cessation support they
received from clinicians might influence their odds of quitting.
The smokers who received assistance such as referrals to counseling
or prescriptions for smoking-cessation drugs were 40 percent more
likely to quit, while those who received follow-up care to monitor
their progress were 46 percent more likely to stop smoking.
“Smokers face physical, environmental and social barriers to
quitting,” lead study author Elyse Park, a researcher at
Massachusetts General Hospital in Boston, said by email. “Primary
care providers can assist smokers, particularly smokers with a heavy
smoking history, to boost their confidence and obtain the counseling
and medication support that can help them improve their odds of
successful quitting.”
SOURCES: http://bit.ly/1IYEOmA, http://bit.ly/1IfRnnY and http://bit.ly/1JTHYqx
JAMA Internal Medicine, online June 15, 2015.
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