Tobacco use is the leading cause of preventable death in United States, causing more than 440,000 deaths annually and resulting in $193 billion in health-related economic losses each year--$96 billion in direct medical costs and $97 billion in lost productivity. Since the first U.S. Surgeon General's report on smoking in 1964, more than 29 Surgeon General's reports, drawing on data from thousands of studies, have documented the overwhelming and conclusive biologic, epidemiologic, behavioral, and pharmacologic evidence that tobacco use is deadly. This evidence base links tobacco use to the development of multiple types of cancer and other life-threatening conditions, including cardiovascular and respiratory diseases. Smoking accounts for at least 30 percent of all cancer deaths, and 80 percent of lung cancer deaths. Despite the widespread agreement on the dangers of tobacco use and considerable success in reducing tobacco use prevalence from over 40 percent at the time of the 1964 Surgeon General's report to less than 20 percent today, recent progress in reducing tobacco use has slowed. An estimated 18.9 percent of U.S. adults smoke cigarettes, nearly one in four high school seniors smoke, and 13 percent of high school males use smokeless tobacco products.

In recognition that progress in combating cancer will not be fully achieved without addressing the tobacco problem, the National Cancer Policy Forum of the Institute of Medicine (IOM) convened a public workshop, Reducing Tobacco-Related Cancer Incidence and Mortality, June 11-12, 2012 in Washington, DC. In opening remarks to the workshop participants, planning committee chair Roy Herbst, professor of medicine and of pharmacology and chief of medical oncology at Yale Cancer Center and Smilow Cancer Hospital, described the goals of the workshop, which were to examine the current obstacles to tobacco control and to discuss potential policy, outreach, and treatment strategies that could overcome these obstacles and reduce tobacco-related cancer incidence and mortality. Experts explored a number of topics, including: the changing demographics of tobacco users and the changing patterns of tobacco product use; the influence of tobacco use on cancer incidence and cancer treatment outcomes; tobacco dependence and cessation programs; federal and state level laws and regulations to curtail tobacco use; tobacco control education, messaging, and advocacy; financial and legal challenges to tobacco control efforts; and research and infrastructure needs to support tobacco control strategies, reduce tobacco related cancer incidence, and improve cancer patient outcomes. Reducing Tobacco-Related Cancer Incidence and Mortality summarizes the workshop.

Contents

• THE NATIONAL ACADEMIES
• WORKSHOP PLANNING COMMITTEE
• NATIONAL CANCER POLICY FORUM
• Reviewers
• Workshop Summary
  • INTRODUCTION
  • CHANGING DEMOGRAPHICS OF TOBACCO USE
  • CHANGING PATTERNS OF TOBACCO USE
  • TOBACCO USE AND CANCER
    • How Smoking Causes Cancer
    • Impact of Smoking on Cancer Incidence and Treatment Outcomes
  • TOBACCO DEPENDENCE
  • TOBACCO CESSATION PROGRAMS
    • Overview of Tobacco Cessation Therapy
    • Use of Tobacco Cessation Therapy
    • Models for Clinician Referrals
    • Tobacco Cessation Therapy for Cancer Patients
    • Training Practitioners
  • OVERVIEW OF TOBACCO CONTROL POLICY
  • ANTISMOKING LAWS AND REGULATIONS
    • Family Smoking Prevention and Tobacco Control Act
    • Patient Protection and Affordable Care Act
    • Point-of-Sale Restrictions
    • Smoke-Free Environments
    • Tobacco Taxes
    • Proposed Laws and Policies
  • SUCCESSFUL STATE AND LOCAL GOVERNMENT ANTISMOKING EFFORTS
    • New York State and New York City
    • Massachusetts
    • California
  • EDUCATION, OUTREACH, AND MESSAGING
    • Educational Efforts
    • Media Campaigns
    • Cigarette Packaging Warning Labels
    • Message Content, Framing, and Placement
  • ANTISMOKING ADVOCACY
  • FINANCIAL AND LEGAL CHALLENGES
    • Funding for Tobacco Cessation Programs
    • Legal Challenges
  • RESEARCH AND INFRASTRUCTURE NEEDS
  • CONCLUDING REMARKS
  • REFERENCES
  • Appendix A WORKSHOP AGENDA
  • Appendix B Speaker, Moderator, and Panelist Biographies

Rapporteurs: Erin Balogh, Margie Patlak, and Sharyl J. Nass.

This activity was supported by Contract Nos. HHSN261200900003C and 200-2005-13434 TO #1 between the National Academy of Sciences and the National Cancer Institute and the Centers for Disease Control and Prevention, respectively. In addition, the National Cancer Policy Forum is supported by the American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, the Association of American Cancer Institutes, Bristol-Myers Squibb, C-Change, the CEO Roundtable on Cancer, GlaxoSmithKline, Novartis Oncology, the Oncology Nursing Society, and Sanofi-Aventis. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity.

Suggested citation:

IOM (Institute of Medicine). 2013. Reducing tobacco-related cancer incidence and mortality: Workshop summary. Washington, DC: The National Academies Press.

NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.