HOW TO PREVENT CANCERS

John Seffrin, CEO of the American Cancer Society, made the point at last week's meeting of the Clinton Global Initiative that tobacco control should remain the highest priority in combatting chronic disease.  It's a point we've certainly echoed on this blog - that efforts to curb tobacco use shouldn't be relegated to the second tier just because they've been around a while and have made some great strides.

There's still a long way to go.

In the United States alone, although smoking prevalence has dropped from around 43 percent in 1965 to 20 percent in 2009, tobacco remains the leading cause of cancer and a major contributor to other serious chronic diseases.

A great deal of tobacco control efforts focus rightly on keeping youth and young adults from starting smoking, yet 47 million Americans are currently smokers who stand to benefit a great deal from stopping.  Risk of stroke and heart attack drop significantly within a year after stopping, as does the risk of lung cancer within 10 years.

This week's New England Journal of Medicine helps put some of the focus back on cessation with a very nice guide for doctors on helping the smokers they see in their practices successfully quit (link).  The take away, not surprisingly, is that quitting it tough, but with a little effort from both doctor and smoker - and the right interventions - chances for successful quitting can increase dramatically.

In the face of a 24 hour news cycle always looking to report on the newest, the most exciting health innovations - tobacco control can often be left behind - a victim of its own success.  It's important, though, that tobacco control - including efforts to boost cessation - remain a top priority in public health.  No other efforts have quite as much potential benefit, even if some people wrongly view them as yesterday's news.

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News came out this week that Lance Armstrong will team up with a new partner - the California Cancer Research Act. The Act proposes increasing the state's tobacco tax by $1 and funneling that money toward cancer research. California is facing a budget crisis and may be cutting huge (billions) sums of money from health care funds. California was one of the states at the front edge of reducing tobacco use through community-wide campaigns and tax measures. We don't know how it will play out, but the proposal has the potential to improve health in the state in two different ways. First, tobacco taxes reduce consumption. Second, by putting the revenue gained toward cancer research, the monies go toward prevention and treatment of smoking's leading health outcomes.

Research has shown time and again that increasing taxes reduces consumption of tobacco, particularly among those in younger age groups. In fact, the World Health Organization has called taxation the single most effective method for reducing the demand for tobacco products. After previously increasing taxes and funneling money toward cessation programs, California saw a 16 percent per capita decline in cigarette consumption. In part, this is because youth are highly sensitive to price changes and the higher cost deters many from taking up smoking. Basically, they have trouble coming with the extra cash.

Proponents of the legislation have offered another benefit of the tax - jobs creation. With state universities facing major budget shortfalls, the revenue being directed toward research could create jobs.

Exactly where the money would wind up is always a little unclear, however.  Despite the best of intentions, politicians have ways of directing tobacco money away from intended programs, as we learned when the tobacco companies settled with the states in 1998.  From a health standpoint, though, the money raised from the tax would almost be secondary; the real payoff would be the drop in smoking rates.  And if the lure of extra state revenue gets the new tax on the books, so much the better for everyone. 

It may not fall into the "shocking" category, but a new Harvard study by our colleagues at the Nurses' Health Study has provided further insight into the links between smoking and breast cancer (study).  To date, many studies have had waffling results on the subject.  Some showing smoking raising risk; some showing it not affecting risk at all; and some even showing it lowering risk.

This new study by Xue et al is a longer followup to an earlier Nurses' Health Study report and included over 110,000 women who were tracked over a 30 year period.  The main finding from this study was that smoking likely has some affect on breast cancer risk, but even with heavy smoking, the risk isn't as high as with other cancers linked to smoking (like lung, oral, and esophageal cancer, to name just a few). Greatest risk came from heavy smoking before giving birth to a first child, which raised risk by about 18 percent compared to never smoking.  The broad analysis comparing those who have ever smoked  to those who have never smoked showed a small six percent increase in risk.

Not surprisingly, heavy smoking after menopause showed a small protective effect against breast cancer.  After menopause, blood estrogen levels drive a lot of breast cancer risk, and for multiple reasons, smoking stems estrogen levels, which in turn could lower risk after menopause. Increases in risk, though, from smoking before menopause outpaced any small drop in risk from smoking afterward. 

So what do these results mean?  While there are still some open questions about the link between smoking and breast cancer, they certainly add one more reason to avoid smoking and to support policies that lead to that end.  Adding breast cancer to the list, there are no fewer than 12 different cancers caused by or directly linked to cigarette smoking.  Heart disease, diabetes, stroke, chronic bronchitis, emphysema, osteoporosis, and a number of other important conditions belong on the list as well.  With the decline in US smoking rates stalling - leaving just over 20 percent of the population regular smokers (previous post) - it's important that we keep our guard up against tobacco use.  It's been a long fight, and we've gained a lot of ground, so it's easy to feel that we've done what we can and move on to some new health promotion venue.  But, really, smoking still deserves a great deal of attention. The potential health gains from further lowering smoking rates are huge and should not be downplayed just because we've made some strides and have been working on the issue a long time.

For a long time, the CNiC team has talked about 8 ways you can prevent cancer. This week, we're proud to announce our 8 ways to stay healthy AFTER cancer. With over 12 million cancer survivors in the US alone, addressing the chronic health needs of cancer survivors is a priority.

Readers will notice that there is a lot of overlap. This is in part because the leading causes of health challenges for cancer surviors (e.g., diabetes, heart disease) share risk factors with cancer itself. The time during and after cancer treatment can be a particularly challenging one, with information overload and an internet full of "miracle" promises. The key to these 8 ways is to not let them add to those feelings - start small, making 1 or 2 changes and add more as you are able.

1. Don't smoke. This is the single best thing you can do for your health as a survivor.
2. Avoid secondhand smoke. Avoid smoky bars and restaurants and make your home smokefree.
3. Avoid inactivity! Regular exercise helps improve the quality and quantity of your life.
4. Avoid weight gain. Eating is a common stress coping mechanism, but weight gain can increase your risk of recurrence and diminish your quality of life.
5. Eat a healthy diet. Focus on fruits and vegetables and whole grains, keeping red meat to a minimum. Avoid messages talking of miracles and quick fixes.
6. Alcohol is something to be consumed only in moderation, if at all.
7. Stay connected. Friends, family and other survivors can all provide important social and emotional support.
8. Get regular check-ups. This means getting necessary screening tests for other cancers and chronic diseases like heart disease, diabetes and osteoporosis.

It is never too early or too late to start making these changes to boost your health!

Here's a free printable guide to staying healthy after cancer.

There is lots of talk in the news right now about scanning - mostly about the kind in airports and whether it is too great an invasion of privacy. But medical scanning has also been making headlines - specifically, whether we do too much of it unnecessarily, as CT and X-ray scans expose the body to radiation, which has risks. Recent reports indicated that CT scans of smokers may reduce their risk of mortality by 20%, which may suggest the exposure to radiation is worth the risk. However, as Laura Gottleib points out in the San Francisco Chronicle, prevention is a cheaper and lower risk option. 87% of lung cancer is caused by smoking and CT scans aren't going to eliminate that - they are simply going to help us catch and treat the lung cancer earlier. Preventing people from starting smoking, minimizing (or eliminating) exposure to secondhand smoke and helping people quit prevent lung cancer from developing.

What about the cost? According to Gottleib, the cost of scanning all former and current smokers in the United States is roughly $30 billion per year. In contrast, California's Tobacco Control Program decreased adult tobacco use by 35 percent, saving $86 billion in health care costs. How does she get at that HUGE savings? For every $1 California spends, it reduces statewide health care costs by $3.60, according to research done by Tobacco Free Kids.

Advances in early detection and treatment are great, but let's not forget the value of prevention!

Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/11/21/EDKC1GEUHP.DTL#ixzz161rYIMli

Second hand smoke exposure in the US was thoroughly documented last week in the CDC report noted in many media stories.

The report evaluated national data from 1999 through 2008, and estimates that 88 million non smokers greater than age 3 were exposed to second hand smoke. The authors note that the decline in exposure within the US has slowed pointing to the tapering off in our national public health efforts to control cigarette smoking.

Despite the increasing attention paid to obesity and the economic burden on society due to obesity, tobacco remains a leading cause of premature mortality, cancer onset. lost productivity, and health care expenditures. Continued efforts at smoking cessation and state-wide comprehensive laws to limit exposure in work places and public places can help avoid serious health effects.

The health effects of second hand smoke are are well documented.
  

• Lung cancer 
• Heart disease

• Sudden infant death syndrome
• Reduced lung function
• Asthma
• Respiratory infections
• Ear infections in children

 The good news is that many of tobacco’s harmful effects can be reduced by smoking cessation, and benefits of quitting can be seen almost immediately.  Quitting smoking is the single best thing that smokers can do to improve their health, and over 46 million Americans have successfully quit.

More news from Alvin J. Siteman Cancer Center showing significant nicotine exposure from cigarette smoke in restaurant and bar workers. It is time for regulations to protect workers. We can cut the health impact of smoking now.  See story 

On Friday, the federal government announced that effective immediately Medicare would cover the cost of smoking cessation counseling. Anyone covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare-recognized practitioner who can work with them to help them quit. (All people with Medicare will continue to have access to tobacco cessation prescription medication through the Medicare Prescription Drug Program.)

This is great news on several fronts:
- there is great evidence for the value of this kind of coverage so it is nice to see the goverment implementing evidence-based medicine
- other insurers typically follow what Medicare does
- it keeps tobacco in the news - an issue we've discussed before