Jan 09 2014

Smoking – Some Good and Bad News

I am extremely anti-smoking for numerous reasons, but primarily because it is one of the most preventable causes of death and disease. Over my lifetime the cultural attitude toward smoking has changed significantly, mostly for the better.

I was born in 1964, the same year that the US Surgeon General came out with his report about the health risks of smoking, leading in part to the famous Surgeon General’s warning on every pack of cigarettes. I was a child in the time of Mad Men, when every adult seemed to smoke. I hated it.

Now I rarely see anyone smoking. It is not allowed at all where I work (a hospital), in restaurants, on airplanes, or in most public places. This is definitely a change for the better.

A recent report looks at the decline of smoking in the US, and estimates that 8 million lives were saved from decreasing smoking rates since the Surgeon General’s report in 1964. This new reports comes out at the same time as the American Cancer Society annual report on cancer deaths and survival. There is more good news here – cancer deaths are down overall by 20% over the last 20 years.

There has been a slow, steady decline in cancer deaths in recent decades. This is partly due to better diagnosis and also to better treatment options with higher remission rates. Some cancers, like pancreatic cancer and the worst forms of brain cancer, have not made much gains. Cancer is still a serious and often deadly disease, but we are steadily moving in the right direction.

To put this into perspective:

Moreover, during the last 20 years, the death rate from cancer has continued to drop from a high of about 215 per 100,000 people to about 172 per 100,000 people in 2010. This means that 1,340,400 fewer cancer deaths (952,700 among men and 387,700 among women) were avoided during that time period, the researchers explained.

Some of the gains have also been made due to lifestyle changes, and chief among them is the decrease in smoking. According to the American Lung Association:

Lung cancer is the leading cancer killer in both men and women in the United States. In 1987, it surpassed breast cancer to become the leading cause of cancer deaths in women.
Lung cancer causes more deaths than the next three most common cancers combined (colon, breast and prostate). An estimated 160,340 Americans were expected to die from lung cancer in 2012, accounting for approximately 28 percent of all cancer deaths.


Smoking, a main cause of small cell and non-small cell lung cancer, contributes to 80 percent and 90 percent of lung cancer deaths in women and men, respectively. Men who smoke are 23 times more likely to develop lung cancer. Women are 13 times more likely, compared to never smokers.

In other words, we can still take a huge chunk out of cancer deaths just by reducing smoking further.

While we are moving in the right direction regarding smoking in the US, worldwide trends are going in the wrong direction. We are close to 1 billion daily smokers worldwide.

Around three in 10 men (31%) and one in 20 women (6%) now smoke daily compared with four in 10 men (41%) and one in 10 women (10%) in 1980.

This is largely due to population increases, but also to increasing rates of smoking in the developing world. China, for example, has seen a dramatic increase in smoking rates. East Timor has the highest rate in the world at 61%.

As health care costs rise, reducing smoking is a clear way to reduce health care costs. 

Smoking cost the United States over $193 billion in 2004, including $97 billion in lost productivity and $96 billion in direct health care expenditures, or an average of $4,260 per adult smoker.

This should be a huge incentive, especially for poorer countries, to put policies into place designed to limit smoking.  Many countries have experimented with numerous policies, so they won’t have to reinvent the wheel. We have some data on what works – such as prohibiting smoking in restaurants and other public venues, graphic warnings on tobacco products, banning advertising, plain packaging, and age limits on purchasing tobacco products.

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