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ACS Report: Smoking Still Causes Large Proportion of Cancer Deaths in U.S.

Mortality rate has remained steady at 30% for three decades

A new study by the American Cancer Society finds that despite significant drops in smoking rates, cigarettes continue to cause about three in 10 cancer deaths in the U.S. The study, published in the Annals of Epidemiology, concludes that efforts to reduce smoking prevalence as rapidly as possible should be a top priority for U.S. public health efforts to prevent cancer deaths.

More than 30 years ago, a groundbreaking analysis by British researchers calculated that 30% of all cancer deaths in the U.S. were caused by smoking. Since that time, no new estimate of this percentage has been published in the scientific literature. During that same time, smoking rates have dropped, but new cancers have been added to the list of those established as caused by smoking, and lung cancer death rates among female smokers have increased.

To provide a well-documented estimate for cigarette smoking and cancer mortality in the contemporary U.S., researchers looked at the most recent data on smoking rates from the National Health Interview Survey (NHIS) as well as at data on the risks of smoking derived from epidemiologic studies to estimate the population-attributable fraction (PAF) –– the proportion of cancer deaths in the population caused by smoking.

The authors found that the PAF for active cigarette smoking was 28.7% when estimated conservatively, including only deaths from the 12 cancers currently established as caused by smoking by the U.S. Surgeon General. When estimated more comprehensively, including excess deaths from all cancers, the PAF was 31.7%. These estimates did not include additional potential cancer deaths from environmental tobacco smoke or from other types of tobacco use, such as cigars, pipes, or smokeless tobacco.

The authors said that despite important declines in smoking prevalence, the PAF for smoking and cancer mortality estimated for 2010 was similar to the 30% estimated by the British researchers more than 30 years ago. But that does not indicate that declines in smoking rates have not made important contributions to reducing cancer mortality. Rather, other factors have contributed to increasing the PAF, including the addition of new cancers to the list of those counted as caused by smoking, increases over time in death rates from lung cancer among female smokers, and progress in reducing deaths from cancer caused by factors other than smoking.

“Our results indicate that cigarette smoking causes about three in 10 cancer deaths in the contemporary United States. Reducing smoking prevalence as rapidly as possible should be a top priority for U.S. public health efforts to prevent future cancer deaths,” the authors concluded.

Sources: ACS; December 9, 2014; and Annals of Epidemiology; November 13, 2014.


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