This article is more than 5 years old. Information may no longer be current.

Up to 40% of US cancer deaths attributable to cigarette smoking

Cigarette smoking led to a significant number of cancer deaths throughout the United States, according to data published in JAMA Internal Medicine.

Joannie Lortet-Tieulent, MSc, from the American Cancer Society, and colleagues reported that the proportion was highest in southern states, where as many as 40% of cancer deaths were related to cigarette smoking.

"Smoking prevalence in the United States has been more than halved since the release of the first Surgeon General's report on the health hazards of cigarette smoking in 1964, as a result of increased awareness and implementation of public health policies against smoking," Lortet-Tieulent and colleagues wrote. "Nevertheless, there are still more than 40 million current adult cigarette smokers, and smoking remains the largest preventable cause of death from cancer and other diseases. Cigarette smoking accounted for an estimated 28.7% of all cancer deaths in U.S. adults 35 years and older in 2010."

The researchers used smoking prevalence data from the Behavioral Risk Factor Surveillance System to estimate the proportion of cancer deaths attributable to smoking in 2014 in adults aged 35 and older. They calculated this based on relative risks for 12 cancers related to smoking: urinary bladder; oral cavity and pharynx; kidney and renal pelvis; esophagus; cervix uteri; stomach; larynx; pancreas; liver; colorectum; trachea, lung and bronchus; and acute myeloid leukemia.

Results showed that 167,133 cancer deaths in 2014 were attributable to cigarette smoking (28.6% of all cancer deaths; 95% CI, 28.2-28.8).

In men, smoking-attributable cancer deaths ranged from 21.8% in Utah (95% CI, 19.9-23.5) to 39.5% in Arkansas (95% CI, 36.9-41.7). In women, smoking-attributable cancer deaths ranged from 11.1% in Utah (95% CI, 9.6-12.3) to 29% in Kentucky (95% CI, 27.2-30.7).

The researchers noted that the majority of the states with the highest proportion of cancer deaths caused by smoking were in the South, including nine of the top 10 for men and six of the top 10 for women.

"The proportion of cancer deaths attributable to cigarette smoking varies substantially across states and is highest in the South, where up to 40% of cancer deaths in men are caused by smoking," Lortet-Tieulent and colleagues concluded. "However, the human costs of cigarette smoking are high in all states, regardless of ranking. Increasing tobacco control funding, implementing innovative new strategies, and strengthening tobacco control policies and programs, federally and in all states and localities, might further increase smoking cessation, decrease initiation, and reduce the future burden of smoking-related cancers."

In an accompanying editorial, Kurt M. Ribisl, PhD, from the University of North Carolina, Chapel Hill, and colleagues wrote that the findings revealed "the grim consequences of state-level disparities in smoking prevalence."

The authors cited a CDC report that indicated a "Big Stall," in which progress in tobacco control policies had halted in some states.

They called for policies at the local, state and federal level to address location-based disparities as well as ethnic, race and income disparities.

"Notably, smoking-attributable cancer mortality was highest among non-Hispanic blacks, who smoke menthol cigarettes disproportionately, which provides more evidence for the [FDA] to include menthol in its regulation of flavored tobacco products," the authors wrote

Ribisl and colleagues also suggested increasing excise taxes, utilizing other pricing approaches such as prohibiting coupons, and expanding campaigns and funding.

"Organizations such as the Campaign for Tobacco-Free Kids, the Truth Initiative, voluntary health agencies, and the Robert Wood Johnson Foundation could fund initiatives for high-risk states," they wrote. "In addition, continued funding for the National Cancer Institute's State and Community Tobacco Control Initiative could benefit stalled states. More than ever, evidence-based policy changes are needed to ‘unstick’ stalled states and to eliminate disparities in smoking prevalence and the burdens of tobacco-related disease and mortality." – by Chelsea Frajerman Pardes

Disclosures: Ribisl serves as an expert consultant in litigation against cigarette manufacturers. None of the other authors report any relevant financial disclosures.