Smoking and cancer: Smoking cessation: Austoker J, Sanders D, Fowler G. Dept. of Public Health/Prim. Care, University of Oxford, Oxford OX2 6PE. Br Med J 1994;308:1478–1482

Abstract

Smoking is the single most important cause of cancer. The risk of developing cancer is reduced by stopping smoking and decreases substantially after five years. Reduction in smoking must be central to any programme aimed seriously at the prevention of cancer. An individual approach, based in primary care, has the potential to bring about modest but important reductions in risk. Many randomised trials have shown the effectiveness of various smoking cessation interventions in primary care. Given resource limitations in primary care, individual effort should be focused on those at highest risk who are motivated to stop smoking. A population strategy has considerable advantages over the high risk approach as the potential for reducing morbidity and mortality in the whole population is much greater. The government must acknowledge its major responsibility; the outstanding example of its failure to do this is its persistent refusal to ban outright all forms of advertising and promotion of tobacco. There is clear evidence that a ban would contribute to a reduction in smoking prevalence and especially in the uptake of smoking by children. Each year about 110 000 deaths in England alone are related to smoking, representing 17% of all deaths. Diseases caused by smoking include cardiovascular disease, respiratory diseases, and some cancers. Smoking is the single most important cause of cancer, being significantly more important than all other causes. Many types of cancer are caused by tobacco. Approximately 30% of all deaths from cancer - that is, over 50 000 deaths from cancer a year - are attributable to tobacco smoking. This includes between 80% and 90% of deaths from lung cancer; a proportion of deaths from cancers of the oral cavity, bronchus, trachea, pharynx, larynx, oesophagus, and bladder; probably some deaths from cancer of the pancreas; and possibly some deaths from cancer of …