Smoking-attributable Cancer Mortality Research Articles

Evaluation of Cancer Deaths Attributable to Tobacco in California, 2014-2019

California's tobacco control efforts have been associated with a decrease in cancer mortality, but these estimates are based on smoking prevalence of the general population. Patient-level tobacco use information allows for more precise estimates of the proportion of cancer deaths attributable to smoking. To calculate the proportion (smoking-attributable fraction) and number (smoking-attributable cancer mortality) of cancer deaths attributable to tobacco use using patient-level data. The smoking-attributable fraction and smoking-attributable cancer mortality were calculated for a retrospective cohort of patients whose cancer was diagnosed from 2014 to 2019 with at least 1 year of follow-up using relative risks from large US prospective studies and patient-level smoking information. Follow-up continued through April 2022. A population-based cohort was identified from the California Cancer Registry. Participants included adults aged 20 years and older with a diagnosis of 1 of the 12 tobacco-related cancers (oral cavity or pharynx, larynx, esophagus, lung, liver, stomach, pancreas, kidney, bladder, colon or rectum, cervix, and acute myeloid leukemia). Tobacco use defined as current, former, or never. The primary outcomes were the smoking-attributable fraction and smoking-attributable cancer mortality for each of the 12 tobacco-related cancers over 2 time periods (2014-2016 vs 2017-2019) and by sex. Among 395 459 patients with a tobacco-related cancer, most (285 768 patients [72.3%]) were older than 60 years, the majority (228 054 patients [57.7%]) were non-Hispanic White, 229 188 patients were men (58.0%), and nearly one-half (184 415 patients [46.6%]) had lung or colorectal cancers. Nearly one-half of the deaths (93 764 patients [45.8%]) in the cohort were attributable to tobacco. More than one-half (227 660 patients [57.6%]) of patients had ever used tobacco, and 69 103 patients (17.5%) were current tobacco users, which was higher than the proportion in the general population (11.7%). The overall smoking-attributable fraction of cancer deaths decreased significantly from 47.7% (95% CI, 47.3%-48.0%) in 2014 to 2016 to 44.8% (95% CI, 44.5%-45.1%) in 2017 to 2019, and this decrease was seen for both men and women. The overall smoking-attributable cancer mortality decreased by 10.2%. California still has a substantial burden of tobacco use and associated cancer. The proportion of cancer deaths associated with tobacco use was almost double what was previously estimated. There was a modest but significant decline in this proportion for overall tobacco-associated cancers, especially for women.

Abstract A081: Using the Arkansas State-Wide Health and Nutrition Examination Survey to understand metabolic health among healthy African-American and White smokers and non-smokers

Abstract Introduction. African-Americans (AAs) have a higher smoking–attributable cancer mortality than any other racial/ethnic groups in the United States and in Arkansas. Cigarette smoking prevalence among adults in Arkansas is the 5th highest (22.3%) and smokeless tobacco (ST) use is 3rd highest in the nation (7.8%). Use of tobacco products, poor nutrition, as well as obesity, have been indicated as major risk factors for various cancers and other chronic diseases. Few studies have examined state-specific metabolic biomarkers representing the status of metabolism among smokers and non-smokers in Arkansas and among racial/ethnic groups. The purpose of this study was to compare the differences in markers of dietary lipids and metabolic health in blood among healthy AA and non-Hispanic white (NHW) adult smokers and non-smokers. Methods. Data were analyzed using the 2008 Arkansas Cardiovascular Health Examination Survey (ARCHES, n=1,385), a survey that used probability sampling methods to obtain a representative sample of Arkansas residents, and the analytical sample was limited to adults with no history of cancer or chronic diseases such as diabetes (n=769). Two-way ANCOVA was used adjusting for age and sex to determine the differences in biomarkers among four groups: non-smokers (n=587, 76.3%), current cigarette smokers (n=130, 16.9%), and current smokeless tobacco users (n=21, 2.7%), and dual users of any two tobacco products (n=21, 2.7%). P-value less than 0.05 was considered significant. Results. Of the 769 adult participants, 25% were AA and 75% were NHW. Nearly 31% were male and the mean age was 52.0 (SD=14.8) years. AA non-smokers had a significant higher BMI (mean 34.1, SD=7.9; NHW mean 29.5, SD=6.3), higher markers of fasting glucose (mean 110.0, SD=64.4; NHW mean 95.6, SD=28.3), fasting insulin (mean 28.3, SD=27.8; NHW mean 20.9, SD=32.8), and levels of dietary fats than NHWs. NHW non-smokers had a higher LDL (mean 124.9, SD=33.4; AA mean 115.5, SD=35.6) and triglycerides (mean 177.3, SD=116.7; AA mean 143.7, SD=107.8) than AA non-smokers. NHW cigarette smokers had significant higher levels of triglycerides than AA smokers. AA smokers had higher blood pressure, trans-fat than NHWs. NHW ST users had higher pulse rate than AA ST users. AA dual users had higher BMI and dietary fats than NHWs. Conclusions. Our results indicate poorer metabolic health among AAs compared to white adult non-smokers, smokers, and ST users. However, differences varied by tobacco use type and for some indicators, there were no differences between racial/ethnic groups potentially due to small sample sizes. Larger and more recent studies including dual use of different products are needed in Arkansas to understand the health burden among tobacco user. Citation Format: Ping-Ching Hsu, Abigail Nowell, Brandy Sutphin, Pebbles Fagan, Lihchyun Joseph Su, Namvar Zohoori. Using the Arkansas State-Wide Health and Nutrition Examination Survey to understand metabolic health among healthy African-American and White smokers and non-smokers [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A081.

Abstract A002: Leveraging resources through the Translational Research Institute to engage communities in tobacco-related health disparities research

Abstract Purpose: Cigarette smoking-attributable cancer mortality is highest among African Americans, who are disproportionately exposed to smoking and secondhand smoke (SHS). In 2016, 13.5% of African American women in the United States smoked compared to 19.8% of African American women in Arkansas. Comprehensive smoke-free policies in the home play a critical role in reducing tobacco exposures and increasing quitting, but policy implementation is often a challenge. This study describes the collaborative process used to engage community in providing feedback on study methods for a randomized trial designed to increase the implementation of smoke-free policies in the homes of African American women smokers who live in rural distressed counties in the Arkansas Delta. Methods: Four Community Review Boards (CRB) (n=38) were conducted in collaboration with the Translational Research Institute (TRI) at the University of Arkansas for Medical Sciences. CRBs are expert community panels who provide feedback on research studies. Our study team worked with TRI's Community Engagement (CE) Core and the CE and Dissemination Core of the Arkansas Center for Health Disparities to recruit African American women smokers aged 18-50 years to obtain input on our study methods. CRBs were co-facilitated by staff from April to June 2018 in rural AR counties. Staff obtained feedback on the collection of biologic samples; surveys; recruitment and retention; use of the tobacco Quitline; incentives; project name and logo; and volunteer board development. Results: CRB I experts felt comfortable with research staff collecting saliva samples from children in the home, but expressed concerns about providing blood or urine samples. Some experts preferred paper, while others preferred short computer-based surveys. None of the experts was interested in using the tobacco Quitline. CRB II experts expressed the need for community development activities (e.g., spa day, support groups) and monetary and nonmonetary incentives such as the nicotine patch. Experts emphasized the need to engage community women in recruitment efforts due to distrust of outsiders. CRB III experts suggested that we incentivize a volunteer board to assist with recruitment. Experts in CRB III and IV selected recruitment messages and delivery channels (e.g., flyers, word of mouth, Facebook). Experts prioritized recruitment activities brainstormed in CRB II, described how to organize the activities, and selected incentives (e.g., Walmart and Dollar General gift cards) and promotional items (e.g., tee-shirts). Experts in CRB IV identified a project name and logo (Families Rising to Enforce Smokefree Homes). An unintended consequence was that women participated in the CRBs because they wanted to quit smoking. Conclusions: CRBs are often a one-time event conducted by researchers seeking expert community opinions. Our repeated sessions conducted with TRI increased our knowledge of community needs, culture, and how to adapt our study methods to address community needs. Citation Format: Anna Huff Davis, Naomi Cottoms, Rachel Hale, Katherine Donald, Ping Ching Hsu, Margarete Kulik, Keneshia Bryant-Moore, Joseph Su, Nicola Spencer, Candace Ruffin, Yana Ivy, Pebbles Fagan. Leveraging resources through the Translational Research Institute to engage communities in tobacco-related health disparities research [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A002.

Cancer mortality attributable to cigarette smoking in 2005, 2010 and 2015 in Qingdao, China.

IntroductionCigarette smoking is among the most important public health concerns worldwide and the leading preventable cause of illness and death associated with cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). Although Qingdao, China implemented smoking control measures in 2007 and smoke-free legislation in 2013, smoking-attributable cancer mortality remains at a high level. The present study aimed to facilitate changes in policy-making, intervention implementation, monitoring and evaluation by estimating and comparing the burden of smoking-attributable cancers in Qingdao during 2005, 2010 and 2015.MethodsThis study used the disease list from the Global Burden of Disease (GBD) study to quantify the burden of smoking-related cancer. Sex and age-specific smoking-attributable mortality data were collected from the Qingdao Municipal Center for Disease Control and Prevention using an online reporting system. The population-attributable fractions (PAFs) of smoking and smoking-attributable cancer mortality in 2005, 2010 and 2015 were estimated using the smoking impact ratio (SIR) and relative risks (RRs) and by multiplying the smoking-attributable fraction by total cancer mortality, respectively.ResultsThe numbers of smoking-attributable cancer deaths increased from 2484 in 2005 to 2999 in 2010 and 4148 in 2015, with corresponding PAFs of 26.41%, 25.76% and 29.13%, respectively. The PAFs were higher among men (vs. women) for all cancers except cervical cancer. In 2005, lung, liver, esophageal and stomach cancers were most frequently associated with smoking-associated cancer mortality, and lung cancer had the greatest PAF, followed by nasopharyngeal, oral and esophageal cancers. Similar patterns were observed in 2010 and 2015. In 2015, 1 in 3 and 1 in 5 cancer deaths in men and women, respectively, were attributable to smoking, and 95% of these deaths were associated with lung, liver, esophageal or stomach cancer. Over time, downward and upward trends in smoking-attributable cancer deaths were respectively observed among people younger than and older than 50 years.ConclusionsThe smoking-attributable cancer burden in Qingdao remains considerable, despite the implementation of tobacco control and smoke-free measures. Tobacco control efforts should remain a major public health priority.

Burden of Cancers Related to Smoking among the Indonesian Population: Premature Mortality Costs and Years of Potential Life Lost.

As smoking is the leading preventable cause of multiple diseases and premature cancer deaths, estimating the burden of cancer attributable to smoking has become the standard in documenting the adverse impact of smoking. In Indonesia, there is a dearth of studies assessing the economic costs of cancers related to smoking. This study aimed to estimate indirect mortality costs of premature cancer deaths and years of potential life lost (YPLL) attributable to smoking among the Indonesian population. A prevalence based method was employed. Using national data, we estimated smoking-attributable cancer mortality in 2013. Premature mortality costs and YPLL were estimated by calculating number of cancer deaths, life expectancy, annual income, and workforce participation rate. A human capital approach was used to calculate the present value of lifetime earnings (PVLE). A discount rate of 3% was applied. The study estimated that smoking attributable cancer mortality was 74,440 (30.6% of total cancer deaths), comprised of 95% deaths in men and 5% in women. Cancers attributed to smoking were responsible for 1,207,845 YPLL. Cancer mortality costs caused by smoking accounted for USD 1,309 million in 2013. Among all cancers, lung cancer is the leading cause of death and economic burden. Cancers related to smoking pose an enormous economic burden in Indonesia. Therefore, tobacco control efforts need to be prioritized in order to prevent more losses to the nation. The data of this study are important for advocating national tobacco control policy.

Smoking-attributable cancer mortality in NSW, Australia, 1972-2008.

To estimate the impact of smoking-attributable cancer mortality on trends in cancer mortality in New South Wales (NSW), Australia, between 1972 and 2008. The study is a retrospective analysis of cancer mortality in NSW using NSW Central Cancer Registry data. Smoking-attributable cancer deaths were estimated using the smoking impact ratio method, which provides an indirect estimate of exposure to tobacco in the NSW population using lung cancer mortality. Trends in age-standardised cancer mortality rates by cancer type and the number of years of life lost due to smoking-attributable cancer deaths were estimated. In NSW, the cancer mortality rate decreased in males by 26% and females by 19% between 1989 and 2008. Nearly half (44%) of the decrease for males was a result of the decline in smoking-attributable cancer deaths. Despite a decline in the female all-cancer mortality rate, the smoking-attributable cancer mortality rate increased from 20.3 per 100 000 to 26.8 per 100 000 between 1989 and 2008. Smoking-attributable cancer deaths in women increased from around 150 per year in the early 1970s to 1186 in 2008; for men, the number remained stable at just over 2000 deaths per year since the 1980s. Although the lung cancer mortality rate declined in men, lung cancer remains the largest cause of cancer death. Lung cancer has overtaken breast cancer to be the largest cause of cancer death among women, with 17.1% (n = 998) of cancer deaths due to lung cancer in 2008. Despite declining all-cancer mortality in NSW, around 3330 cancer deaths in 2008 were due to the accumulated hazard of smoking in current and ex-smokers. This highlights the importance of tobacco control as part of a comprehensive cancer control plan.

Using Current Smoking Prevalence to Project Lung Cancer Morbidity and Mortality in Georgia by 2020

IntroductionTobacco use is the leading preventable cause of disease and premature death in the United States. In Georgia, approximately 18% of adults smoke cigarettes, and 87% of men’s lung cancer deaths and 70% of women’s lung cancer deaths are due to smoking. From 2004–2008, the age-adjusted lung cancer incidence rate in Georgia was 112.8 per 100,000 population, and the mortality rate was 88.2 per 100,000 population.MethodsThe Georgia Behavioral Risk Factor Surveillance System Survey was used to estimate trends in current adult smoking prevalence (1985–2010). Georgia smoking–attributable cancer mortality was estimated using a method similar to the Centers for Disease Control and Prevention’s Smoking-Attributable Morbidity, Mortality, and Economic Costs application. Data on cancer incidence (1998–2008) were obtained from the Georgia Comprehensive Cancer Registry, and data on cancer deaths (1990–2007) were obtained from the Georgia Department of Public Health Vital Records Program.ResultsFrom 1985 through 1993, the prevalence of smoking among Georgians declined by an average of 3% per year in men and 0.2% in women. From 2001 through 2008, lung cancer incidence rates declined in men and increased in women. Lung cancer mortality rates declined in men and women from 2000 through 2007. By 2020, Georgia lung cancer incidence rates are projected to decrease for men and increase for women. Lung cancer mortality is projected to decrease for both men and women.ConclusionThe lung cancer mortality rates projected in this study are far from meeting the Healthy People 2020 goal (46 per 100,000 population). Full implementation of comprehensive tobacco-use control programs would significantly reduce tobacco-use–related morbidity and mortality.

Smoking-attributable cancer mortality in California, 1979–2005

BackgroundThe adult smoking prevalence has declined more in California than the rest of the US in the past 2 decades. Further, California has faster declines in cancer mortality, lung cancer...

Role of smoking in global and regional cancer epidemiology: Current patterns and data needs

Although smoking is widely recognized as a major cause of cancer, there is little information on how it contributes to the global and regional burden of cancers in combination with other risk factors that affect background cancer mortality patterns. We used data from the American Cancer Society's Cancer Prevention Study II (CPS-II) and the WHO and IARC cancer mortality databases to estimate deaths from 8 clusters of site-specific cancers caused by smoking, for 14 epidemiologic subregions of the world, by age and sex. We used lung cancer mortality as an indirect marker for accumulated smoking hazard. CPS-II hazards were adjusted for important covariates. In the year 2000, an estimated 1.42 (95% CI 1.27-1.57) million cancer deaths in the world, 21% of total global cancer deaths, were caused by smoking. Of these, 1.18 million deaths were among men and 0.24 million among women; 625,000 (95% CI 485,000-749,000) smoking-caused cancer deaths occurred in the developing world and 794,000 (95% CI 749,000-840,000) in industrialized regions. Lung cancer accounted for 60% of smoking-attributable cancer mortality, followed by cancers of the upper aerodigestive tract (20%). Based on available data, more than one in every 5 cancer deaths in the world in the year 2000 were caused by smoking, making it possibly the single largest preventable cause of cancer mortality. There was significant variability across regions in the role of smoking as a cause of the different site-specific cancers. This variability illustrates the importance of coupling research and surveillance of smoking with that for other risk factors for more effective cancer prevention.

Smoking-attributable cancer mortality in 1991: Is lung cancer now the leading cause of death among smokers in the United States? : Shopland DR, Eyre HJ, Pechacek TF. Smoking and Tobacco Control Program, Executive Plaza North, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892. J Natl Cancer Inst 1991;83:1142–8

Smoking-attributable cancer mortality in 1991: Is lung cancer now the leading cause of death among smokers in the United States? : Shopland DR, Eyre HJ, Pechacek TF. Smoking and Tobacco Control Program, Executive Plaza North, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892. J Natl Cancer Inst 1991;83:1142–8

Smoking-Attributable Cancer Mortality

Smoking-Attributable Cancer Mortality Get access EDWARD J. SONDIK EDWARD J. SONDIK Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 83, Issue 24, 18 December 1991, Page 1834, https://doi.org/10.1093/jnci/83.24.1834 Published: 18 December 1991

Smoking-Attributable Cancer Mortality

Journal Article Smoking-Attributable Cancer Mortality Get access EDWARD J. SONDIK EDWARD J. SONDIK Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 83, Issue 24, 18 December 1991, Page 1834, https://doi.org/10.1093/jnci/83.24.1834 Published: 18 December 1991

Smoking-Attributable Cancer Mortality in 1991: Is Lung Cancer Now the Leading Cause of Death Among Smokers in the United States?

Findings from the new American Cancer Society prospective study of 1.2 million men and women indicate that mortality risks among smokers have increased substantially for most of the eight major cancer sites causally associated with cigarette smoking. Lung cancer risk for male smokers doubled, while the risk for females increased more than fourfold. On the basis of the new American Cancer Society relative risks, we project that cigarette smoking alone will contribute to slightly more than 157,000 of the 514,000 total cancer deaths expected to occur in the United States in 1991. Overall, smoking directly contributes to 21.5% of all cancer deaths in women but 45% of all cancer deaths in men. It would also appear that lung cancer has now displaced coronary heart disease as the single leading cause of excess mortality among smokers in the United States.