Lighting a Fire Under Tobacco-Related Cancers
As researchers unravel the extent and scientific underpinnings of tobacco-related cancers and addiction, patients can seek support to quit tobacco or cope with the stigma often associated with these cancers.
By Stephen Ornes
Tony Gwynn’s baseball career was the stuff of sports legend. During 20 seasons with the San Diego Padres, the likable lefty racked up more than 3,000 hits, earned eight National League batting titles and was selected for the All-Star Game 15 times. After his final season with the Padres, in 2001, he became a coach at San Diego State University, and in 2007, he was elected to the National Baseball Hall of Fame.
Like many ballplayers, Gwynn, who died of salivary gland cancer in June 2014 at age 54, chewed tobacco through most of his career. And in the years before his death, he publicly blamed tobacco for his cancer, which doctors had discovered in 2010.
Though no studies have conclusively linked tobacco to salivary gland cancer, Gwynn’s death has reignited public awareness about the strong role of tobacco—whether smoked or chewed—as both a cause of cancer and an impediment to its treatment.
For half a century, researchers and health officials have urged the public to acknowledge a tobacco-cancer link. Today, there is an even better understanding of the increased cancer risk associated with using tobacco. According to the American Cancer Society (ACS), tobacco use has been linked to cancer in many different parts of the body, including the bladder, cervix, colon and rectum, esophagus, kidneys, lungs, mouth, nasal cavity, ovaries, pancreas, stomach and throat. Its use is responsible for about 30 percent of cancer deaths in the United States.
For tobacco users who already have cancer, studies show that quitting can lengthen survival, improve the safety and effectiveness of treatment, decrease treatment-related toxicity, and enhance quality of life. Getting off tobacco can also reduce a cancer patient’s risk of recurrence and secondary tumors. “It’s never too late to quit,” says thoracic oncologist Roy Herbst, the chief of oncology at Yale Cancer Center in New Haven, Connecticut. “A person can always make a positive impact on health by quitting tobacco.”
Of course, quitting is easier said than done. According to the U.S. Centers for Disease Control and Prevention (CDC), nicotine may be as addictive as heroin, cocaine and alcohol. Meanwhile, studies suggest most physicians don’t develop quit plans with their patients. Adding to the challenge, tobacco users who have cancer are frequently blamed for causing their illness, a stigma that can impede both a patient’s ability to cope with a diagnosis as well as research and health care for patients with tobacco-associated cancers.
But those who want to kick the habit should take heart: Doctors have gained a better understanding of tobacco’s addictive potency, and that knowledge is driving new approaches to help people quit. Likewise, patients and researchers are focusing on ways to move beyond the tobacco stigma to improve patient care and support.
A Well-Known Enemy
In 1964, more than 40 percent of Americans regularly smoked cigarettes—possibly the highest smoking rate in U.S. history. That year, U.S. Surgeon General (and longtime smoker) Luther Terry released a report that would be credited with changing the smoking habits of the country. The report, the first of its kind, told the public that smoking causes lung cancer and other diseases. Based on thousands of studies, the report sparked a major public health initiative and paved the way for new government control over the sale and marketing of tobacco products. The following year, the U.S. Congress passed the first legislation requiring warning labels on cigarette packs.
The smoking rate has dropped significantly since 1964, though roughly 18 percent of American adults continue to smoke, according to data from 2013, the latest year for which statistics are available. In the 1980s, Congress enacted additional tobacco-related laws—including ones governing smokeless tobacco. The U.S. Food and Drug Administration (FDA) was given authority over tobacco products in 2009.
The tobacco controls that followed the 1964 Surgeon General’s report have saved the lives of about 8 million people who would have died prematurely from tobacco-related diseases, according to a study published Jan. 8, 2014, in the Journal of the American Medical Association (JAMA). Despite that success, tobacco use continues to take a heavy toll. Overall, the ACS estimates that nearly 176,000 of more than 585,000 U.S. cancer deaths in 2014 can be blamed on tobacco use.
The vast majority of current tobacco users started young, and even with efforts to educate youth about the dangers of tobacco use, kids continue to light up. “Every kid at the end of elementary school can recite all the bad things that are due to smoking, but as soon as they hit middle school and see those ninth-graders smoking, all that stuff goes out the window,” says Peter Shields, a physician at the Ohio State University Comprehensive Cancer Center in Columbus who studies the impact of environmental factors, including tobacco use, on cancer risk. “We still have it in our culture that smoking is sexy and cool and rebellious.”