Five Cancers Added  to List of Smoking-Related Diseases

WASHINGTON—The 2004 US Surgeon General’s report on the health risks of smoking adds five cancers to the list of diseases caused by cigarettes—acute myeloid leukemia, and stomach, pancreatic, cervical, and kidney cancers. Other newly listed diseases are abdominal aortic aneurysm, cataracts, periodontitis, and pneumonia.

Published 40 years after the first Surgeon General’s report on smoking and health, which documented the evidence that cigarettes cause cancer of the lung and larynx in men and chronic bronchitis, Health Consequences of Smoking concludes that cigarettes cause disease in almost every organ, at every stage of life.

"In addition to cancer, cardiovascular, and respiratory diseases, and reproductive effects, the 2004 report documents many other damaging effects of smoking," said Surgeon General Richard H. Carmona, MD. The report estimates that 440,000 Americans die each year from smoking-related diseases and notes that smokers reduce their life expectancy by 13.2 years for males and 14.5 years for females. Beginning with the 2004 report, the Surgeon General’s office will indicate the strength of the evidence supporting a causal link between cigarette smoking and disease by using four categories. The cancers in each category are:

■ Sufficient to infer a causal relationship: lung, laryngeal, oral cavity and pharyngeal, esophageal, pancreatic, bladder and kidney, cervical, and gastric cancers, and acute myeloid leukemia.

■  Suggestive but not sufficient to infer a causal relationship: noncardia gastric, colorectal, and liver cancers.

■  Inadequate to infer the presence or absence of a causal relationship: ovarian.

■  Suggestive of no causal relationship: prostate, adult brain, and breast cancers.

The report omitted several cancers—lymphomas and multiple myeloma, and cancers of the skin, bone, and testicles—because they have not been linked to smoking. It also found that "the evidence is sufficient to infer that current smoking reduces the risk of endometrial cancer in postmenopausal women."

Major Conclusions

Health Consequences of Smoking is the first comprehensive assessment since 1990 of the evidence that indicts active cigarette smoking as a hazard to health. "We’ve known for decades that smoking is bad for your health, but this report shows that it is even worse," Dr. Carmona said. The report reached several major conclusions about cigarettes in addition to listing the new diseases attributed to smoking as a cause:

■  Smoking harms nearly every organ of the body, causing many diseases and reducing the health of people who smoke in general.

■  Quitting smoking has immediate as well as long-term benefits, reducing the risk of diseases caused by smoking and improving health in general.

■ Smoking cigarettes with lower machine-measured yields of tar and nicotine provides no clear benefit to health.

Changes in Smoking

The report notes that significant changes have occurred in cigarette smoking in the United States in the 4 decades since then-Surgeon General Luther Terry, MD, released his groundbreaking report on smoking and health. Among them:

■  There has been a broad reduction in society’s acceptance of smoking, which accompanied the growing awareness of tobacco’s dangers.

■  Per capita adult consumption of cigarettes has dropped from its peak of 4,345 annually in 1963 to 1,979 in 2002.

■  The number of former smokers today is greater than the number of current smokers.

■ Cigarette smoking was once a rite of passage for most teens. Today, only about half of high school seniors have ever smoked a cigarette, and about one in four is a current smoker.

The report calls for a sustained effort against smoking, a comprehensive approach to reducing tobacco use, and continued scientific research to address a number of tobacco-related health issues.

Such factors as smoking in motion pictures, the enormous advertising and promotional efforts of cigarette companies, and the belief by some that the smoking problem has been solved support the need to continue antismoking efforts, particularly among children and adolescents, the Surgeon General said.

Finally, the report emphasizes the need for research that further delineates the adverse health effects of tobacco use, improves the efficiency of tobacco surveillance and epidemiology, devises strategies to eliminate tobacco-related health disparities, and provides better prevention and treatment of addiction.