Nearly 30% of US Cancer Deaths Linked to Smoking

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A new study from the American Cancer Society indicates that the proportion of cancer deaths from cigarette smoking varies substantially by state, but is highest in the South where as many as 40% of cancer deaths in men are smoking-related.

Overall, Joannie Lortet-Tieulent, MSc, of the American Cancer Society, Atlanta, and colleagues estimated that more than one-fourth of all cancer deaths in 2014 were attributable to smoking, according to data published today in JAMA Internal Medicine.

“The human costs of cigarette smoking are high in all states, regardless of ranking,” the researchers wrote. “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.”

According to the study, state-level initiatives are at the forefront of tobacco control; however, data are lacking about smoking-related cancer mortality on a state-by-state level. Lortet-Tieulent and colleagues used data from large US prospective studies and state-specific smoking prevalence data from the Behavioral Risk Factor Surveillance System to calculate the population-attributable fraction of cancer deaths due to cigarette smoking in 2014 using 12 smoking-related cancers.

They found 167,133 cancer deaths (28.6%) in the United States in 2014 that could be attributed to cigarette smoking. The rate of smoking-related cancer death varied state to state. However, 9 of the top 10 ranked states for men and 6 of the top 10 ranked states for women were in the South.

According to the researchers, “higher smoking attributable cancer mortality in the South is driven by higher historic smoking prevalence, which has prevailed in large part due to weaker tobacco control policies and programs.”

In addition, smoking rates were also particularly high in Alaska and Nevada, especially among women.

“In Alaska, which had the second highest smoking attributable cancer mortality in women, smoking prevalence was the same in men and women in 2009, in contrast to most states where it was 10% to 60% higher in men,” the researchers wrote.

Among men in Utah the proportion of cancer deaths attributable to smoking was 21.8%, but in Arkansas it was 39.5%. The proportion of smoking-related cancer death in men was at least 30% in every state except Utah, the researchers noted.

Similarly, among women the proportion was only 11.1% in Utah but was 29% in Kentucky, and was at least 20% in all states except Utah, California, and Hawaii.

“The larger burden of smoking attributable cancer mortality in men than in women likely reflects a lower prevalence of smoking among women than men in the older birth cohorts,” the researchers wrote. “However, sex differences in smoking attributable cancer mortality may diminish in the future because smoking histories and risk of mortality from smoking-related diseases are comparable for men and women in more recent birth cohorts.”

In a commentary published with the article, Kurt M. Ribisl, PhD, of University of North Carolina, Douglas A. Luke, PhD, of Washington University in St. Louis, and Lisa Henriksen, PhD, of Stanford University School of Medicine, suggested that many of the state-by-state disparities seen in this study are due to variations in tobacco control policies across states and uneven funding for state tobacco control programs. In addition, they noted that interference from tobacco companies has also slowed support for tobacco control.

“There have been 16 ballot initiatives to increase cigarette taxes in US states over the past 20 years, with a worse record since 2006 (2 wins, 5 losses) than in the prior 10 years (8 wins, 1 loss),” they wrote. “Reversing this trend requires more resources to monitor the industry and its front groups, investment in message-framing research to promote evidence-based policies, and mining social media and other data for lessons learned from the failures to promote policy change.”