Tobacco.org

• Smoking: why women are at great risk 

Recently, further scientific evidence has emerged to suggest that women may be at particular risk from smoking.

This year, a Norwegian study of almost 2000 women showed that women were at a higher risk of chronic obstructive pulmonary disease (COPD) at a younger age, and after smoking less heavily, than men.

COPD is an umbrella term that incorporates emphysema and chronic bronchitis. There are four stages of the condition, which are ranked in terms of their severity.

"We estimate that 2.1 million people in Australia have some form of COPD, and half of them don't know it," says Heather Allan, director of the COPD National Program at the Australian Lung Foundation. . . .

This isn't the first study that suggests that women may be more at risk from smoking than men. A 2005 Monash University found that women were more susceptible to exposure to smoke than men. Allan says researchers believe this could be because women have narrower and more sensitive airways than men.

A report by the British Lung Foundation in 2005 suggested it may be because women's lung capacity is smaller, and population studies have also suggested that there may be a genetic element involved.

This is why health campaigners are so concerned that more young women in their teens and 20s are starting and continuing to smoke than men. . . .

The reasons for women's increased risk of lung disease have not yet been fully researched. According to NHS Direct in the UK, a gene that speeds up the growth of lung tumours is known to be more active in women.

The female hormone oestrogen is also known to affect the development of such tumours. . . .

For the cost of a local call from anywhere in Australia, the Quitline provides advice and assistance to smokers who want to quit.

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• Cancer hits Tennesseans hard  

Tennesseans die of cancer at the fifth-worst rate in the nation.

What kills them most frequently is cigarettes, but a powerful mix of misinformation and denial also drives up the death count.

A Tennessean examination that included dozens of interviews with doctors, cancer experts and patients across the state found health professionals frequently encounter people who have ignored symptoms for months or even years before going to a doctor. A lack of urgency or confusion about routine cancer screenings, coupled with misconceptions about treatment and even a fatalistic acceptance of the disease, leads to cancers being diagnosed too late to be treated successfully.

"There's a personal value system, a thought process that says, 'It can't be me,' and an incredibly complicated health system," said Mary Jane Dewey, director of the state Health Department's sole free cancer screening program. "Even people with insurance can't understand their policies."

Lung, breast, prostate and colorectal cancers are the most commonly diagnosed in the state. In the 2001-05 reporting period, more Tennesseans died from lung cancer — 20,629 victims — than from the other three combined. . . .

But money can be an issue. The Tennessee legislature put $10 million into smoking prevention and cessation programs for the first time for the 2007-08 fiscal year, but then halved that the following year. This year, the state's tobacco control program is running on a $1.5 million budget, all but $300,000 of that from a Centers for Disease Control grant.

The money pays for the state's 1-800-QUIT-NOW line, which matches smokers with counselors to help them quit, and literature.

But anti-smoking advocates look most longingly at the state's $4.8 billion settlement with tobacco companies, which it began receiving in annual payments in 1999. The legislature voted to put the money into the general fund; none into anti-smoking programs. Tennessee has collected $1.9 billion to date.

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• New lung cancer wonder drug offers cure hope for deadliest form of disease  

A new lung cancer drug that can cure the deadliest form of the disease is being developed by scientists.

The treatment, which appears to have no side affects, killed all traces of the 'small cell' version of the cancer in more than 50 per cent of the British trials on laboratory mice. It also blocked the cells' ability to resist standard chemotherapy treatment.

A fifth of lung cancer patients have the 'small cell' form, in which the tumours spread so quickly they can rarely be removed. Only 3 per cent of sufferers can expect to survive five years after diagnosis.

Professor Michael Seckl, head of Molecular Oncology and Lung Cancer Research at Imperial College, which led the research, said he hoped to start clinical trials with human patients as early as next year.

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• Debate continues over diagnostic scans for lung cancer  

For the 42 percent of Americans who smoke cigarettes or once did, a ruling from the state's highest court last month seemed to offer hope that a simple screening tool could help them ward off advanced lung cancer.

The judges decided that Philip Morris USA may have to pay for lung scans for smokers so they can get early warning if they've developed cancer - and get treatment before it spreads into a deadly mass. (A federal court would have to affirm the state's decision before the company would have to pay.)

Even before the court weighed in, advocates had been pressing politicians for money to pay for CT scans for high-risk but asymptomatic people - insurers generally don't cover the test for screening - particularly since a group of New York researchers published results in 2006 suggesting that screening is saving the lives of smokers, former smokers, and people exposed to secondhand smoke and other hazards, such as asbestos. Some smokers are so convinced of the benefits of CTs they pay the $400 screening fee themselves.

"Our movement is really taking hold,'' said Joanne O'Connor, cochair of the Lung Cancer Alliance in Massachusetts, which is lobbying legislators for funding. "I wouldn't want to find out [I had lung cancer] like my sister did when she was already stage four. She died six months later.''

But even as pressure for CT scanning builds, many of the country's top cancer specialists are saying not so fast. . . .

The Massachusetts Supreme Court relied in part on Miller's expert testimony during the lawsuit brought against Philip Morris by two Massachusetts smokers. Since the 2006 study was published, however, the New England Journal has published three corrections, including one from Henschke revealing that some of the funding for the study came from cigarette-maker Liggett Tobacco.

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• A review of human carcinogens—Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish 

New evidence continues to add to the extensive list of tobacco-related cancers (table); there is now sufficient evidence that tobacco smoking causes cancer of the colon3 and of the ovary.4 More than 150 epidemiological studies of tobacco smoking and breast cancer were reviewed. Large cohort studies5, 6 published since 20022 consistently show a small positive association (relative risks 1·1—1·3). Many chemicals in tobacco smoke cause mammary-gland tumours in animals, and these carcinogens are stored in breast adipose tissue in women; therefore, the Working Group concluded that there is limited evidence that tobacco smoking causes breast cancer. A causal link between parental smoking and childhood cancers has been established. Four recent studies showed that children born of parents who smoke (father, mother, or both, including the preconception period and pregnancy) are at significantly higher risk of hepatoblastoma, a rare embryonic cancer. The UK Childhood Cancer Study7 reported a relative risk of 1·86 for paternal smoking only and 2·02 for maternal smoking only, increasing to 4·74 (95% CI 1·68—13·35) when both parents smoke. For childhood leukaemia, a meta-analysis reported an association with paternal smoking before pregnancy (summary relative risk 1·12, 1·04—1·21).8 Second-hand smoke causes lung cancer.2 There is now limited evidence for an association with cancers of the larynx and the pharynx,9 whereas evidence for female breast cancer remains inconclusive. Since second-hand smoke contains most of the constituents of mainstream smoke, it might also be associated with other cancer sites. Many types of smokeless tobacco are marketed and all contain nicotine and nitrosamines. Hundreds of millions of people use smokeless tobacco, mainly in India and southeast Asia, but also in Sweden and the USA. Earlier findings showed a causal association between use of smokeless tobacco and cancers of the oral cavity and pancreas, and there is now sufficient evidence for cancer of the oesophagus.10 All of the forms of tobacco discussed above induce malignant tumours in laboratory animals.

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• November Is Lung Cancer Awareness Month 

More people die from lung cancer than any other type of cancer. In 2004,* lung cancer accounted for more deaths than breast, prostate, and colon cancer combined. The most important thing you can do to prevent lung cancer is to not start smoking or to quit if you currently smoke.

In 2004,*

* 108,355 men and 87,897 women were diagnosed with lung cancer.†

* 89,575 men and 68,431 women died from lung cancer.†

Smoking and Secondhand Smoke

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• More Scottish women die of lung cancer 

Soaring numbers of Scottish women are dying of lung cancer despite survival rates among men improving significantly, new figures show.

The increase also bucks the trend for death rates from other types of cancer north of the Border, all of which are going down.

Lung cancer deaths in men plummeted by 21 per cent in the 10 years to 2008, but increased by more than 11 per cent among women. . . .

However, the figures also reinforced major health differences across Scotland, with those living in the poorest areas 40 per cent more likely to have cancer than those in the wealthiest neighbourhoods.

Death rates in the most deprived communities are 75 per cent higher than those in the richest areas.

Dr Richard Simpson, Scottish Labour health spokesman, said: "I welcome the general improvement in cancer survival rates, but I am both disappointed and deeply concerned that more women are dying of lung cancer.

"This mainly reflects the increase in smoking among women over the past 20 years."

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• Is Smoking Tougher on Women?  

Women may be more vulnerable than men to the carcinogens and other noxious substances in cigarette smoke, a growing body of research suggests.

In one study of nearly 700 people with lung cancer, Swiss experts found that women tended to be younger when they received the diagnosis, even though they smoked less than the men who developed lung cancer.

In another study, researchers from Harvard University and the University of Bergen in Norway evaluated more than 950 men and women with chronic obstructive pulmonary disease (COPD), known to be linked to smoking. The result: The women with COPD were younger when they got the diagnosis and had smoked less than the men with the respiratory ailment.

"Maybe women are more susceptible to the lung-damaging effects of smoking," said Dr. Inga-Cecilie Soerheim, a visiting research fellow at Harvard and a researcher at the University of Bergen, who led the COPD study. She presented the findings in May at the American Thoracic Society's annual conference.

In fact, several other studies in the past 20 years have suggested that female smokers may be more susceptible to lung cancer than male smokers.

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• DONOVAN v. PHILIP MORRIS USA, INC.  

In this case, it is not merely the risk of cancer of which the plaintiffs have notice, but the substantial increase in the risk of cancer, as reflected in their complaint. Because the harm involves subclinical changes that only will be discovered by a physician, notice most likely will take the form of advice by a physician, together with a recommendation for diagnostic testing conformably with the medical standard of care. In short, the statute begins to run when (1) there is a physiological change resulting in a substantial increase in the risk of cancer, and (2) that increase, under the standard of care, triggers the need for available diagnostic testing that has been accepted in the medical community as an efficacious method of lung cancer screening or surveillance.

As previously discussed, medical monitoring expense is the plaintiffs' only arguably provable damages. They could not have sued for pain and suffering or lost earning capacity. This is not a case where plaintiffs recovered damages for pain and suffering, lost earning capacity, but only some medical expenses based on existing medical technology. These plaintiffs, or so they allege, had absolutely no remedy until LDCT technology appeared. If they can establish these circumstances, which are unusual and perhaps unique to medical monitoring claims, then their claims are timely. This is a question that cannot be resolved on the record before us; it must be resolved on a motion for summary judgment or, if genuine issues of material fact remain, by a jury. The plaintiffs also must show that the standard of care of the reasonable physician did not call for monitoring of any precancerous condition prior to the statute of limitations period, not just that the technology at that time was less effective for monitoring.

We answer the second certified question in the negative, subject to determination as we have outlined it.

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• SJC: Philip Morris may have to pay for diagnostic tests for smokers  

Massachusetts' high court said today that cigarette maker Philip Morris USA may have to pay for diagnostic chest exams so smokers can get early warning they have developed lung cancer.

In a unanimous ruling, the Supreme Judicial Court said that Massachusetts law has an antiquated definition of negligence that must be updated. Historically, plaintiffs had to show explicit injury -- such as a broken leg -- before the other party can be ordered to pay for diagnostic tests. Writing for the court, Justice Francis X. Spina said that legal thinking had to change.

"Modern living has exposed people to a variety of toxic substances," Spina wrote. "Illness and disease from exposure to these substances are often latent, not manifesting themselves for years or even decades after the exposure."

Spina added, "Our tort law developed in the late 19th and early 20th centuries ...We must adapt to the growing recognition that exposure to toxic substances and radiation may cause substantial injury which should be compensable even if the full effects are not immediately apparent." . . .

"The overwhelming majority of federal and state courts have rejected class certification of smokers' claims, including those seeking medical monitoring," Murray Garnick, Altria senior vice president and associate general counsel, said in a statement. "Six of the last seven state supreme courts to consider the issue have refused to recognize claims for medical monitoring based on the risk of future injury.''

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Modern living has exposed people to a variety of toxic substances. Illness and disease from exposure to these substances are often latent, not manifesting themselves for years or even decades after the exposure. Our tort law developed in the late 19th and early 20th centuries . . . We must adapt to the growing recognition that exposure to toxic substances and radiation may cause substantial injury which should be compensable even if the full effects are not immediately apparent.
MA Supreme Court Justice Francis X. Spina, writing for the court in the Donovan medical monitoring suit.

• New York Senators Chuck Schumer (D-NY) and Kirsten Gillibrand (D-NY) Join As Co-Sponsors of The Lung Cancer Mortality Reduction Act 

Today, Lung Cancer Alliance (LCA) hailed the support of Senators Chuck Schumer (D-NY) and Kirsten Gillibrand (D-NY) who have signed on as co-sponsors of a bill to establish the first ever multi-agency, comprehensive program targeted at lung cancer.

Entitled Lung Cancer Mortality Reduction Act of 2009, S.332 authorizes a five year program to reduce the mortality rate of lung cancer which continues to be the number one cause of cancer deaths both nationally and in New York State. Lung cancer causes more deaths each year than breast, prostate, colon, kidney, melanoma and liver cancers combined.

"Lung cancer affects millions of men and women everyday and we must do everything we can to fund ways to combat this deadly disease," said Senator Schumer. "I am proud to sign onto this legislation to help promote earlier detection and better disease management to improve cancer survival rates in New York State and across the country." . . .

To insure accountability, the bill requires an annual report to Congress and creates an oversight board composed of the three Cabinet Secretaries and representatives from the fields of lung cancer treatment, research and advocacy.

In addition, the bill directs the Secretaries of Department of Defense (DOD) and Veterans' Affairs (VA) to implement an early detection and disease management program for military personnel who are at high risk for lung cancer because of smoking or exposure to carcinogens during active duty.

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• Smoking Threatens Africa With Cancer Epidemic 

Tobacco use in Africa is growing faster than in other continents, says Dr. John Seffrin, who has been on the frontlines in the war against cancer for several years and now serves as the chief executive officer of the American Cancer Society. Taking part in the recent LIVESTRONG Global Cancer Summit in Dublin, Ireland, he hailed the global unity shown in reducing the stigma of cancer and working harder at prevention, early diagnosis and treatment. He spoke with allAfrica.com.

How did the cancer summit come about?

Lance Armstrong [the American professional road racing cyclist who has survived cancer] and the Lance Armstrong Foundation decided that it was important to have not just another meeting on cancer, but a special summit that would bring together people from all over the world and a diverse group of people that would include scientists, public health professionals, survivors and advocates. The foundation raised money and worked with other organizations like the American Cancer Society to put this summit on. It was a smashing success and we hope it will be a launch pad for people to work better together to solve the cancer problem. . . .

How does Africa fit in when it comes to global tobacco use?

Africa has relatively low tobacco use prevalence rates. But it has the fastest increasing prevalence rates. They're low compared to China, where 60 percent of the men smoke, but they're going up faster than anywhere in the world. We at the American Cancer Society are committed to doing tobacco control in Africa because here's a chance to prevent an epidemic of disease that otherwise will happen.

The tobacco industry is rapaciously promoting its product in all areas of the world where prevalence rates are low. So we're targeting Africa and we need to get on the ground with prevention programs before it's too late. It's a lot easier to prevent people from starting ever to smoke than it is to get them to quit because it's so addictive. Here's an opportunity to get dramatic results and that is to prevent what has become the single largest cause of preventable death in the world: addiction to tobacco.

How might you go about doing that in Africa?

The number one thing that can be done in any part of Africa is to change current public policies. If every country in Africa would implement the protocols of the Framework Convention on Tobacco Control they could get dramatic results.

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• Poor 'lacking lung cancer help' 

The poorest people in the UK are least likely to receive treatment when they get lung cancer, a study suggests.

Analysis of data from 35,000 lung cancer patients in northern England found living in a deprived area cut the chance of treatment such as surgery.

The problem was exacerbated further if patients lived a long distance from a specialist hospital, the British Journal of Cancer reported.

Cancer Research UK said there were "unacceptable variations" in care.

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• Defeating nicotine's double role in lung cancer 

A lung cancer treatment that inhibits nicotine receptors was shown to double survival time in mice, according to Italian researchers.

The results of the early phase animal model study were reported in the June 15 issue of the American Journal of Respiratory and Critical Care Medicine.

Changes in genes encoding nicotine receptors are strongly associated not only with the tendency to smoke, but with susceptibility to lung cancer. Nicotine exposure also heightens the expression of the nicotine receptors, which leads to increased cell proliferation and inhibition of apoptosis, further setting the stage for cancer. . . .

John Heffner, M.D., past president of the ATS stated that "this research clearly has profound clinical implications regarding the role of nicotine in stimulating lung cancer and nicotine receptor antagonists in treating the disease. The highly addictive nature of nicotine, however, complicates patients' ability to quit smoking and avoid ongoing nicotine exposure."

"This [addictive nature of nicotine] underscores the importance of potential FDA regulation of nicotine in tobacco products to limit exposure to this drug that promotes tumor growth," wrote Dr. Spindel.

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• Drug Significantly Improves Smoking-caused Lung Damage in Former Smokers  

Iloprost, a drug used regularly to treat high blood pressure in the lungs, has been found to significantly improve the damage in former smokers, according to results of a multicenter Phase II clinical trial led by the University of Colorado Cancer Center. The results of the study were presented Aug. 2 at the International Association for the Study of Lung Cancer meeting in San Francisco.

The researchers examined lung biopsies of 152 people who had smoked at least 20 pack-years—equivalent to one pack a day for 20 years—before and after six months of treatment with either oral iloprost or placebo.

None of the 82 current smokers who entered the trial saw significant improvement in the signs of lung disease, but former smokers treated with iloprost showed significant improvement.

“These results are exciting because they show we can actually keep former smokers from developing lung cancer with a drug that has been used routinely for other problems,” said the study’s principal investigator, Dr. Robert Keith, associate professor of pulmonary medicine at the University of Colorado Denver School of Medicine and associate chief of staff for research at the Denver Veterans Administration Medical Center.

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