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Commemorating and Reconfirming the 1964 Surgeon General’s Message on Smoking

It has been clearly understood for decades that smoking causes lung cancer and heart disease, but there are many other health problems that are increasingly recognized as being caused or worsened by tobacco use. The first Surgeon General’s Report, released January 11, 1964 under tight security, identified smoking as a cause of lung cancer in men. The ramifications for public health policy were far-reaching and generated a major long-standing public health initiative to reduce tobacco use and exposure in the United States. Today, it is recognized that cigarette smoking harms almost every organ in the human body.

Since 1964, 32 reports have been released by the Surgeon General on topics ranging from adverse outcomes for smoking among women, racial/ethnic minority groups, and children, to specific health issues including nicotine addiction, benefits of smoking cessation, and conditions such as cancer, heart disease, and chronic lung disease. Although the number of lung cancer cases has been reduced nationally, Kentucky continues to have one of the highest rates. In 2011, approximately 106 men and women out of every 100,000 individuals were diagnosed with lung cancer.

The 2014 50th Anniversary Surgeon General’s Report, The Health Consequences of Smoking – 50 Years of Progress, describes the historical trends on smoking; new research and results related to the effect on health from exposure to active cigarette smoking and secondhand smoke; implications for the future; and a continuing resolution to end the smoking epidemic. Although there has been a reduction in the prevalence of smoking among adults from 42.7 percent in 1965 to 18 percent in 2012, cigarette smoking continues to have a major health impact. More than 16 million Americans suffer from a smoking-related chronic disease, with total costs for disability, death, and lost productivity estimated at more than $289 billion per year. Staggering statistics. Moreover, the emotional and life-altering impact on individuals and their loved ones is immeasurable.

For the 2014 anniversary report, we were tasked with writing a section to clarify the association of smoking with breast cancer in women based on the epidemiologic evidence. Partners at Johns Hopkins University (Dr. Kala Visvanathan) and University of Pittsburgh (Dr. Nancy Davidson) reviewed the evidence for a biological basis and mechanism for effects of tobacco smoke related to breast cancer, and we completed an exhaustive review and analysis weighing the epidemiologic evidence for a link between breast cancer and exposure to cigarette smoke. The analysis considered the consistency, strength, and plausibility of the evidence. Our section is one of many in the report that evaluates the growing number of health conditions potentially affected by smoking.

Breast cancer is second only to lung cancer as a cause of cancer-related death, and is the most frequently diagnosed cancer among women nationally and in the Commonwealth of Kentucky. In 2014, about 3,000 Kentucky women will be diagnosed with invasive breast cancer, and 600 will die from the disease. Our state has one of the highest rates of smoking in the nation, 29 percent; 32 percent of men and 27 percent of women smoke, based on Centers for Disease Control 2011 data. Furthermore, 59 percent of Kentucky high-school students say they have tried cigarette smoking and about 19 percent smoke regularly.

Over the last decade, plausible biological mechanisms for an effect of tobacco smoke on breast tissue have been established, and the consistency of the epidemiologic evidence has steadily improved. However, the strength of the association is weak relative to other established health outcomes such as lung and cardiovascular disease. Taken together the available scientific data to date is suggestive, but not sufficient to infer that exposure to tobacco smoke, whether active or passive, is related to breast cancer. Therefore, there is emerging evidence for a meaningful, but weak association between tobacco smoke exposure and breast cancer.  While the risks of lung and cardiovascular disease in women are considerably greater for smoking, our findings provide one more reason why women should not smoke and avoid exposure to secondhand smoke.

The 2014 report will provide a further basis for national recommendations on future tobacco control. A half-century after the initial warning against cigarette smoking, we continually recognize that this seminal report was just the beginning. We hope the 2014 report marks not only a significant anniversary, but acts as a catalyst to further encourage change in health.

Kathy B. Baumgartner, PhD, Professor
Richard N. Baumgartner, PhD, Professor
Dongyan Yang, MD, MS, Assistant Professor
Stephanie D. Boone, PhD, Postdoctoral Associate

School of Public Health & Information Sciences
James Graham Brown Cancer Center
University of Louisville

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