Late-stage cancer detection in the USA is costing lives

Source: The Lancet

In the USA, cancer is the most common cause of death in people aged between 49 and 80 years. In 2007, 562 875 cancer deaths were reported, which account for about 23% of all deaths. Cancers of the lung, colorectum, breast, and prostate are the most common and have the highest mortalities. In high-income countries remarkable progress has been made in cancer management and care, and although cancer incidence continues to rise, due to the influences of ageing, lifestyle, and population growth, mortality has fallen and survival rates are improving for several cancers, largely because of advances in screening, early detection, and treatment.

So in light of this progress, the US Centers for Disease Control and Prevention (CDC) report published last week makes for troubling reading, showing as it does that almost half of colorectal and cervical cancers and a third of breast cancers are being diagnosed at a late stage when treatment is less effective. The study is the first nationwide examination of stage-specific cancer incidence rates and screening prevalence for breast, cervical, and colorectal cancer by demographics including age and race or ethnic origin. The study found a lower uptake of screening and the presentation of symptoms late in low-income and ethnic minority communities, who also had longer delays in getting their diagnosis and treatment after an abnormal test. All these factors have been well documented to be associated with a late diagnosis for over a decade, so it is disappointing to see that cancer care is still failing the same patient groups. A further finding was the wide variation in late-stage diagnosis across different locations, which is a sad reflection of the fragmented health-care system in the USA. The CDC also reported that people without appropriate health insurance had less access to services despite the Patient Protection and Affordable

Care Act that is supposed to cover recommended screening tests by supporting people financially through co-payments.

Patient delay can be a major factor behind late diagnosis; many patients are unaware of (or ignore) the symptoms of cancer; and health literacy, cultural attitudes towards seeking medical care, fear and embarrassment of a cancer diagnosis, and difficulties navigating the health-care system all play a part. But physicians can add to delays by failing to recognise sentinel signs and by failing to triage the right patients forward for further investigation. Symptoms of early cancer can be non-specific and mistaken for other conditions, a factor behind the late presentation of ovarian or pancreatic cancers, for example. Biomarkers could have a role in helping to identify and stratify high-risk populations. Education of both the patient and general physician is essential to move to an early diagnosis of cancer. For example, if patients have a family history of certain cancers, such as colorectal or breast cancer, then these individuals can present earlier than might be expected. Both patient and physician should be aware of these indicators and appropriate screening programmes made available to all who need them.

A shortcoming of the CDC report is the lack of discussion about the nature of diagnostic tests and the challenges they present. For colorectal cancer, the fecal occult blood test is not discriminative, and the follow-up tests of sigmoidoscopy or colonoscopy are invasive and not without risk. Although, encouragingly, the recent trial of once-only flexible sigmoidoscopy screening has been shown to be safe and practical. However, overdiagnosis and overtreatment can limit the effectiveness of screening in the general population; thus, identification of high-risk groups is crucial. There is a need for better initiatives to support the development of specific tests for particular cancers and to direct treatment to specific patient groups.

Several initiatives to promote early diagnosis in symptomatic patients are noted in the report and should be credited. The CDC have recently established the Colorectal Cancer Control Program, which provides funding to 25 states and four tribal organisations to promote screening and follow-up care to low-income individuals who are uninsured for screening. The CDC’s National Comprehensive Cancer Control Program provides funding and technical assistance to all states and minority community organisations to develop and implement coordinated cancer control plans to provide a continuum of services including prevention, early detection, treatment, survival, and palliation.

Efforts to identify people most at risk of cancer and those who are difficult to reach must continue to be a priority if the alarming statistics in the CDC report are to improve. More research aimed at improving diagnostic tests and biomarker development would complement and improve early clinical diagnoses, and should go hand-in-hand with the removal of patient and physician barriers to effective cancer care.

December, 2010|Oral Cancer News|

Pertussis reaches epidemic proportions in California; New links identified between vaccine-preventable infections and cancer.

Source: Disabled World

New data from the Centers for Disease Control and Prevention (CDC) show that adults remain largely unvaccinated against preventable infectious illnesses. At a news conference convened today by the National Foundation for Infectious Diseases (NFID), experts in public health, infectious disease, oncology and other medical specialties discussed the data and the health consequences for adults who skip vaccines. They collectively called on all adults and health care providers to improve vaccination rates.

“For more than six decades, vaccines have protected us from infectious illnesses that have a wide range of consequences, from lost work days and inability to meet our daily obligations, to pain, discomfort, hospitalization, long-term disability and death,” said Susan J. Rehm, M.D., NFID medical director. According to Dr. Rehm, by foregoing needed vaccines, adults not only leave themselves vulnerable to sickness, but they expose those around them to unnecessary risks, too.

This problem is evident right now, as pertussis (whooping cough) continues to claim the lives of infants in California, while adults, who are frequently responsible for transmitting the disease to infants, fail to get the one-time pertussis booster vaccine. The impact of other vaccine-preventable infections may not be as immediately apparent, but they are no less important. Other vaccines for adults protect against viruses that cause several types of cancer, reactivation of the chickenpox virus that causes shingles later in life, and infection with bacteria that are the leading cause of community-acquired pneumonia.

New survey results from NFID suggest that doctor/patient communication challenges may be at least part of the problem. While physicians perceive they are encouraging their adult patients to be vaccinated, patients say the topic of vaccination rarely comes up during their doctor visits.

Vaccination rates highest among seniors; lowest among minority groups

In unveiling the adult vaccination data from the 2009 National Health Interview Survey (NHIS), Melinda Wharton, M.D., M.P.H., deputy director of the National Center for Immunization and Respiratory Diseases at the CDC, noted that the highest immunization rates are among older Americans, who tend to be vaccinated against influenza and pneumococcal infections. She suggested that one reason for this might be that older persons tend to have more routine visits with health care providers, providing more opportunities to learn about and adopt good preventive care behaviors.

“A good ongoing relationship with your medical provider is positive for so many reasons,” said Dr. Wharton, “not least of which is that you will have an ongoing opportunity learn about the best ways to stay healthy, including the best preventive care choices like vaccines.”

While adult vaccination rates are showing slow improvement overall, one vaccination trend Dr. Wharton specifically noted is the 7.4 percent decrease in pneumococcal vaccination rate in high-risk adults 19 to 64 years of age. She pointed out that this is not because people are suddenly foregoing this vaccine. Rather, the decrease reflects the recent addition of new risk groups — namely smokers and people with asthma — increasing the pool of people who should get the vaccine. Dr. Wharton called on smokers and people with asthma to check with their physicians or other health care providers about this vaccine.

In addition to generally low adult vaccination rates, Dr. Wharton touched on the problem of racial and ethnic vaccination disparities. While strides have been made to close racial and ethnic gaps, some significant vaccination gaps continue to exist among Whites, Blacks and Hispanics.

Vaccine (age and/or risk status) Non-


White (%)



Black (%)

Hispanic or

Latino (%)

Tetanus, diphtheria, pertussis (19-64 years) 51 54 49
Pneumococcal (65 years and older) 65 45 40
Pneumococcal (19-64 years, high risk) 18 18 12
Hepatitis B (19-49 years, high risk) 43 44 37
HPV (19-26 years) 20 13 13
Shingles (60 years and older) 11 4 5
Influenza (65 years and older) 69 51 51
Influenza (50-64 years) 42 37 31

The NHIS survey also reported vaccination rates in health care professionals for influenza (up 7 percent, to 53 percent), hepatitis B (up 2.5 percent, to 65 percent) and Tdap (up 1.6 percent, to 58 percent). “It’s gratifying to see health care worker vaccination rates continue to increase,” said CDC’s Melinda Wharton. “By modeling good preventive care behaviors our health care professionals are truly leading the way as good partners in their relationship with patients.” The NHIS vaccination data include anyone employed in a health care occupation or setting. In contrast, physician-only vaccination rates are much higher (>90 percent for influenza) as reported in two separate NFID surveys fielded before and during the current influenza season.

Doctor/patient communication breakdown a factor in low vaccination rates

A dramatic physician-patient communication disconnect was revealed by new data from two NFID surveys. Nearly 90 percent of primary care physicians say they discuss vaccines with their patients, yet in a separate survey of consumers, almost half cannot recall ever discussing vaccines with their physicians. As further evidence of the communication gap between physicians and their patients, 99 percent of physicians say that they or their staff initiates vaccine discussions, but just 44 percent of patients say that is true.

“Busy primary care physicians think they’re doing a good job recommending vaccines, but the survey indicates that patients aren’t getting the message,” suggested Dr. Rehm. “Consumers overwhelmingly said they look to physicians for vaccine recommendations and are likely to act on those recommendations, so it’s clear that we physicians need to be more effective in communicating with our patients.”

Among the positive findings, consumer familiarity with vaccine-preventable illnesses is rising, although still limited. Familiarity with specific vaccine-preventable diseases rose 4 to 12 percent compared with results from a 2009 survey, with the largest increase for pertussis vaccine. The only vaccine-preventable disease not to register an increase in familiarity is pneumococcal vaccine. Consumers also report that they rarely refuse vaccines if their physicians recommend them.

A realized consequence: disease resurgence

The ongoing pertussis epidemic in California demonstrates the danger still posed by diseases once thought to be gone in the U.S. There are reports of more than 6,400 cases so far in California this year, the most since 1958. While pertussis can affect people of any age and in fact, national rates have been rising in adults, it is the infants who adults pass this on to who bear the burden. Ten infants, all younger than three months, have died from whooping cough in California this year.

Patrick Joseph, M.D., a California infectious disease physician who is NFID’s vice president, implored adults to get the one-time booster vaccine, “While the epidemic is in adults, the tragedy is in kids. The situation is grave when babies too young to be immunized are dying.”

Dr. Joseph said this crisis means California doesn’t have the luxury of bringing people along slowly. The time to increase vaccination rates for pertussis is now. The California Department of Public Health recommends pertussis boosters for all adults, including those over 65, a move supported by the CDC’s Advisory Committee on Immunization Practices (ACIP). At its October meeting, ACIP voted to extend pertussis booster vaccination recommendations to include adults 65 and older nationwide.

While California has been hardest hit so far, many other areas have seen increased cases this year, including Ohio, South Carolina, Michigan, Texas, Idaho, upstate New York and the Philadelphia suburbs. Since pertussis knows no boundaries, Dr. Joseph voiced his hope that adults outside his home state would also take notice and seek a Tdap vaccine now to protect themselves and infants around them.

Importance of pneumococcal and influenza vaccines also highlighted

AARP board member Catherine Georges, R.N., Ed.D., reminded adults that the time to get an influenza vaccine is now. “We know it’s important for Americans of all ages to go out now and get the flu vaccine, but it’s even more critical for people 50-plus,” said Dr. Georges, a registered nurse and professor and chair of the department of nursing at Lehman College and the Graduate Center at the City University of New York. “Older Americans are often caring for their children and for older loved ones. Getting vaccinated not only protects you, but also helps protect your family and friends.” Dr. Georges echoed the universal recommendation from CDC for influenza vaccination of all Americans six months and older.

Since pneumococcal infection is an all too frequent complication of influenza, Dr. Georges reminded Americans that, “pneumococcal and influenza vaccines can be given at the same medical visit.” Pneumococcal vaccine is recommended for everyone 65 and older and for younger adults with certain risk factors or conditions like asthma, smoking, heart disease and diabetes. For most people, pneumococcal is a one-time vaccination.

Alarmingly few Americans immunized against debilitating disease of shingles

The lowest vaccination rate for a routinely recommended vaccine is for the shingles vaccine, which is recommended for everyone starting at age 60. Only ten percent of eligible persons have received the shingles vaccine. Not only does the likelihood of getting shingles increase with age, so does the severity of shingles pain, which can last long after the shingles rash has disappeared (this pain is known as post-herpetic neuralgia, or PHN). This pain diminishes quality of life and functional capacity as much as congestive heart failure, a heart attack, type II diabetes or major depression.

Adults in the NFID survey say they are familiar with shingles, but further questioning reveals knowledge gaps; for instance, 42 percent do not know that anyone who has had chickenpox is at risk for shingles. Still, adults are aware of the pain of the disease; 55 percent say they “know someone who has had it and it was terrible.” Unfortunately, only half of adults even know there is a shingles vaccine available and just 16 percent know it is currently recommended for everyone 60 and older.

“Shingles can be a terribly painful and debilitating disease, particularly in the elderly,” said Jeffrey Cohen, M.D., chief of the Laboratory of Infectious Disease at the National Institute of Allergy and Infectious Diseases. “Shingles pain can be very difficult to treat. Current therapies are only somewhat effective and often associated with frequent and problematic side effects, especially in older people, which is why it is vitally important that we educate Americans about the vaccine.”

Vaccines prevent cancer

“Human papillomavirus (HPV) not only causes cervical cancer, but also a growing portion of head and neck cancers,” according to Maura Gillison, M.D., Ph.D, Jeg Coughlin Chair of Cancer Research at the Ohio State University College of Medicine. “Twenty years ago about 40 percent of these cancers were due to HPV; today that number is over 60 percent in the U.S. Even more alarming is that these cancers are happening in younger people without traditional risk factors—smoking and alcohol consumption.”

The hepatitis B vaccine also protects against certain cancers. The hepatitis B virus causes 30 percent of all liver cancers in the U.S. and doubles the risk of non-Hodgkin’s lymphoma. Both HPV and hepatitis B viruses are common. An estimated 70 percent of Americans will be infected with HPV in their lifetime and up to 1.4 million Americans have chronic hepatitis B infection.

CDC recommends HPV vaccine for all women 19 to 26 years of age if not previously vaccinated and recommends the hepatitis B vaccine for all sexually active adults who are not in a long-term, mutually monogamous relationship and others in more defined risk groups.

“I urge everyone to get the HPV and hepatitis B vaccines as recommended,” said Dr. Gillison. “These vaccines are truly life-saving. As a cancer-specialist, I can tell you that prevention is a far better option than treatment. These are not cancers you want to have or want your kids to have.”

About the NHIS data – The NHIS has monitored the health of the nation since 1957. The interviewed sample for 2009 consisted of 33,856 households, which yielded 88,446 persons in 34,640 families.

About the NFID data – The NFID consumer survey, conducted by Opinion Research Corporation (ORC), was based on telephone interviews with 1,013 Americans aged 18 and older when from October 15-18, 2010. The margin of error for the full sample is +/-3 percent. The NFID physician survey, also conducted by ORC, was conducted online with 300 primary care physicians

About the National Foundation for Infectious Diseases – The National Foundation for Infectious Diseases (NFID), a non-profit organization, has been a leading voice for education about infectious diseases and vaccination since 1973. It is dedicated to educating the public and health care professionals about the causes, treatment and prevention of infectious diseases. For more information on vaccines and vaccine-preventable diseases, please visit and

November, 2010|Oral Cancer News|

Smokeless Tobacco Rates on the Rise

Source: WebMD

By: Bill Hendrick

Even after a generation of warnings from public health officials about the dangers of tobacco use, about 20% of Americans still smoke cigarettes, a CDC report says. The report also shows the rate of smokers who also use smokeless tobacco, such as chewing tobacco and snuff, is rising.

Using smokeless tobacco can keep the nicotine habit alive, making it even harder to quit than going cold turkey, Terry Pechacek, PhD, of the CDC, tells WebMD.

More Americans are turning to smokeless tobacco because of laws that prohibit smoking in public places such as bars, restaurants, and airplanes — and also because smokeless forms can be used in offices and on the job, Pechacek says.

Immediate Benefits of Smoking Cessation

The tobacco companies market smokeless tobacco as a substitute for smokers, but they don’t help people quit smoking, Pechacek tells WebMD.

“We are making no progress in getting people to quit smoking,” he says. “This is a tragedy. Over 400,000 people are dying prematurely and won’t be able to walk their children down the aisle or see their grandchildren.”

Contrary to common beliefs of smokers, the benefits of quitting start immediately, Pechacek tells WebMD.

“We see lower rates for heart attacks within months of quitting,” he says. “And lower rates for lung cancer, too. Stopping a decline in lung function is one of the biggest benefits of quitting smoking.”

The national smoking prevalence rate was 20.6% in 2008 and 2009. About 23% of males smoke, compared to 18.3% of females.

“We are not making progress and we are going to have this burden for tobacco-related diseases for decades to come,” Pechacek tells WebMD.

Who’s Using Smokeless Tobacco

The CDC report says the use of smokeless tobacco is “predominantly a problem among men, young adults, those with a high school education or less and in some states with higher smoking rates.”

Smoking prevalence varies widely among states and territories, from 25.6% in Kentucky and West Virginia and 25.5% in Oklahoma to 9.8% in Utah, 12.9% in California and 14.9% in Washington.

Smoking prevalence was 6.4% in the U.S. Virgin Islands, 10.6% in Puerto Rico, and 24.1% in Guam.

Smoking prevalence for men was significantly higher than for women in 15 states, plus Guam and Puerto Rico. Smokeless tobacco use was highest in Wyoming at 9.1%, West Virginia at 8.5%, and Mississippi at 7.5%. It was lowest in California at 1.3% and Massachusetts and Rhode Island at 1.5%.

Among findings and conclusions in the report:

  • Smokeless tobacco use was most common among those aged 18 to 24.
  • Smokeless tobacco use decreased with higher educational attainment.
  • Among the 25% of states in which smoking prevalence was greatest, seven also had the highest numbers for smokeless tobacco use, Alabama, Alaska, Arkansas, Kentucky, Mississippi, Oklahoma, and West Virginia.
  • Doctors, dentists, and others in their offices should encourage patients to quit smoking and help them find ways to do so.

CDC Director Tom Frieden, MD, MPH, says it’s unfortunate that so many smokers also are using smokeless tobacco products, which “may keep some people from quitting tobacco altogether.” He says in a news release that anti-tobacco efforts need to be beefed up against all forms of use.

Tim McAfee, MD, MPH, director of the CDC’s Office on Smoking and Health, says in the news release that the new numbers showing smokeless tobacco use “are concerning” and that officials “need to fully put into practice effective strategies, such as strong state laws that protect nonsmokers from secondhand smoke, higher tobacco prices, aggressive ad campaigns that show the human impact of tobacco use and well-funded tobacco control programs, while stepping up our work to help people quit using all forms of tobacco.”

Tobacco Use State by State

Here’s a list of percentages of smokers who also use smokeless tobacco, by state, from lowest to highest.

State                   Percentage

Delaware                   2.9

Washington, D.C.     3.0

Rhode Island            3.0

California                  3.2

Maryland                  3.6

Massachusetts        4.1

New Jersey              4.4

Maine                        4.7

Louisiana                  4.8

Illinois                        5.2

Nevada                     5.2

New York                  5.2

Arizona                      5.7

Hawaii                       5.7

Connecticut              5.8

Colorado                  6.1

Wisconsin                6.1

Georgia                    6.4

Ohio                          6.5

Tennessee              6.5

North Carolina        6.6

Florida                     6.7

New Mexico           6.8

Nebraska               6.9

Missouri                 7.0

South Carolina      7.0

Pennsylvania        7.1

Kansas                  7.5

Kentucky               7.7

Washington          7.8

Indiana                  8.0

Vermont                8.1

Iowa                      8.3

West Virginia       8.3

Texas                   8.4

Mississippi           8.5

Oregon                 8.7

South Dakota       8.7

Alaska                   8.8

New Hampshire   9.2

Oklahoma             9.2

Idaho                      9.6

Alabama                9.8

Michigan               9.9

Minnesota           10.5

Virginia                10.5

Utah                    10.9

Arkansas            11.7

North Dakota     11.8

Montana             12.1

Wyoming            13.7

Puerto Rico          0.9

Guam                    3.2

Virgin Islands      4.2

November, 2010|Oral Cancer News|

Snus smokeless tobacco: Less harmful than cigarettes, but not safe.

Source: WebMD

By: Daniel J. DeNoon

If you use snus, do you win or lose?

Snus — alternately pronounced snoose or snooze — is a smokeless, flavored tobacco product very different from snuff. When placed between cheek and gum, it doesn’t make you spit.

Even its critics admit that snus is less harmful than other forms of smokeless tobacco. And it is far less harmful than cigarette smoking.

So is snus a good thing?

It would be a good thing if everyone who smoked cigarettes or dipped snuff switched to snus instead. It would be a good thing if snus were a way station on the road to quitting all forms of tobacco. It would even be a good thing if kids who would have become smokers became snus users instead.

But despite all of that, mounting evidence suggests snus isn’t a good thing — and may be far worse than they appear.

Snus: Less Harmful, But Not Safe

Cigarettes are the world’s most efficient nicotine delivery device. They are also the most deadly. Many of the most dangerous byproducts of cigarettes are created during the burning process.

Smokeless tobacco products obviously don’t burn. But smokeless tobacco is a major cause of oral cancer, pancreatic cancer, and esophageal cancer.

Much of this risk comes from cancer-causing chemicals called nitrosamines and polycyclic aromatic hydrocarbons (PAH). And snuff products actually deliver more cancer-causing nitrosamines than cigarettes do.

But nitrosamine content is far lower in snus than in snuff, says Stephen S. Hecht, PhD, professor of cancer prevention at the University of Minnesota.

“Snus are made with a special process to help control nitrosamine levels,” Hecht tells WebMD.

There’s a catch, of course. Carcinogen levels in snus may be lower — but they are not low.

“Nitrosamine levels in snus are still 100 times greater than levels of nitrosamines in foods like nitrite-preserved meats,” Hecht says. “This is not a harmless product.”

And there’s evidence that these nitrosamines — or something else in snus — are causing cancer. In Sweden and Norway, where snus originated, snus users have a significantly higher risk of pancreatic cancer.

Snus are also linked to mouth sores, dental cavities, heart attack, stroke, and diabetes risk. And they do deliver nicotine — an addictive drug.

Snus: Harm Reduction or Multiplication?

OK, so snus isn’t without harm. But if it’s so much safer than cigarettes, wouldn’t it be good for smokers to switch to snus?

In Scandinavia, there’s some evidence that snus contributed to a decline in smoking. Whether that happens in the U.S. depends on young people, says Michael Eriksen, ScD, director of the Institute of Public Health at Georgia State University and former director of the CDC Office on Smoking and Health.

“If we see that existing smokers are the primary users of snus and go from smoking to snus, that would be a public health success story,” Eriksen tells WebMD. “But if kids start out on snus and then grow into smoking, that is going to be a disaster.”

It’s a huge public health experiment — and the results already are plain to see, says Terry Pechacek, PhD, associate director for science at the CDC’s Office on Smoking and Health.

Pechacek notes that more than a fourth of white, male high school students report having used smokeless tobacco products in the last month. Overall, nearly 7% of all U.S. high school students already use smokeless tobacco.

And they are not using snus instead of cigarettes.

“The overwhelming pattern is to smoke cigarettes along with smokeless tobacco — and two-thirds of this is among young adults,” Pechacek tells WebMD. “Over half of teens using smokeless tobacco are also using cigarettes. … It is of great public health concern.”

This isn’t an accident, says Michael Steinberg, MD, MPH, director of the tobacco dependence program at the University of Medicine and Dentistry of New Jersey.

Steinberg notes that in 2006, major U.S. cigarette companies bought the major smokeless tobacco brands. And the two major brands of snus? They’re from leading cigarette makers Altria/Philip Morris (Marlboro Snus) and RJ Reynolds (Camel Snus).

“Snus is being co-marketed with cigarettes,” Steinberg tells WebMD. “The companies are not shy in saying, ‘When you can’t smoke, use snus.’ But when you can smoke, it is clear they want you to smoke cigarettes. They make more money from cigarettes sales than anything else on the planet.”

Steinberg also notes that U.S. snus deliver less nicotine than do cigarettes.

“So if people try to get nicotine from snus, they will not get what they are used to. They will go through nicotine withdrawal and so will not use snus alone,” Steinberg says. “My conclusion is that companies do not want to replace cigarettes with snus.”

Snus: An Aid to Quitting Cigarettes?

Data from Sweden show that snus users don’t always progress to cigarette use, and that it’s possible to use snus to reduce dependence on cigarettes.

One Swedish study, for example, found that there were more ex-smokers using snus that there were ex-snus users using cigarettes.

However, Steinberg notes that this study fails to account for significant anti-smoking efforts taking place in Sweden at the same time, such as indoor health programs and government assistance to smoking cessation programs.

“Other countries, such as Norway, have not seen the same outcomes in terms of health benefits of snus as in Sweden,” he says.

Steinberg points to studies showing that snus isn’t any more helpful than nicotine replacement products such as nicotine gum and nicotine nasal spray.

“The real question is who do you buy your nicotine from?” GSU’s Erickson says. “Do you buy it from a tobacco company that can put anything on the market with no testing … or do you buy it from pharmaceutical companies that have to demonstrate the safety and effectiveness of their products as a drug and demonstrate they actually work?”

It’s right there in a big black box on the home page of the Camel Snus web site: “WARNING: Smokeless tobacco is addictive.”

Snus users get hooked on nicotine. This means that if users try to quit, they will go through the unpleasant sick feeling known as withdrawal. Many will find it very difficult, if not impossible, to stop using nicotine in one form or another.

“Those who sell nicotine would like to keep people hooked on nicotine forever. That is a question, whether lifetime nicotine addiction is acceptable,” Erikson says. “There are 50 million people in the U.S. who are regular nicotine users. The sooner we can get them from relying on smoked nicotine to not-smoked nicotine the better. The sooner we can get them all off nicotine entirely, the better.”

All of the experts who spoke with WebMD agree: Snus clearly aren’t as deadly as cigarettes, but they pose a significant risk to your health.

“The bottom line is there is no safe form of tobacco use,” Pechacek says.

November, 2010|Oral Cancer News|

Oral Cancer Foundation founder named Survivor Circle Award winner by ASTRO

The American Society for Radiation Oncology (ASTRO) has named Brian Hill of Newport Beach, Calif., as its 2010 Survivor Circle Award winner. Hill will be recognized with a trophy and a $1,000 prize during the Awards Ceremony on Tuesday, November 2, 2010, during ASTRO’s 52nd Annual Meeting in San Diego. He has chosen to donate the funds from the award to benefit The Oral Cancer Foundation, the nonprofit he started a decade ago.

The Survivor Circle Award recognizes a cancer survivor who has given back to the community by devoting his or her time to helping others with cancer. Hill was diagnosed with Stage 4 metastatic tonsil cancer in 1997. When he was going through treatment, he had many questions about side effects and realized there was a lack of information and awareness about head and neck cancer even though the disease has a very high death rate, due to it being caught at a late stage in most cases.
“There was a huge lack of information available, and I was desperate to find someone to talk to who had gone through the same thing I was experiencing,” Hill said. “I knew that if I was feeling this way, there had to be others feeling my frustrations too. I then became a student of the disease. ”

After Hill completed his grueling but successful radiation treatments at M.D. Anderson Cancer Center in Houston, he and his wife Ingrid founded The Oral Cancer Foundation in 1999, which is now a national non-profit charity. Besides its original mission of patient support and information dissemination, it is involved in advocacy issues, sponsorship of research, and increasing public awareness and early discovery of the disease.

“Being chosen by ASTRO in this way is a huge honor. I feel as if this is the second time I am the beneficiary, as I owe my being here today to the doctors and radiation technology, which saved my life.” He said. As the pro bono director of the foundation, Hill spends his time speaking at symposia and universities worldwide. He has also worked as an advocate with congressmen and senators on issues as varied as the tobacco bill, Medicare issues of post-treatment patients, the HPV vaccine, and the issues of early cancer detection.

Hill was inducted as the first non-doctor member of the American Academy of Oral Medicine in recognition of contributions to oral cancer public literacy and awareness programs and the promotion of early diagnosis of oral cancer via free public screenings. He has also received awards from the NIH/NIDCR and the Chicago Dental Society, and is a recipient of NYU’s prestigious Strusser award for public service. He sits on oral cancer work groups from the CDC to numerous professional dental and medical society organizations.

“Congratulations to Brian Hill for winning this prestigious award,” Anthony Zietman, M.D., ASTRO president and a radiation oncologist at Massachusetts General Hospital in Boston, said. “Brian embodies everything that the Survivor Circle Award stands for. He beat the odds with his own cancer and has worked tirelessly to promote awareness for an under-recognized type of cancer. I’m proud to have him as a part of the Annual Meeting.”

The ASTRO Annual Meeting is the premier scientific meeting in radiation oncology and attracts more
than 11,000 attendees of various disciplines, including oncologists, physicists, biologists, nurses and other healthcare professionals from all over the world. The theme of this year’s meeting is “Gathering Evidence, Proving Value” and the program will examine the realities of practicing medicine in 2010.

Provided by American Society for Radiation Oncology

October, 2010|OCF In The News|

Decreases in adolescent tobacco use leveling off


Declines in rates of adolescent tobacco use have stagnated in the past few years, prompting the CDC to call for better prevention efforts, according to a recent report.

“Smoking continues to be the leading preventable cause of death and disability in the United States; and among adult established smokers in the United States, more than 80% began smoking before age 18 years,” CDC researchers wrote.
To evaluate behaviors and attitudes toward tobacco use during the critical period of adolescence, the researchers used National Youth Tobacco Survey (NYTS) data collected from 2000 to 2009.
The NYTS, which presents school-based survey responses from a cross-sectional, nationally representative sample of middle school and high school students, gleans information on youth tobacco use; smoking cessation; tobacco-related knowledge and attitudes; access to tobacco; media and advertising and secondhand smoke exposure. The study has been conducted every 2 years since 2000.
From the 205 participating schools, 22,679 students responded. They were polled about any use of, current use of and experimentation with certain tobacco products, including cigarettes, cigars, smokeless tobacco, pipes, bidis and kreteks. Survey questions also investigated students’ willingness to initiate tobacco use.
Results indicated that 8.2% of middle school students and 23.9% of high school students reported current tobacco use in 2009, the researchers said, with 5.2% of middle school and 17.2% of high school students reporting current cigarette use. The researchers also noted that 21.2% of middle school and 24% of high school students were willing to start smoking cigarettes.
Data from 2009 also suggested that, among middle school students, 3.9% currently used cigars; 2.6%, smokeless tobacco; 2.3%, pipes; 1.6%, bidis; and 1.2%, kreteks. A similar distribution of use of these products was noted among high school students, with 10.9% currently using cigars; 6.7%, smokeless tobacco; 3.9%, pipes; 2.4%, kreteks; and 2.4%, bidis.
From 2000 to 2009, decreases occurred among middle school students for current tobacco use, 15.1% to 8.2%; current cigarette use, 11% to 5.2%; and cigarette smoking experimentation, 29.8% to 15%. Overall rates for susceptibility to smoking, however, did not decline. Analysis also indicated that rates of decreases demonstrated no change during this time.
Among high school students, current tobacco use decreased from 34.5% to 23.9% from 2000 to 2009, according to the researchers, with current cigarette use also declining from 28% to 17.2% and rates of experimentation falling from 39.4% to 30.1%. Again, rates of decline did not change.
Prevalence of susceptibility to smoking remained steady for middle school and high school students throughout the study period.
Between 2006 and 2009, however, the willingness to start using tobacco products and current use of cigarettes, cigars, smokeless tobacco, pipes, bidis and kreteks did not change among middle school or high school students. For middle school students, the researchers only noted declines in two subpopulations, with rates of current cigarette use falling from 6.4% to 4.7% among girls and decreasing from 6.5% to 4.3% among white students.
Similarly, from 2006 to 2009, prevalence among high school students only declined in girls for current tobacco use, decreasing from 21.3% to 18.2%, and current cigarette use, with rates falling from 18.4% to 14.8%. Prevalence for current bidi use also declined among white students (2.6% to 1.7%).
“The findings in this report indicate that, from 2000 to 2009, prevalences of current tobacco and cigarette use and experimentation with smoking cigarettes declined for middle school and high school students, but no overall declines were noted for the 2006-2009 period,” the researchers wrote. “The general lack of significant change during the shorter period indicates that the current rate of decline in tobacco use is relatively slow.”
Researchers noted that prevention programs are effective, but they do not receive adequate financial support. “Comprehensive tobacco control programs should be fully funded and implemented, as recommended by the CDC,” they wrote.
The researchers also said better control of cigarette advertisements and more graphic warnings on cigarette packs may help deter adolescents from smoking by altering the general public’s attitudes toward tobacco use.
“Changes in social norms might help reduce youth susceptibility to try cigarettes and other tobacco products and accelerate the decline in tobacco use among youths,” the researchers wrote.

August, 2010|Oral Cancer News|

A tough one to chew on: smokeless tobacco and teens

Source: Medscape Today
Author: Mary E. Muscari, PhD, CPNP, APRN-BC, CFNS


One would think that the mere image of a bulgy cheek spewing brown, foul-smelling goo would be more than enough to turn anyone, especially appearance-conscious teens, off of using smokeless tobacco (ST). But then, these media-savvy adolescents probably have discovered snus, a smoke- and spit-free tobacco. According to a recent article in Reuters,[1] the use of ST is on the rise among US teens, reversing a downward trend in tobacco product use by adolescents. The Reuters article cites comments made by Terry Pechacek, PhD, Associate Director for Science, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), in a report to a US Congressional Panel. Among his comments is the suggestion that ST-using Major League Baseball® (MLB) players may be influencing young men to take up the cancer-causing habit. In his report, Dr. Pechacek noted that “the recent increases in ST use by adolescent boys and young adult men and the increasing dual use of cigarettes and ST products may portend a leveling off or even a reversal in the decline in smoking, the perpetuation of nicotine dependence, and continuing high levels of tobacco-related disease and death in the country.”[2] Given this grim outlook, healthcare professionals need to kick up their fight against teen tobacco use by increasing their focus on smokeless forms of tobacco.

Smokeless Tobacco

ST (also known as spit, plug dip, chaw, rack, spits, grizz, and tasties) comes in 2 forms: chew and snuff. Chewing tobacco is available in loose-leaf, twist, and plug forms, whereas snuff comes in moist, dry, and sachet forms.[2,3]

  1. Snuff: Available in dry or moist forms, snuff isfinely ground or shredded tobacco leaves that are packaged in tins or teabag-like pouches. A pinch of snuff is placed between the lower lip and gum or cheek and gum. Users typically spit out the tobacco juices, but those who swallow the juices become more addicted. Dry forms of snuff can be sniffed into the nose; using snuff is also called dipping.[2,3]
  2. Chew (chaw): A wad of chewing tobacco is placed inside the cheek and held there, sometimes for hours, and users spit out the tobacco juices. Chew is made fromloose tobacco leaves that are sweetened and packaged in pouches.
  3. Plug: Chewing tobacco is pressed into a brick, usually with the help of molasses or another sweet syrup. Users cut off or bite off a piece of the plug and hold it between the cheek and gum, spitting out the tobacco juices.
  4. Twist: Twist is flavored chew, braided and twisted into rope-like strands. It is held between the cheek and gum, and users spit out the tobacco juices.
  5. Snus: The relatively new snus(pronounced “snoos”) is a smokeless, spitless tobacco product that originated in Sweden. Snus comes in a pouch that is placed between the upper lip and gum for about a half-hour before discarding.
  6. Dissolvable tobacco products: Pieces of compressed powdered tobacco, similar to small hard candies, dissolve in the mouth and require no spitting of tobacco juices. Instead, they melt like breath mints. Sometimes called “tobacco lozenges,” these products are sold in shiny plastic cases and are not to be confused with the nicotine lozenges used for smoking cessation. Dissolvable tobacco products include[4]:
    • Orbs: similar to popular tiny breath mints;
    • Sticks: similar to toothpicks; and
    • Strips: similar to mouthwash breath strips.

According to the National Cancer Institute, ST contains at least 28 carcinogens in varying concentrations. The most harmful are the tobacco-specific nitrosamines, which are formed during the growing, curing, fermenting, and aging of tobacco. Tobacco-specific nitrosamines have been detected in some ST products at higher levels than levels of other types of nitrosamines, which are allowed in foods, such as bacon and beer. Other carcinogens include N-nitrosamino acids, volatile N-nitrosamines, benzo(a)pyrene, volatile aldehydes, formaldehyde, acetaldehyde, crotonaldehyde, hydrazine, arsenic, nickel, cadmium, benzopyrene, and polonium-210. Similar to smoked tobacco, ST contains nicotine, which is addictive, and the amount of nicotine absorbed from ST is 3 to 4 times greater than the amount delivered by a cigarette. Nicotine is absorbed more slowly from ST than from cigarettes; however, more nicotine per dose is absorbed from ST than from cigarettes, and the nicotine stays in the bloodstream for a longer time.[5]

Prevalence of Smokeless Tobacco Use in Teens

In 1970, men aged 65 years or older were almost 6 times as likely as those aged 18 to 24 years to use ST regularly, but by 1991, young men were 50% more likely than the oldest men to be regular users.[6] The 2009 Youth Risk Behavior Surveillance Survey[7] (YRBSS), which summarized results from public and private schools with students in at least 1 of grades 9-12 in the 50 US states and the District of Columbia, found that 8.9% of students had used ST (eg, chewing tobacco, snuff, or dip) on at least 1 day during the 30 days before the survey. The YRBSS also found that use was higher among boys (15.0%) than girls (2.2%) and higher among white persons (11.9%) than black (3.3%) and Hispanic persons (5.1%).[7]

ST has long been a staple in the rural United States, and it remains a problem among rural youth. The table demonstrates that in many states with large rural areas, prevalence of ST use among youth was higher than the national average.[8] Compared with urban children, rural children in the US are more likely to be poor, be white, and have less educated parents. Rural children also engage in more smoking, drinking, and drug use than their urban counterparts.[9]

Table. 2009 YRBSS Results on Smokeless Tobacco in US Rural Regionsa

State Prevalence Percentage
National 8.9
Alabama 12.4
Alaska 13.6
Arkansas 12.4
Colorado 10.7
Idaho 9.4
Louisiana 9.6
Kentucky 14.2
Montana 14.6
North Dakota 15.3
Oklahoma 10.5
South Carolina 10.4
South Dakota 14.6
Tennessee 12.2
West Virginia 14.4
Wyoming 16.2

a Used chewing tobacco, snuff, or dip on at least 1 day during the 30 days before the survey.

To describe substance use among Pennsylvania rural youth, Aronson and colleagues[10] identified changes and trends from 2001 through 2005 and compared these trends with use among urban youth. They found that ST use was more prevalent among rural youth than urban youth, although a significant shift toward increased ST use among urban 10th-grade boys occurred in 2005. They also found that:

  1. ST use by rural Pennsylvania youth far exceeded use reported at the national level.
  2. In the 12th grade, approximately 25% of rural boys used ST, compared with no more than 15% of urban boys.
  3. Nearly 12% of rural 12th grade girls used ST in 2005.
  4. Prevalence doubled for rural girls in 6th through 8th grades in both 2003 and 2005.
  5. At nearly every time point and in every grade, lifetime ST use increased for rural girls and boys.

Health Hazards of Smokeless Tobacco

The health hazards of ST vary as widely as the types of products and the manner in which they are used. Variations in health risks are possible for persons using both cigarettes and ST compared with those using ST alone. Potential hazards include[3,11]:

  • Nicotine dependence: The nicotine in ST is absorbed directly into the bloodstream and is addicting. Withdrawal often creates the same symptoms as those seen in heavy smokers who attempt to quit. Some manufacturers of ST products have altered the nicotine content and pH, added flavors, and packaged moist snuff in sachets as starter products that gradually move novice users on to higher levels of nicotine as their tolerance increases;
  • Cancer: ST can contribute to oral cancers, as well as cancer of the esophagus and pancreas;
  • Leukoplakia: ST increases the risk for leukoplakia (precancerous lesions);
  • Heart disease: ST contains nicotine, which can contribute to cardiovascular disease and hypertension; and
  • Dental problems: ST can contribute to gingivitis and dental caries.

The Allure of Smokeless Tobacco

ST has been around for a long time. So why are more teens discovering it now? Increased interest in ST may have several causes[3,12]:

  1. Teens may still view ST as relatively harmless compared with cigarettes.
  2. Adolescent girls may use ST to try to lose weight.
  3. With increasing smoking restrictions, ST gives people a way to get nicotine without having to go out in the cold or having to wait until they are out of the no-smoking zone.
  4. Recent mergers and acquisitions resulted in the production and sales of ST moving from companies that do not manufacture cigarettes to companies that do manufacture them.
  5. New forms and flavors of ST are more appealing to youth. A quick Internet search revealed such flavors as apple, butternut, peach, tequila, black wild cherry, “fresh,” and “mellow.” Some of the new snus containers are downright adorable.
  6. Smokeless products are heavily promoted.
  7. Smokeless products are used by youth role models, including MLB players and rodeo stars.

Whereas rodeo stars are more likely to influence rural children, baseball players have a much broader influence, and it is the association between MLB and ST that concerns Dr. Pechacek. Chew is probably as much a symbol of baseball as hot dogs, and its use dates back to the mid-1800s. Players initially used it to keep their mouths moist and gloves soft (by spitting into them). ST use began to decline with the increased use of cigarettes in the 1950s, but players reversed that trend and went back to ST when they learned about the dangers of cigarettes. In 1990, MLB warned players of the dangers of ST and began efforts to help players quit. Since that time, many players have educated young baseball players on the dangers of ST.[13]

Implications for Healthcare Providers

Healthcare providers need to be as aggressive with ST as they are with cigarettes, in both research and practice. Research must focus on the specific types of ST to firmly establish correlations with health problems, particularly in pediatric users, to understand the short- and long-term effects. Research should also guide the development of evidence-based prevention and cessation programs. Practitioners should work together with dental professionals to incorporate possible ST use into assessment, prevention, and intervention.

Primary prevention. Healthy People 2010 objective 27-3 is “Reduce the initiation of tobacco use among children and adolescents.” Objective 27-4.a is “Increase the average age of first use of tobacco products by adolescents (from an average of age 12 to an average of age 14 years) and young adults (from age 15 to age 17 years).”[14]These are average ages of initiation; children younger than 12 years often use tobacco products, especially ST. The first thing practitioners must do is to take this objective to a lower age level, preferably beginning with the early school-age years. Primary care providers need to incorporate ST prevention into anticipatory guidance counseling and to instruct parents to talk with their children about ST products and to role-model positive health behaviors by not using ST — or any form of tobacco.

Secondary prevention. All healthcare providers should ask clients, regardless of age, about the use of ST. This is especially true in inpatient facilities, where clients may be using these products while hospitalized. Of course, healthcare providers should also encourage — and help — clients to quit. Quitting is not easy, even for adolescents, because of nicotine dependence. Withdrawal symptoms (dizziness, depression, frustration, impatience, anger, anxiety, irritability, trouble sleeping, difficulty concentrating, restlessness, headaches, tiredness, and increased appetite) are unpleasant. Users may benefit from cessation support groups, such as Nicotine Anonymous or local groups available through the American Cancer Society or those listed in the phone book. Appropriate nicotine replacement treatments may be beneficial; however, these are not approved by the US Food and Drug Administration (FDA) for ST cessation. Smoking cessation medications (such as Bupropion [Zyban®]) are not FDA-approved for children younger than 18 years.[15,16]

On a broader level, healthcare providers can assist schools and state agencies by providing group education on ST. Several federal agencies are available to provide support, including the CDC’s Smoking and Tobacco Use Media Campaign Resource Center.[17] Finally, healthcare providers can become involved in advocacy by supporting legislation that minimizes ST advertising and exposure to minors. Healthcare providers cannot allow the fight against tobacco to be chewed up and spit in the gutter.

Web Resources

Campaign for Tobacco Free Kids

Smokeless Tobacco Fact Sheets

Spit Tobacco: A Guide for Quitting by the National Institute of Dental and Craniofacial Research

Tips for Teens: The Truth About Tobacco

World Health Organization’s Tobacco Free Initiative

July, 2010|Oral Cancer News|

CDC: Global tobacco marketing is reaching young women

Source: CDC
Author: Staff

As World Recognizes “World No Tobacco Day 2010”

Although women account for only about 20 percent of the world’s 1.3 billion smokers, tobacco use among women is on the rise.  Particularly troubling is new data from three countries —Bangladesh,Thailand, and Uruguay—indicating greater exposure to cigarette marketing among young women (ages 15 to 24) than older women, according to a CDC study.

In Bangladesh, exposure to bidi cigarettes (80.1 percent) and smokeless tobacco (69.9 percent) marketing was widespread among women and did not vary by age.  Bidi cigarettes are hand rolled cigarettes made of tobacco that are primarily used in Bangladesh, India, and Pakistan.

Launched in 2007, the Global Adult Tobacco Survey (GATS) is a nationally representative household survey of persons ages 15 years and older being implemented in 14 countries around the world.  Bangladesh, Thailand and Uruguay are the first three countries for which 2009 data is available.  Before GATS, no one standard global survey for adults has consistently tracked tobacco use and other tobacco control measures.

“Tobacco kills more people each year than HIV, tuberculosis, and malaria combined, and tobacco deaths are increasing steadily,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “The results of these surveys show one of the key reasons for the tobacco epidemic – marketing, including to women and girls. Countries around the world should establish and enforce comprehensive bans on advertising, sponsorship, and promotion of tobacco products,” he said.

Other report highlights:

  • In Bangladesh, 1.5 percent of women are current smokers, compared with 44.7 percent of men, while the prevalence of smokeless tobacco use is similar for men and women (26.4 percent and 27.9 percent, respectively)
  • In Thailand, 3.1 percent of women are current smokers, compared with 45.6 percent of men, while the prevalence of smokeless tobacco use is 6.3 percent for women, compared with 1.3 percent for men.
  • In Uruguay, 19.8 percent of women are current smokers, compared with 30.7 percent of men. Uruguay has almost no smokeless tobacco use.

“Monitoring the global tobacco epidemic is essential to measuring the impact of tobacco control policies and interventions,” said Samira Asma, D.D.S., M.P.H., Chief, Global Tobacco Control Branch, CDC’s Office on Smoking and Health.  “The Global Adult Tobacco Survey is critical to our understanding of tobacco use worldwide.”

To effectively combat the tobacco epidemic, the World Health Organization recommends MPOWER, a technical assistance package that requires monitoring tobacco use and prevention policies, protecting people from tobacco smoke, offering help to quit tobacco smoking, warning about the dangers of tobacco, enforcing bans on tobacco advertising, promotion and sponsorship, and raising taxes on tobacco.

The World Health Organization (WHO) created World No Tobacco Day in 1987 to draw global attention to the tobacco epidemic and the preventable death and disease it causes. The theme for this year’sWorld No Tobacco Day—which takes place on May 31—is “gender and tobacco with an emphasis on marketing to women.”

Funding for GATS is provided by the Bloomberg Initiative to Reduce Tobacco Use and is conducted in partnership with the Campaign for Tobacco Free Kids, CDC Foundation, Johns Hopkins Bloomberg School of Public Health, World Health Organization, and the World Lung Foundation. Other participating countries are Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russian Federation, Turkey, Ukraine and Vietnam.

For an online version of the MMWR report, please visit  For information on World No Tobacco Day, visit, and for additional information and materials, including posters, visit WHO’s Tobacco Free Initiative at

June, 2010|Oral Cancer News|

U.S. cigarette brands tops in cancer causing chemicals

Source: CNN
Author: Miriam Falco

Smokers of U.S. brand cigarettes may get more bang for their buck in the worst way according to a small study conducted by the Centers for Disease Control and Prevention.

Researchers found U.S. made cigarettes contain more cancer-causing chemicals than some cigarettes brands made elsewhere around the world.

“Not all cigarettes are made alike” says Dr. Jim Pirkle, deputy director for science at the CDC’s National Center for Environmental Health. He says this is the first study to show that “U.S. cigarettes have more of the major carcinogen [TSNAs] than foreign made cigarettes.” TSNAs are “tobacco-specific nitrosamines,” the major cancer-causing substance in tobacco.

126 smokers in five cities – Waterloo, Ontario; Melbourne, Victoria (Australia); London, England, Buffalo, New York, and Minneapolis, Minnesota – were recruited for this study.

They were between the ages of 18 and 55 and smoked at least 10 cigarettes a day for the past year and had been brand loyal for at least three months. The cigarettes smoked by the study recruits represented some of the more popular brands for each country including: Players light and DuMaurier in Canada; Marlboro, Newport Light, Camel Light in the U.S.; Peter Jackson and Peter Stuyvesant in Australia; and Benson & Hedges and Silk Cut Purple in the United Kingdom.

Scientists analyzed more than 2,000 cigarette butts to get the data they are reporting today, says Pirkle.

When researchers compared cigarette brands in the U.S. to those in Canada and Australia, they found three times higher levels of the cancer causing substance in the U.S. smokers’ mouths. The mouth levels are important because they give an indication of what levels if carcinogens are going into the lungs. (Smoking tobacco is a major cause of lung cancer).

“If you want to stop exposure to these things, you have to stop smoking.”

They also found twice as much TSNA in the urine samples of U.S. smokers compared to those in Canada and Australia, an indication that cancer-causing substance has traveled throughout the body.

There is no one group that speaks for the tobacco institute anymore, according to Darryl Jason, a spokesman for the Tobacco Merchants Association (TMA), which is why he couldn’t comment on the study. The TMA was founded in 1915 to “manage information of vital interest to the worldwide tobacco industry according to their website. Jason did point out that cigarettes manufactured in the U.S. contain a different blend of tobacco from cigarettes made elsewhere.

The study acknowledges that there are different types of tobacco depending where the cigarettes are made. But that’s only one factor says Pirkle: “The TSNA levels largely come from the way tobacco is cured.” The heating process, humidity and the type of the ferlizer used to grow the tobacco also contribute to the levels of cancer causing substances, says Pirkle.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

June, 2010|Oral Cancer News|

CDC urges 50-state anti-smoking effort

Source: CNN
Author: Ann Curley

In 2007, the Institute of Medicine, the medical branch of the National Academy of Sciences, released “Ending the Tobacco Problem: A Blueprint for the Nation,” stating a goal of eliminating smoking as a public health problem in the United States. The strategies included strengthening and fully activating tobacco control methods similar to the CDC’s plans, as well as tobacco regulation.

In 2008, the World Health Organization’s MPOWER program outlined additional steps that complemented and reinforced the other agencies’ recommendations.

As an example of the success of these strategies, the CDC cites the state of California, which has one of the oldest comprehensive tobacco control programs. California cut adult smoking rates from 22.7 percent in 1988 to 13.3 percent in 2006. That reduction in smoking accelerated the decline of heart disease deaths and lung cancer incidence in California, compared with the rest of the country.

In 2009, 14 states and the District of Columbia implemented an excise tax on cigarettes. Those state tax hikes followed a 62-cent federal cigarette tax hike instituted by Congress in April 2009.

Twenty-four states and D.C. have comprehensive smoke-free laws. Seven states do not have statewide smoke-free laws of any type: Indiana, Kentucky, Mississippi, South Carolina, Texas, West Virginia and Wyoming.

While some progress has been made in getting more states to implement tobacco control measures, the report stresses that much more is still needed.

The CDC’s Best Practices for Comprehensive Tobacco Control Programs 2007 noted that states could plan and enact tobacco control programs with a small percentage of tobacco excise tax revenues and funds from a 1998 agreement between states’ attorneys general and the four largest tobacco companies.

The report concludes that putting uniform tobacco control policies in place would dramatically reduce the health and economic burden on states.

“The first step is knowledge, knowing what the issues are,” Frieden said. “We need to act.”

April, 2010|Oral Cancer News|