On signing the National Cancer Act of 1971, which embodied his plan for a War on Cancer, President Nixon called for “a national commitment for the conquest of cancer.”
In 2016, then-Vice President Biden inaugurated a Cancer Moonshot to accelerate progress against cancer.
On February 2 this year, the White House announced that now-President Biden was reigniting the Cancer Moonshot “to reduce the death rate from cancer by at least 50% over the next 25 years, and…end cancer as we know it today.” The initiatives of both Presidents focused on research and development of new treatments but also included cancer prevention and screening and improved patient care.
Neither Nixon in 1971 nor Biden in 2016 mentioned reducing cigarette smoking, the leading cause of cancer death in both men and women. The February 2 Moonshot statement did, however, acknowledge progress against smoking. (Long the leading cause of male cancer mortality, lung cancer surpassed breast cancer as the leading cause of cancer death in women in 1987. Even decades later, two-thirds of women still believed breast cancer was the leading cause.)
More recently, on June 21, the Biden administration announced plans for what would likely be the most effective measure ever to reduce smoking: requiring the reduction of nicotine in combusted tobacco products to non-addictive levels. This could also be the most effective single measure to reduce future cancer mortality.
If seriously pursued, this controversial regulation will ignite a firestorm of opposition from the tobacco industry, tobacco product retailers, philosophical opponents, and of course many smokers. That opposition means that implementation will not occur for years, if ever. (Interestingly, a significant if uncertain fraction of current smokers supports reducing nicotine to non-addicting levels.)
How significantly might a very-low nicotine regulation impact cancer mortality? We can get a feel for the answer by looking back, asking how the War on Cancer has progressed to date, and how the decades-old battle against smoking has affected that progress.
While progress against cancer affects rates of cancer diagnosis, incidence, and 5-year survival, I will focus exclusively on arguably the most important metric: the cancer death rate. Smoking causes a myriad of cancers, including cancers of the mouth, throat, bladder, kidney, liver, stomach, pancreas, colon and rectum, and cervix. However, I will examine only lung cancer, the single largest source of smoking-produced cancer mortality and the most important cancer “marker” of smoking. The other cancer sites have several causes (some unknown), while 80-90% of lung cancers are linked to cigarette smoking and second-hand exposure to cigarette smoke.
Adult smoking prevalence has declined substantially since Nixon declared his War on Cancer, from 37% in 1971 to 12.5% in 2020. Both laws and norms impede smoking today, with smoking prohibited in many workplaces and public places, and cigarettes increasingly expensive due to increases in manufacturers’ wholesale prices and government excise taxes. In addition to reducing smoking prevalence, these factors have significantly reduced the percentage of current smokers who smoke every day, and the number of cigarettes daily smokers consume. The decreases in the percentage of smokers and the numbers of cigarettes they smoke have produced a sharp decline in a measure that combines both smoking prevalence and daily cigarette consumption: annual adult per capita cigarette consumption (APCCC).
Kenneth Warner – MedPage Today – 2022-07-30
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