Tobacco Cessation and Control a Decade Later: American Society of Clinical Oncology Policy Statement Update

Tobacco use constitutes the largest preventable cause of death and disability in developed countries and a rapidly growing health problem in developing nations. It is responsible for 30% of all cancer deaths and 80% of lung cancer deaths and is associated with increased risk for at least 17 types of cancer. In addition to the tremendous human toll tobacco has taken in the 20th and 21st centuries, the economic costs of tobacco-related illnesses remain enormous. From 2000 to 2004, the United States spent approximately 193 billion each year on tobacco-related illnesses and lost productivity because of tobaccorelated premature death. Loss in productivity and increased health care costs associated with secondhand smoke (SHS) were reported in 2005 to have cost the United States an additional 10 billion per year. Although the United States has witnessed a decline in cigarette use, the use of other tobacco products is on the rise. Furthermore, the rate of reduction of youth tobacco use is no longer as rapidly decreasing, despite intense public education and policy efforts to reduce youth tobacco use. At the global level, the epidemic of tobacco-related disease and death has just begun, because of the several-year lag between when individuals begin using tobacco and when their health suffers. Tobacco caused 100 million deaths in the 20th century. If current trends continue, it will cause up to 1 billion deaths in the 21st century. Unchecked, tobacco-related deaths will increase to more than 8 million per year by 2030. More than 80% of those deaths will be in lowand middle-income countries. As the leading professional organization representing physicians involved in cancer treatment and research, the American Society of Clinical Oncology (ASCO) is dedicated to the prevention and treatment of cancer. The overarching goal of the tobacco cessation and control efforts of ASCO are to promote the rapid, worldwide reduction and ultimate elimination of tobacco-related disease through discouraging the use of tobacco products and exposure to secondhand tobacco smoke. The tobacco control efforts of ASCO are led by a subcommittee of the Cancer Prevention Committee. The primary tobacco control goals of ASCO are multifaceted: 1) to develop an oncology workforce that effectively integrates tobacco cessation and control into its practices; 2) to collaborate with other organizations and professional societies to promote rapid, worldwide reduction in tobacco use and ultimate elimination of tobacco-caused disease, including disease resulting from secondhand smoke; and 3) to urge oncology providers to become proponents of tobacco policy change. In 2003, ASCO released a policy statement on tobacco cessation and control, which set forth specific recommendations and called for personal accountability in eradicating tobacco use domestically and globally. Since that time, there have been significant developments in tobacco cessation and control that have changed the political and scientific landscape. In response, the ASCO Cancer Prevention Committee commissioned this update of the previous ASCO statement to reflect the evolving regulatory and policy environment. This statement reviews advancements that have been made in tobacco cessation and control since 2003 and sets forth a refined set of recommendations for addressing tobacco cessation and control based on current challenges and opportunities. Key principles in the statement are as follows: