Public health approach needed to win the war on cancer

31 January 2009

Smoke-free laws and other proven methods are an essential component of the public health approach to preventing cancer, according to an article published in The Oncologist.

"Winning the war on cancer will require a much larger investment in prevention to complement efforts to improve treatment," according to lead author Dr Thomas R Frieden, Commissioner of the New York City Department of Health and Mental Hygiene. The new article comes at a time when increasing evidence shows the effectiveness of one particular preventive strategy: smoke-free legislation.

Steps to reduce tobacco use are "the most important actions for primary prevention of cancer," Dr Frieden and colleagues write. In New York City, a tobacco control program including smoke-free legislation, led to a decline in adult smoking prevalence of about 300,000 smokers. In the years ahead, this is expected to prevent early death in approximately 100,000 New Yorkers.

A recent study including researchers from the US Centers for Disease Control and Prevention found that a smoking ban in Pueblo, Colorado, was followed by a sharp reduction in hospitalization for heart attacks — 40% lower than in a neighbouring community.

"This is the latest in a growing list of studies showing a sharp drop in heart attack hospitalizations after smoke-free ordinances — it's a very real and reproducible effect," comments Dr. Richard D. Hurt, Director of the Nicotine Dependence Center at the Mayo Clinic. "Considering that 30% of cancers in the United States are caused by cigarette smoking, we can expect a similarly consistent effect on cancer rates in the years ahead."

The call for an emphasis on prevention is echoed by the CEO Roundtable on Cancer, a partnership of business, academic, and government leaders dedicated to continual progress toward the elimination of cancer as a personal disease and public health problem. A key initiative is the "CEO Cancer Gold Standard," which encourages risk reduction, early detection, and quality care of cancer. Dr. Martin J. Murphy, Executive Editor of The Oncologist, also serves as Convener and Chief Executive Officer, CEO Roundtable on Cancer.

"Of the 'five pillars' of the CEO Cancer Gold Standard, the first three focus on risk reduction and prevention," says Dr. Murphy. "Efforts to reduce tobacco use start with the first pillar which focuses on a tobacco-free workplace."

Other components include no-cost coverage for evidence-based treatments and other workplace-based tobacco cessation initiatives. Complete information on the Gold Standard is available at

"The New York City tobacco laws and the CEO Cancer Gold Standard are examples of the types of policies that can successfully limit people's exposure to active and passive smoking in every aspect of their daily lives," comments Dr Michael C Fiore, Director of the Center for Tobacco Research and Intervention at University of Wisconsin Medical School. "If we truly want to prevent cancer in America, such proven approaches provide a clear roadmap."

Along with smoke-free environment policies, other approaches to reducing tobacco use include taxation, advertising restrictions, "counter advertising," and smoking cessation programs. However, Frieden and colleagues cite evidence that less than five percent of people in the world were covered by these effective prevention programs.

"Without a doubt, we still have much work to do, in researching the biological, if not genetic, origins of tobacco addiction—and, on a more practical level, continuing to strive to help millions more Americans rid themselves of tobacco addiction," says Dr. John E. Niederhuber, director of the National Cancer Institute.

"We know a great deal about the true dangers of active and passive exposure to tobacco, and we have learned a great deal about what we need to do—especially with our youth. We need desperately to re-energize our collective efforts."

The article entitled "A Public Health Approach to Winning the War Against Cancer," has been published by "The Oncologist," and is freely available online at:

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