SMOKING AND LUNG CANCER IN SOUTHERN NC: What the data tell us. Lynn Erdman, RN, MN, OCNS American Cancer Society

Transcription

1 SMOKING AND LUNG CANCER IN SOUTHERN NC: What the data tell us Lynn Erdman, RN, MN, OCNS American Cancer Society

2 Tobacco and Cancer Tobacco use remains the leading preventable cause of death and disease for men and women in the US. Nearly one-third of all cancer deaths are directly linked to smoking. Smoking causes more than 85% of lung cancers. USDHHS. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA 2010

3 National Trends in Lung Cancer Incidence and Smoking Lung cancer incidence in men ( ) continued to decrease Lung cancer incidence in women ( ) decreased for first time in decades Decreases closely parallel smoking behavior patterns across the US CDC. State-specific trends in lung cancer incidence and smoking United States, MMWR 2011,60:

4

5

6

7 Causality of smoking and lung cancer The evidence is sufficient to infer a causal relationship between smoking and lung cancer. USDHHS, The Health Consequences of Smoking: A Report of the Surgeon General

8 Criteria for Causality 1. Temporal relationship 2. Strength of the association 3. Dose response relationship 4. Consistency of findings 5. Biological plausibility Bradford-Hill, Austin (1965). "The Environment and Disease: Association or Causation?". Proceedings of the Royal Society of Medicine 58:

9 1. Temporal relationship Smoking cessation is the only proven strategy for reducing the pathogenic processes leading to cancer USDHHS. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA 2010

10 2. Strength of the Association Cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking far outweighs all other factors. The data for women, though less extensive, point in the same direction. US Department of Health Education and Welfare Smoking and Health. Report of the Advisory Committee to the Surgeon General of the Public Health Service, p. 196

11 3. Dose-response relationship Risk of lung cancer depends largely on the duration of smoking and the number of cigarettes smoked (Samet 1996) Many studies provide RR estimates for developing lung cancer of 20 or higher for smokers compared with lifetime nonsmokers (USDHHS 1990; Wu-Williams and Samet 1994) USDHHS, The Health Consequences of Smoking: A Report of the Surgeon General

12 No Risk-free Level of Exposure to Tobacco Smoke

13 4. Consistency of findings Scientific evidence for link between tobacco products and damage to the human body has grown for 50 years 29 Surgeon Generals reports documented that tobacco use is harmful and can be deadly USDHHS. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA 2010

14 5. Biological plausibility Several carcinogens in cigarette smoke are noted for their high concentrations and carcinogenic potency Smoking increases the frequency of DNA adducts (carcinogen bonded to DNA) Adducts lead to DNA miscoding and mutations that result in tumor formation and progression USDHHS. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA 2010

15 Lung Cancer In Southern NC

16

17

18 Lung/Bronchus Cancer Rates by County per 100,000 population 1 Incidence Mortality Cases Rate Cases Rate United States North Carolina 34, , Southern Regional AHEC: Bladen Cumberland Harnett Hoke Moore Richmond Robeson Sampson Scotland

19 Lung/Bronchus Cancer Rates by County per 100,000 population 1 Incidence Mortality Cases Rate Cases Rate United States North Carolina 34, , Southeast AHEC: Brunswick Columbus Duplin New Hanover Pender

20 Lung/Bronchus Cancer Incidence by Age South Central AHEC Incidence Rate (cases per 100,000) 300 White population in North Carolina Black population in North Carolina White population in South Central NC Black population in South Central NC Age Age Age Age 70-79

21 Lung/Bronchus Cancer Incidence by Age South East AHEC Incidence Rate (cases per 100,000) 300 White population in North Carolina Black population in North Carolina White population in South East NC Black population in South East NC Age Age Age Age 70-79

22 Stage Distribution and 5-year Relative Survival by Stage at Diagnosis for , US, All Races, Both Sexes Stage at Diagnosis Stage Distribution (%) Localized (confined to primary site) Regional (spread to regional lymph nodes) Distant (cancer has metastasized) Unknown (unstaged) year Relative Survival (%) From: NCI, SEER Stat Fact Sheets: Lung and Bronchus, 2011

23 Stage at Diagnosis of Lung/Bronchus Cancer by percent; NC SE SC Local Regional Distant

24 Cigarette Use In Southern NC

25

26 2010 Smoking Status Rates per 100,000 Never smoked Former smoker Smokes some days North Carolina South East South Central Smokes every day BRFSS Report of Individual Cancer Risk Factors

27 Resources Tobacco Use and Lung Cancer in Western North Carolina North Carolina Prevention Report Card 2010 American Cancer Society