Dreams become reality - success with tobacco control means success with cancer control Christopher Squier College of Dentistry University of Iowa.

Dreams become reality Dreams become reality - - success with tobacco control means success with tobacco control means

success with cancer controlsuccess with cancer control

Dreams become reality Dreams become reality - - success with tobacco control means success with tobacco control means

success with cancer controlsuccess with cancer control

Christopher SquierChristopher SquierCollege of DentistryCollege of Dentistry

University of IowaUniversity of Iowa

The presentation will:The presentation will:

review the relationship between tobacco and cancerreview the relationship between tobacco and cancer

discuss the elements of tobacco control discuss the elements of tobacco control

celebrate our successes in tobacco control and describe celebrate our successes in tobacco control and describe the challenges that remain the challenges that remain

Tobacco use is the single most preventable Tobacco use is the single most preventable cause of cancercause of cancer

Approximately 30% of all cancer is related to Approximately 30% of all cancer is related to tobacco use and this rises to 80% for lung and tobacco use and this rises to 80% for lung and oral canceroral cancer

Types of exposure to tobaccoTypes of exposure to tobaccoTypes of exposure to tobaccoTypes of exposure to tobacco

VoluntaryVoluntary SmokingSmoking Smokeless – snuff and chewing tobaccoSmokeless – snuff and chewing tobacco

Involuntary Involuntary secondhand smokesecondhand smoke

Why does tobacco cause cancer?Why does tobacco cause cancer?Why does tobacco cause cancer?Why does tobacco cause cancer?

Because of what is in it – carcinogensBecause of what is in it – carcinogens

Smoke contains Smoke contains Strong carcinogens Strong carcinogens (polycylic aromatic hydrocarbons e.g. benthanthracene)(polycylic aromatic hydrocarbons e.g. benthanthracene) Weak carcinogens Weak carcinogens (nitrosamines e.g. NNN, NNK)(nitrosamines e.g. NNN, NNK) Co-carcinogens Co-carcinogens (catechols)(catechols)

Unburned (smokeless) tobacco containsUnburned (smokeless) tobacco contains Weak carcinogens Weak carcinogens (nitrosamines e.g. NNN, NNK)(nitrosamines e.g. NNN, NNK)

Why does tobacco cause cancer?Why does tobacco cause cancer? Because of where it goesBecause of where it goes

Why does tobacco cause cancer?Why does tobacco cause cancer? Because of where it goesBecause of where it goes

Into the mouth, airways and lungsInto the mouth, airways and lungs and then into the bloodstreamand then into the bloodstream

Cancers related to smokingCancers related to smokingCancers related to smokingCancers related to smoking Lung cancerLung cancer Laryngeal cancerLaryngeal cancer Oropharyngeal cancer Oropharyngeal cancer Esophageal cancerEsophageal cancer

Other cancers Other cancers – bladderbladder– pancreaspancreas– kidneykidney– stomachstomach– cervixcervix– breast?breast?

Aero-digestive cancers represent theAero-digestive cancers represent themajority of cancers related to smokingmajority of cancers related to smoking (clear evidence of causality)(clear evidence of causality)

Other forms of tobacco exposureOther forms of tobacco exposureOther forms of tobacco exposureOther forms of tobacco exposure

Smokeless tobaccoSmokeless tobacco

Secondhand smokeSecondhand smoke

Smokeless tobacco Smokeless tobacco Smokeless tobacco Smokeless tobacco Recent data suggests thatRecent data suggests that:: The risk of oral cancer from the use of chewing tobacco The risk of oral cancer from the use of chewing tobacco

and snuff is relatively low*and snuff is relatively low*

Chewing tobacco 1.2 (1.0-1.4)*Chewing tobacco 1.2 (1.0-1.4)*

Moist snuff 1.0 (0.8-1.2)Moist snuff 1.0 (0.8-1.2)

The risk from dry snuff is high (but this is rare in the US)The risk from dry snuff is high (but this is rare in the US)

Dry snuff 5.9 (1.7-20)Dry snuff 5.9 (1.7-20)

There may be a risk of pancreatic cancer associated with use of Swedish ‘snus’There may be a risk of pancreatic cancer associated with use of Swedish ‘snus’

* Relative risk and confidence limits; data from Rodu, B et al., Harm Reduct J. Relative risk and confidence limits; data from Rodu, B et al., Harm Reduct J. 33, 37,2006, 37,2006

Secondhand Smoke – why is it harmful?Secondhand Smoke – why is it harmful?Secondhand Smoke – why is it harmful?Secondhand Smoke – why is it harmful?

Sidestream (secondhand) smokeSidestream (secondhand) smoke has been shown to be more has been shown to be more carcinogenic than mainstream smokecarcinogenic than mainstream smoke (Ninth Report on Carcinogens, (Ninth Report on Carcinogens, U.S. Department of Health and Human Services Public Health Service National U.S. Department of Health and Human Services Public Health Service National Toxicology Program 2001)Toxicology Program 2001)

You don’t get the benefit of the filter!You don’t get the benefit of the filter!

Cancers related to secondhand smoke exposureCancers related to secondhand smoke exposureCancers related to secondhand smoke exposureCancers related to secondhand smoke exposure

Deaths from secondhand smoke~50,000 per year

Ischaemic Heart DiseaseIschaemic Heart Disease46,15046,150

Lung CancerLung Cancer4,400

SIDSSIDS431

**Attributable Risks Associated with ETS; Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Attributable Risks Associated with ETS; Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant, California Environmental Protection Agency, March 2005Contaminant, California Environmental Protection Agency, March 2005

**

Other cancers relatedOther cancers relatedto SHS exposure;to SHS exposure;– nasalnasal–breastbreast–cervixcervix–bladderbladder

Tobacco Control is a three-legged stoolTobacco Control is a three-legged stoolTobacco Control is a three-legged stoolTobacco Control is a three-legged stool

$$SignificantSignificanttaxation of taxation of tobaccotobacco

EffectiveEffectivesmokefreesmokefreelegislationlegislation

ComprehensiveComprehensivetobacco control tobacco control

programsprograms

In Iowa we have two of the legs in place!In Iowa we have two of the legs in place!In Iowa we have two of the legs in place!In Iowa we have two of the legs in place!

$$SignificantSignificanttaxation of taxation of tobaccotobacco

EffectiveEffectivesmokefreesmokefreelegislationlegislation

ComprehensiveComprehensivetobacco control tobacco control

programsprograms

Calls up 3x!Calls up 3x!

TUPC budgetTUPC budgetdoubled!doubled!

SHS and Smokefree LegislationSHS and Smokefree LegislationSHS and Smokefree LegislationSHS and Smokefree Legislation

We need comprehensive legislation to protect employeesWe need comprehensive legislation to protect employees – it is – it is not about customers who can go elsewhere but about safe not about customers who can go elsewhere but about safe workplaces for workers who cannot!workplaces for workers who cannot!

This is a public health not a business decisionThis is a public health not a business decision – we don’t leave – we don’t leave clean food preparation to the whims of the business owner, clean food preparation to the whims of the business owner, why should we leave smokefree workplaces?why should we leave smokefree workplaces?

SHS and Smokefree LegislationSHS and Smokefree LegislationSHS and Smokefree LegislationSHS and Smokefree Legislation

How do we get it?How do we get it? State-wide legislation is very attractive but it isState-wide legislation is very attractive but it is

easily corrupted by the tobacco lobby– everyone easily corrupted by the tobacco lobby– everyone

wants an exception (casinos, bars, restaurants)wants an exception (casinos, bars, restaurants)

Local control brings Local control brings - local debate and community changelocal debate and community change- ease of enactment; policy makers responsive to local wishesease of enactment; policy makers responsive to local wishesease of enforcementease of enforcement

• Most of the states that have achieved state-wide legislationMost of the states that have achieved state-wide legislation

have started with local control e.g. Illinoishave started with local control e.g. Illinois

The goal for the coming sessionThe goal for the coming session -repeal pre-emption -repeal pre-emption -gain local control -gain local control

With your help we can do it!With your help we can do it!

The goal for the coming sessionThe goal for the coming session -repeal pre-emption -repeal pre-emption -gain local control -gain local control

With your help we can do it!With your help we can do it!