Fifty years after the original landmark report of the United StatesSurgeon General’s Advisory Committee on Smoking and Health, a new report, published today, the 32nd tobacco-related Surgeon General’s report issued since 1964, highlights both the dramatic progress the United States has made reducing tobacco use and the continuing burden of disease and death caused by the vice of smoking.

The new report called: The Health Consequences of Smoking – 50 Years of Progress – A Report of the Surgeon General, presents new data on the health consequences of smoking, and discusses opportunities that can potentially end the smoking epidemic in the United States.

Commenting on the smoking and health, Thomas R. Frieden, M.D. M.P.H., Director of the Centers for Disease Control and Preventions said: “As a physician, when I think about smoking, I recall the patients I have cared for. The man who had a leg amputated. The woman who had to gasp for every single breath that she took. The man with heart disease who hoped to see his son graduate, but didn’t live long enough to do so. That?s the reality of smoking that health care providers see every day.”

…when I think about smoking, I recall the patients I have cared for. The man who had a leg amputated. The woman who had to gasp for every single breath that she took. The man with heart disease who hoped to see his son graduate, but didn’t live long enough to do so…

This report published today documents that smoking causes even more diseases, kill even more people, and costs even more in medical bills and other economic losses by a wide margin than has previously been reported. The scientific evidence contained in this groundbreaking report supports three clear conclusions:

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  • While remarkable progress has been made in the past 50 years and smoking rates have been cut by more than half (from 42.4% in 1965 to 18.1% in 2012), tobacco use continues to have a uniquely devastating impact on the health of individual Americans and the nation as a whole. Each year, smoking kills 480,000 Americans causing about one out of every five deaths in the U.S. It costs at least$289 billion in medical bills and lost productivity, which is nearly $ 100 billion more than previously reported. Without urgent action to reduce smoking, 5.6 million children under age 18 alive today will die prematurely from the smoking-caused disease.
  • Shockingly, cigarettes are more deadly today than they were 50 years ago because of actions taken by the tobacco industry. The report concludes that smokers’ risk of death from all causes, compared to those who never smoked, has gone up significantly over the past 50 years. It also finds that smokers today both men and women have a much higher risk of lung cancer and chronic obstructive pulmonary disease (COPD) than smokers in 1964, despite smoking fewer cigarettes”. The report points to changes in the design and composition of cigarettes as the only reasonable explanation for the increased risk of lung cancer.
  • All of the deaths, diseases, and costs caused by tobacco use are entirely preventable by implementing proven strategies developed over the past 50 years. This report leaves no doubt that we know what to do to end the tobacco epidemic significantly increase tobacco taxes, enact comprehensive smoke-free air laws in every state, conduct hard-hitting mass media campaigns, fully fund state tobacco prevention and cessation programs, provide tobacco users with access to treatments that can help them quit, and effectively implement the U.S. Food and Drug Administration’s (FDA’s) regulatory authority over tobacco products, including graphic warning labels. We know what to do but have lacked the political will required to get the job done. It is time to fight the tobacco epidemic with a level of urgency and action that matches the enormous scope of the problem. We cannot afford another 50 years of death and disease caused by tobacco.

Cigarettes Have Become More Deadly
The new report shows that cigarettes are more deadly today than they were 50 years ago. The findings include:

  • During the past 50 years, smokers’ risk of death from all causes, compared to non-smokers, has more than doubled in men and more than tripled in women. The report concludes: “The evidence is sufficient to infer that the relative risk of dying from cigarette smoking has increased over the last 50 years in men and women in the United States.”
  • Since 1959, the lung cancer risk for people who never smoked has stayed about the same, but the risk for smokers increased steadily. The lung cancer risk increased tenfold for female smokers and doubled for male smokers.
  • The report links the increase in lung cancer risk among smokers to changes in the design and composition of cigarettes: “The evidence is sufficient to conclude that the increased risk of adenocarcinoma of the lung in smokers resulted from changes in the design and composition of cigarettes since the 1950s.” The increased risk of adenocarcinoma is the reason for the overall increase in lung cancer. The report adds, “The evidence is not sufficient to specify what design changes are responsible for the increased risk of adenocarcinoma, but there is suggestive evidence that ventilated filters and increased levels of tobacco-specific nitrosamines [a carcinogen] have played a role.”

It is deeply disturbing that 50 years after the tobacco industry and the public learned conclusively that smoking causes lung cancer, cigarettes are even more dangerous and pose an even greater risk of lung cancer. Even worse, no government agency had the power to find out about it, prevent the changes that caused it or do anything about it until Congress granted the FDA authority over tobacco products in 2009. In light of the new report, the FDA must make it a priority to regulate how tobacco products are made and take action to stop tobacco industry practices that make their products even more harmful or addictive.

Tobacco Kills and Costs Even More
The new report published today drives home the magnitude of the harm resulting from tobacco use, which is the nation’s number one cause of preventable death. Key findings include:

  • Over the past 50 years, more than 20 million Americans have died as a result of smoking, including 2.5 million nonsmokers who died from heart disease or lung cancer caused by exposure to secondhand smoke.
  • The report adds several more diseases to the long list caused by smoking, including colorectal and liver cancer, diabetes and rheumatoid arthritis. In 1964, the Surgeon General concluded definitively that smoking causes lung cancer. Today, we know that smoking causes at least 13 types of cancer.
  • Smoking causes 480,000 premature deaths annually among Americans, an increase from the previous estimate of 443,000 deaths.
  • The economic costs of smoking are far greater than previously thought. These costs total $ 289 – $ 332.5 billion a year, including $ 132.5 – $ 175.9 billion for direct medical care of adults,$151 billion for lost productivity due to premature death and $ 5.6 billion for lost productivity due to exposure to secondhand smoke. Previous estimates put the annual economic costs at $ 193 billion, including $ 96 billion in health care costs and $ 97 billion in lost productivity.

A Road Map for Ending the Tobacco Epidemic
Last week, seven public health and medical organizations called for bold action to achieve three goals:

  • Reduce smoking rates to less than 10% within 10 years;
  • Protect all Americans from secondhand smoke within five years; and
  • Eliminate the death and disease caused by tobacco use.

The new report confirms that we have scientifically proven strategies to achieve these goals and lays out a detailed road map for implementing these strategies more aggressively than ever before. Specific actions called for by the report include:

  • Continuation and expansion of national media campaigns such as the CDC’s Tips from Former Smokers campaign and the FDA’s youth prevention campaign. The report calls for conducting such campaigns “at a high-frequency level and exposure for 12 months a year for a decade or more.”
  • Increasing cigarette taxes to prevent kids from smoking and encourage smokers to quit.
  • Effective implementation of the FDA’s authority over tobacco products “in order to reduce tobacco product addictiveness and harmfulness.”
  • Fulfilling the Affordable Care Act’s requirement that health plans provide coverage for tobacco cessation treatment, including counseling and medication.
  • Fully funding state tobacco prevention and cessation programs at CDC-recommended levels. Currently, only two states (North Dakota and Alaska) meet that standard, and most states fall woefully short.
  • Enacting comprehensive smoke-free laws that protect all Americans from secondhand smoke. Currently, 24 states, Washington, DC and hundreds of cities have such laws, protecting 49.1% of the U .S. population.

Presenting the new 980-page report during a White-house ceremony, acting Surgeon General Boris D. Lushniaknoted that it is time to take action: “Enough is enough. The clock is ticking, We can’t wait another 50 years.”

Action in prevention
With the intense use of proven interventions, we can save lives and reduce health care costs. In 2012, the Centers for Disease Control and Prevention (CDC) launched the first-ever paid national tobacco education campaign Tips From Former Smokers(Tips) to raise awareness of the harms to health caused by smoking, encourage smokers to quit, and encourage nonsmokers to protect themselves and their families from exposure to secondhand smoke. The results of the campaign were quite remarkable: it pulled back the curtain in a way that numbers alone cannot, and showed the tobacco-caused tragedies that we as health care professionals see and are saddened by every day. As a result of the CDC-campaign, an estimated 1.6 million smokers made an attempt to quit and, based on a conservative estimate, at least 100,000 smokers quit for good. Additionally, millions of nonsmokers talked with friends and family about the dangers of smoking and referred smokers to quit services. In 2013, CDC launched a new round of advertisements that helped even more people quit smoking by highlighting the toll that smoking-related illnesses take on smokers and their loved ones.

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