AT THE WORLD CONGRESS ON LUNG CANCER
DENVER (FRONTLINE MEDICAL NEWS) – The International Association for the Study of Lung Cancer (IASLC) this week released an updated Tobacco Control and Smoking Cessation declaration that outlines a set of measures aimed at reducing smoking and lung cancer.
The declaration could be viewed as a vaccine of sorts, according to Kenneth Michael Cummings, PhD, a professor at the Hollings Cancer Center, Medical University of South Carolina, and Co-Chair of IASLC’s Tobacco Control and Smoking Cessation Committee.
“How about a vaccine to prevent 80% of lung cancer deaths worldwide? We have it: get rid of cigarettes,” he said in a press conference at the World Congress on Lung Cancer, where the declaration was released.
The previous declaration, released in 2008, focused heavily on giving the Food and Drug Administration (FDA) the authority to regulate tobacco in the United States, which it now has. Since then, the economics of tobacco have evolved rapidly, and new products such as e-cigarettes have become available.
Also, 180 countries have ratified the World Health Organization’s Framework Convention on Tobacco Control (FCTC) treaty, allowing them to implement evidence-based policies such as smoke-free environments, warning labels, advertising bans, and taxation.
Nevertheless, lung cancer still accounts for nearly 2 million cases and 1.6 million lives lost each year. And at least 80% of those deaths are directly attributable to smoking, Dr. Cummings said.
In some parts of the world, cigarette consumption has declined, but “that’s not happening everywhere,” he said. “In parts of Asia, such as China, Japan, and Southeast Asia, and in Latin America, we are still seeing a rapid increase in lung cancer deaths. And in parts of the world which have not taken up smoking but are the targets of the industry, such as Africa and Indonesia, we are likely going to see an epidemic there, which can be prevented, which is really the point of our new statement.”
The 2015 declaration has five components that address tobacco control and smoking cessation.
The first component calls for forceful implementation of the FCTC treaty, especially through higher cigarette prices via taxation. “This is…the most important component of our ‘vaccine,’ for every member of this organization to really advocate for raising the cigarette prices to a level where it makes it unaffordable for young people to take up the behavior,” Dr. Cummings said. In low- and middle-income countries, where cigarettes remain relatively inexpensive, imposing a tax of at least 70% of the retail price would immediately cut consumption by about a third ( N Engl J Med. 2014;370:60-8 ).
Trade policies and tobacco interference are related issues, he noted. “Our organization has been strong in trying to keep tobacco out of trade agreements.” Some countries, such as Malaysia, have refused to allow tobacco to be part of the Trans-Pacific Partnership agreement now under negotiation. “We need to support that (stance) because if tobacco is in there, we have countries being sued under trade agreements for doing the right things in terms of implementing policies.”
The declaration’s second component calls for holding cigarette companies civilly and criminally accountable for their actions. While Philip Morris International has stated that they support evidence-based regulation of tobacco, “I think our organization can help (by taking) cigarettes off the shelf today,” Dr. Cummings said. Holding manufacturers accountable in courts is another way to raise the price of cigarettes and thereby reduce consumption, he added.
The third component of the declaration is to support policies that keep young people from starting to smoke, such as raising the legal age of use to 21. “The neurobiology is very clear : the younger you are when you get exposed to an addictive substance, the more likely it is you are going to find it hard to quit at the end. So raising the legal age is certainly something we ought to do,” Dr. Cummings asserted, adding that 21 “is sort of a compromise” as the brain continues to develop until the age of 25.
Ensuring provision of tobacco-cessation services to all smokers, the declaration’s fourth component, is important no matter what a patient’s status. “Even in our cancer patients, it’s not too late. It has a big effect on their outcomes,” he said.
The fifth component is support for policies that address alternatives for nicotine delivery that are likely safer than cigarettes. “I don’t really care if companies make money selling something, but they don’t have to kill one out of two of their consumers to do it,” Dr. Cummings commented.
These alternatives might include e-cigarettes, provided evidence supports their inclusion. “I think that’s the problem we have with e-cigarettes today,” he said, noting that much less is known about them as compared with standard cigarettes, and that the products and manufacturers change monthly.
These factors have made it difficult for the FDA to address e-cigarettes. “They have done one thing I would have recommended they do: they have proposed deeming authority to take into account a whole variety of [tobacco] products,” he said. Although e-cigarettes contain a nicotine nebulizer with an electronic device, and as such could potentially have been regulated as medical devices just like nicotine patches and gum, courts have instead ruled that they are tobacco products.
“It’s a complex issue, but I’m all for getting people off of cigarettes, and there are alternative nicotine delivery devices,” Dr. Cummings concluded. “I think they need to be shown to be safe and effective.”