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
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
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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