Letter to VP Joe Biden: Ending tobacco use would be the fastest cheapest way to reduce cancer

When President Obama announced his new "War on Cancer" I decided it would be worth a blog post commenting on how the fastest, most cost-effective way to reduce cancer would be to reduce smoking.
 
After all, we know how to do it.  All it takes is political will.
 
Before I had a chance to draft such a post Allan Erickson, who led tobacco control efforts at the American Cancer Society until he retired, sent me this letter, which makes all the points I would have made.
 
It is worth a read.
 
                                              BEGINNING THE END OF TOBACCO USE
 
February 6, 2016
 
Joe Biden, Vice President, United States of America
 
Dear Mr. Vice President:
 
We commend you on your important new assignment to lead the revitalized ‘War on Cancer’ as President Obama announced in his State-of-the-Union speech. We are aware that the organization and planning for this major effort are well underway, and we hear the thrust of the so-called ‘War’ is to be focused on research, early detection and treatment of cancer.
 
The purpose of this letter is to urge you and your team to be mindful of the almost unbelievable fact that fully one-third of all cancer deaths are caused by one agent -- cigarette smoking. According to your own researchers at the National Cancer Institute, of the estimated 595,000 total cancer deaths expected to occur this year, almost 200,000 will be due to this one, very preventable cause. Yet, according to the most recent national survey conducted by the Substance Abuse and Mental Health Services Agency, 55 million of our citizens continue to use cigarettes on a regular basis and 11 million more use some other form of tobacco, adding further to the nation’s cancer burden.
 
Several of the cancers related to cigarette use are some of the most difficult to diagnose, treat and cure. For example, 5-year survival rates for lung cancer, the leading cancer killer among both males and females,  is just 18%, up only slightly from 12% 40 years ago; yet, 9 out of every 10 lung cancer deaths are directly due to cigarette smoking and, thus, could be prevented. For 2016, the American Cancer Society (ACS) estimates there will be 234,000 new lung cancer cases and 158,000 lung cancer deaths. However, smoking is associated with many more cancer sites other than the lung, according to the most recent Surgeon General’s report on the health consequences of smoking. In addition to lung cancer, cigarette smoking is a demonstrated cause of at least 12 other major cancer sites: larynx, oropharynx, esophagus, bladder, kidney, pancreas, colon and rectal, liver, stomach and AML among both men and women, and cervical cancer in women.
 
Clearly, any effort to reduce the cancer burden on our society, will achieve only limited success if we only address diagnosis and treatment and not the primary cause of those cancers, and the prevention of cigarette smoking must be the cornerstone of any such public health effort. To be sure, new research is urgently needed to improve diagnosis and treatment modalities, but we need be mindful of the fact that such an approach holds out hope for a cure, but that realization could be years, if not decades, away. By contrast, research has consistently demonstrated that a reduction in cigarette smoking can produce changes in the national lung cancer rate in as little as five years. Furthermore, a $1.00 increase in the federal excise tax on a pack of cigarettes would generate an estimated $13 billion annually in additional revenue, an amount more than sufficient to pay for an even greatly expanded War on Cancer, including significantly expanded cancer services for low income individuals.
 
In early 2014, on the 50th Anniversary of the Surgeon General’s Advisory Committee historic Report on Smoking and Health, we created a four-person team of retired national staff leaders (with 125 years of experience in the public health effort to reduce cigarette smoking).
 
This Core Team includes Michael Terry, son of former Surgeon General, Luther Terry, M.D. We decided to offer our services as volunteer ‘catalysts’, not affiliated with any one voluntary health organization or governmental agency, because we felt a ‘neutral entity’ with no vested interests was needed to assess the adequacy and readiness of today’s tobacco control effort. This includes how the tobacco control community is organized, the toolkit of interventions, program delivery/outreach capabilities, and the funding required to implement an aggressive and sustained nationwide effort to end the epidemic of cigarette smoking in the U.S.
 
Some of the challenges that must be addressed include (a) the agencies are working too much in isolation and their own ‘silos’ with the left hand not knowing what the right hand is doing, (b) there is little ongoing communications and collaboration between the key agencies engaged in tobacco control, (c) no strategic plan exists to guide the tobacco control forces in the pursuit of intermediate/long-term goals for reducing smoking prevalence among adults, and (d) a formal mechanism is needed to provide direction for and help to coordinate a re-energized tobacco control movement.  
 
Most of the leading national voluntary health organizations and public-sector agencies have adopted the intermediate goal of reducing the rate of cigarette smoking among adults to 10% or lower by 2024. However, and most importantly, there currently is no coordinated national strategy in place that details where current adult smokers (many in marginalized population groups) can be found, the types of interventions proven to be most impactful, doable and cost-effective in getting these smokers to quit, how the inter-related, and the costs of implementing such an initiative going forward. It is critical that the respective organizations and agencies commit to a common goal and speak with ‘one voice’ in seeking to win the war on cancer.   
 
The original war on cancer emanating from the National Cancer Act has achieved only limited success, because the U.S. Public Health Service has never committed the resources necessary to prevent the single largest cause of excess cancer mortality – cigarette smoking. As a result, it has taken us 50 years, two plus generations, to cut the adult smoking rate in half. Do we need to wait another 50 years to cut the current rate of adults who smoke cigarettes in half, meanwhile our nation’s tobacco-related cancer epidemic will continue unabated?
 
In our view, we have outgrown the original National Cancer Act, and we need a new one, including a new organizational structure, and possibly even a ‘cancer czar’. Now is as good a time as any to launch a concerted effort to conquer this dread disease. We know the new War on Cancer is winnable, and we know how to get there, which absolutely must include an all-out effort to expedite the demise of cigarette smoking as soon as possible.
 
Core Team leaders, Michael Terry and John Seffrin, immediate past CEO of the American Cancer Society (1992-2015), would very much like to meet with you and your team at the earliest possible time. Such a meeting would give you a better understanding of the weaknesses and strengths of the current tobacco control effort in the U.S., as well as our perspective on what programming changes are needed in order to bring the tobacco-related cancer epidemic under control.
 
We are confident that our ‘neutral position’ and unbiased approach to this will serve you, the War on Cancer team and panel of distinguished public health leaders far better than if you were to rely exclusively on what each of the competing organizations and agencies would tell you.
 
Therefore, Mr. Vice President, we strongly urge you to arrange a meeting with representatives of our Core Team at the earliest possible time. We are excited about what our relationship might mean for the advancement of tobacco control, and we look forward to working with you on what will undoubtedly become a landmark effort to save millions of lives from cancer.
 
Please get back to us by emailing [email protected] or call him at 404-512-1104.  
 
Regards,
 
John Seffrin, Ph.D., Professor of Practice, School of Public Health, Indiana University, immediate past CEO, American Cancer Society (ACS)
Michael Terry, son of former U.S. Surgeon General, Luther Terry, M.D.
Donald Shopland, former Director, Office on Smoking and Health, CDC
Allan Erickson, Core Team Leader; former ACS National Vice President, Tobacco and Cancer