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

The presentation will: l review the relationship between tobacco and cancer l discuss the elements of tobacco control l celebrate our successes in tobacco control and describe the challenges that remain

l Tobacco use is the single most preventable cause of cancer l Approximately 30% of all cancer is related to tobacco use and this rises to 80% for lung and oral cancer

Types of exposure to tobacco l Voluntary l Smoking l Smokeless – snuff and chewing tobacco l Involuntary l secondhand smoke

Why does tobacco cause cancer? Because of what is in it – carcinogens l Smoke contains l Strong carcinogens (polycylic aromatic hydrocarbons e.g. benthanthracene) l Weak carcinogens (nitrosamines e.g. NNN, NNK) l Co-carcinogens (catechols) l Unburned (smokeless) tobacco contains l Weak carcinogens (nitrosamines e.g. NNN, NNK)

Why does tobacco cause cancer? Because of where it goes Into the mouth, airways and lungs and then into the bloodstream and then into the bloodstream

Cancers related to smoking l Lung cancer l Laryngeal cancer l Oropharyngeal cancer l Esophageal cancer l Other cancers – bladder – pancreas – kidney – stomach – cervix – breast? Aero-digestive cancers represent the majority of cancers related to smoking (clear evidence of causality) (clear evidence of causality)

Other forms of tobacco exposure l Smokeless tobacco l Secondhand smoke

Smokeless tobacco Recent data suggests that : l The risk of oral cancer from the use of chewing tobacco and snuff is relatively low* Chewing tobacco 1.2 ( )* Moist snuff 1.0 ( ) l The risk from dry snuff is high (but this is rare in the US) Dry snuff 5.9 (1.7-20) l 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. 3, 37,2006 * Relative risk and confidence limits; data from Rodu, B et al., Harm Reduct J. 3, 37,2006

Secondhand Smoke – why is it harmful? Sidestream (secondhand) smoke has been shown to be more carcinogenic than mainstream smoke (Ninth Report on Carcinogens, U.S. Department of Health and Human Services Public Health Service National Toxicology Program 2001) You don’t get the benefit of the filter!

Cancers related to secondhand smoke exposure Ischaemic Heart Disease 46,150 Lung Cancer 4,400 SIDSSIDS 431 * 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 2005 * Other cancers related to SHS exposure; – nasal –breast –cervix –bladder

Tobacco Control is a three-legged stool $ Significant taxation of tobacco Effectivesmokefreelegislation Comprehensive tobacco control programs

In Iowa we have two of the legs in place! $ Significant taxation of tobacco Effectivesmokefreelegislation Comprehensive tobacco control programs Calls up 3x! TUPC budget doubled!

SHS and Smokefree Legislation l We need comprehensive legislation to protect employees – it is not about customers who can go elsewhere but about safe workplaces for workers who cannot! l This is a public health not a business decision – we don’t leave clean food preparation to the whims of the business owner, why should we leave smokefree workplaces?

SHS and Smokefree Legislation How do we get it? l State-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) l Local control brings - local debate and community change - ease of enactment; policy makers responsive to local wishes - ease of enforcement Most of the states that have achieved state-wide legislation Most of the states that have achieved state-wide legislation have started with local control e.g. Illinois have started with local control e.g. Illinois

The goal for the coming session -repeal pre-emption -gain local control With your help we can do it!