A New Death Toll for Smoking

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A new study has found that 28.6 percent of all cancer deaths in the United States are attributable to cigarette smoking.

Researchers calculated the number using the relative risks for 12 smoking-related cancers, including acute myeloid leukemia, mouth cancers, and those of the esophagus, stomach and colon.

Smoking is involved in 22.9 percent of cancer deaths in women and 33.7 percent in men. In all, the authors estimate that 167,133 people died of cancers associated with smoking cigarettes in 2014. (This number does not include deaths from many other diseases linked to smoking.)

There are considerable geographic variations. For example, smoking explains more than 38 percent of cancer deaths in men in Kentucky, Arkansas, Tennessee, West Virginia and Louisiana, but only 21.8 percent in Utah, 31.6 percent in California and 31 percent in New York.

Citing a previous study, the authors wrote that tobacco control efforts have been credited with preventing about eight million premature deaths. Yet tobacco control in many parts of the country is quite weak.

Only about a third of states prohibit smoking in public places. No state follows the World Health Organization recommendation to tax cigarettes at 75 percent of the retail price. Only North Dakota devotes the level of funding to tobacco prevention that the Centers for Disease Control and Prevention recommends. And only seven states provide comprehensive coverage under Medicaid for cessation treatment.

The picture may be even worse than these numbers suggest because the authors included only cigarettes in their analysis, leaving out cancers caused by secondhand smoke, pipes, hookahs, cigars, smokeless tobacco and electronic nicotine delivery systems.

Moreover, the data depends on self-reports, which may underestimate smoking prevalence. “There are lower numbers in states like Utah and California,” said the lead author, Joannie Lortet-Tieulent, an epidemiologist with the American Cancer Society, “but there is still room for improvement. Those deaths are avoidable.”

While the influence of the tobacco industry has waned, she added, there are still regions where it has influence.

“Ninety-five percent of the tobacco is grown in the Southern states, where the numbers are highest,” she said. “This political and economic influence has translated into weaker tobacco control policy and cheaper cigarettes where taxes on them are lower.” NICHOLAS BAKALAR