Tobacco use is the most preventable cause of death in the United States. Each year, tobacco use is responsible for nearly 440,000 deaths. Smoking accounts for at least 30% of all cancer deaths and 87% of lung cancer deaths, making smoking cessation (quitting smoking) the single most important thing a person can do to lower his or her individual cancer risk.

Approximately 44.5 million U.S. adults are current cigarette smokers, according to the 2004 National Survey on Drug Use and Health. Smoking estimates vary significantly by age, gender, race/ethnicity, education level, and socioeconomic status:

• The highest rates of smoking are among people 18 to 44 years old.
  
  
• More men (23%) than women (18%) smoke cigarettes.
  
  
• Smoking rates are the highest among American Indians/Alaska Natives (33%), and the lowest (11%) among Asians.
  
  
• College graduates are less likely to be current smokers and more likely to never smoke compared with other adults.
  
  
• Adults living below the poverty level (29%) are more likely to be current smokers than adults at or above the poverty level (21%).

In addition to cigarettes, other forms of tobacco use include cigar/pipe smoking and smokeless tobacco, such as chewing tobacco and snuff. Approximately 15.5 million Americans (7%) age 12 and older are cigar/pipe smokers and 7.2 million Americans (3%) use smokeless tobacco, according to the 2004 National Survey on Drug Use and Health. Men are more likely than women to use smokeless tobacco (6% versus 0.3%), which is not a safe substitute for smoking because it can cause various cancers.

Tobacco use is associated with increased risk for at least 15 types of cancer, including:

Misconceptions about quitting smoking

Up to 70% of smokers want to quit, and quitting can be difficult. Misconceptions about quitting may make quitting even harder. Some of these include:

Myth: Smoking is a matter of personal choice.

Fact: While more than half of all Americans who ever smoked quit successfully, nicotine (the chemical found in tobacco products) is addictive, and nicotine dependence may continue for a long time in many people.

Myth: Smokers can quit by themselves; a doctor's advice isn't needed.

Fact: Doctors can provide support and information to help motivate people to quit. In fact, efforts to quit that include a doctor's guidance are twice as successful as other attempts.

Myth: Quit rates with most treatments are low.

Fact: Quit rates longer than five months can approach 20% to 30% with medication and behavioral counseling. Taking effective medication can double or triple the quit rate. Among people with cancer, quit rates often exceed 50%.

Myth: Quitting smoking is not helpful for a person diagnosed with cancer.

Fact: Quitting smoking can both improve the results of treatment and improve a person's overall health, survival, and quality of life.

Myth: Quitting smoking is too stressful for patients undergoing cancer treatment.

Fact: Although nicotine dependence is hard to break and the withdrawal process can be uncomfortable, the benefits of quitting smoking outweigh the discomforts of quitting.

The effect of tobacco use on cancer treatment

Tobacco use increases the risk of complications for all types of cancer treatment and may reduce the effectiveness of cancer treatment.

Surgery. Patients who smoke and undergo surgery have an increased risk of heart and lung complications, including increased problems from general anesthesia (sedation medication given during surgery). In addition, smoking causes harmful effects on wound healing and may increase the risk of wound infection. Stopping smoking, even shortly before surgery, has been found to reduce complications.

Radiation therapy. Radiation therapy is not as effective for patients who smoke compared with nonsmokers or smokers who quit before treatment. Smoking during radiation treatment can also increase side effects, including oral mucositis (inflammation of the mouth and throat), loss of taste, xerostomia (dry mouth), weight loss, fatigue (extreme tiredness), pneumonitis (inflammation of lung tissue), bone and soft tissue damage, and poor voice quality.

Chemotherapy. Although less is known about effects of smoking during chemotherapy, smoking has the potential to increase side effects including weight loss, cachexia (weight loss with muscle weakening), fatigue, and lung and heart problems. In addition, smoking during chemotherapy may suppress the immune system and increase the risk of infection.

Benefits of quitting smoking after diagnosis

People with cancer who stop smoking experience many physical and psychologic benefits that improve cancer treatment and their overall health. Stopping smoking has been shown to:

Increase survival rates. Studies have generally shown that a longer length of time between stopping smoking and the start of cancer treatment is associated with better prognosis (chance of recovery). Stopping smoking can lower the risk of treatment side effects and potentially improve the effectiveness of the treatment.

Decrease risk of secondary cancers. Quitting smoking, even at the time of diagnosis, can significantly lower the risk of developing secondary cancers (cancers that develop because of treatment for the first cancer). However, the length of time and amount a person smoked also influences the development of such cancers.

Improve quality of life in people with cancer. Quality of life has been shown to be lower among smokers in the general population as well as among people with cancer compared with nonsmokers and former smokers. In one study, people treated for head and neck cancer who were former smokers had significantly a higher quality of life after one year of follow up, compared with patients who had not stopped smoking.

Many people with cancer may feel guilty or anxious about their smoking habit and feel that others may judge them or that they receive less support for their cancer. It is important to know that quitting smoking at any point is useful, and health-care professionals can help whenever a person wants to quit.

Talking with your doctor about your tobacco use

To begin the process of successfully quitting tobacco for the long term, talk with your doctor about your tobacco use behaviors. Understanding your nicotine dependence can help the doctor determine the appropriate course of treatment needed to help you break nicotine dependence or help you remain nicotine-free. Let you doctor know:

• If you've smoked at least 100 cigarettes in your entire life
  
  
• If you currently smoke cigarettes
  
  
• If you smoke within the first 30 minutes of waking up
  
  
• How many years you've smoked regularly and how many cigarettes a day
  
  
• At what age you began smoking
  
  
• How long it's been since you've last smoked regularly (if you've currently stopped smoking)
  
  
• How many times you have tried to quit smoking and how long you were successful in each attempt
  
  
• If people in your household smoke
  
  
• If smoking is allowed in your workplace
  
  
• If you use, or used in the past, other forms of tobacco (in addition to cigarettes) and how often

Methods and Resources to Help Stop Tobacco Use

A variety of resources are available to help people who want to stop using tobacco. Talk with your doctor about the various methods.

Medications

Three types of medication have been approved by the U.S. Food and Drug Administration (FDA) to treat nicotine dependence:

Nicotine replacement therapy (NRT). NRT is the most widely used, has mild side effects, and is available over the counter as gum, as a patch you place on the skin, an inhaled nasal spray, and as a lozenge. By providing a dose of nicotine, NRT reduces symptoms of nicotine withdrawal and craving. Studies show that people using NRT are twice as likely to quit smoking compared with people receiving a placebo (inactive medicine).

Bupropion (Zyban). This drug helps reduce withdrawal symptoms and helps people break the habit. Clinical trial results suggest that bupropion doubles the chance of successful quitting compared with a placebo. Side effects are slightly more serious than for NRT and include jitteriness, insomnia (inability to fall asleep and/or stay asleep), headache, dry mouth, and risk of seizure.

Varenicline (Chantix). This FDA-approved medication has been shown to help people quit smoking by preventing nicotine withdrawal symptoms.

Although not FDA-approved for nicotine dependence, several clinical trials have indicated the antidepressant, nortriptyline (Aventyl, Pamelor), and a medication for high blood pressure called clonidine (available under several brand names) may be effective. However, both have potentially serious side effects and may not be appropriate for many smokers. Rimonabant (Zimulti) is also being studied to see if it is effective in helping people quit smoking. In addition, efforts are underway to develop effective nicotine vaccines.

Questions to ask the doctor about tobacco use

Your doctor can help answer questions about tobacco use and ways to stop using tobacco. Questions to ask include:

• How is smoking hurting my health?
  
  
• What are the health benefits to quitting smoking?
  
  
• Will smoking or tobacco use affect my cancer treatment?
  
  
• How can I prepare to stop smoking?
  
  
• How can you help me stop smoking?
  
  
• What medications are available to help me stop smoking?
  
  
• What behavioral changes do I need to make to stop smoking?
  
  
• How can I avoid or minimize the triggers that make me want to smoke?
  
  
• What smoking cessation resources are available in my community?
  
  
• How can family and friends help me?
  
  
• How often should you and I discuss my progress?

Counseling

Consider talking with your doctor about getting a referral to a professionally trained smoking cessation counselor or mental health therapist if:

• Several of your attempts to quit have been unsuccessful
  
  
• You experience severe feelings of anxiety or depression
  
  
• You don't have enough support from family and friends in your effort to quit
  
  
• You also have a dependence on alcohol or other substances

Community resources

In addition to your doctor, a variety of community resources can aid and support your efforts to stop smoking:

• Smokefree.gov
  
  
• The National Cancer Institute's (NCI) toll-free telephone quitline: 800-QUITNOW (800-784-8669)
  
  
• Smoking and Tobacco Use, from the Centers for Disease Control and Prevention
  
  
• The American Cancer Society's (ACS ) Guide to Quitting Smoking and toll-free telephone quitline from the ACS: 800-ACS-2345 (800-227-2345)
  
  
• American Lung Association Freedom from Smoking Online cessation program
  
  
• The American Legacy Foundation
  
  
• Many communities have meetings of the twelve-step program group, Nicotine Anonymous.
  
  
• The state or local health department has information about quit smoking classes and support in your area.
  
  
• Kick Butts Day is the Campaign for Tobacco Free Kids' annual celebration of youth advocacy, leadership, and activism.

More Information

Resources to Help You Quit Smoking

Prevention