(Last week I began a discussion of the launch by R. J. Reynolds, Inc., the giant tobacco company, of Camel No. 9, a brand of cigarettes deliberately designed and packaged to appeal to women. I conclude that discussion this week.)

The statistics on lung cancer among both women and men are grim. The age-adjusted lung cancer death rate, which was extremely low at the time of World War One, is currently 40 per 100,000. This may not seem like a lot, but lung cancer now accounts for most US cancer-related deaths in both men and women. An estimated 160,390 lung cancer deaths will occur in 2007. Since 1987, more women have been dying each year of lung cancer than of breast cancer. In men, lung cancer deaths have declined a bit, about 1.9 percent per year from 1991-2003, largely due to effective anti-smoking campaigns. But women, who started smoking later, have been playing catch-up with their male counterparts. Death rates among women who smoke have risen alarmingly for several decades and have only recently begun to plateau.

Taking into account the long latency period of the disease, lung cancer trends mirror the smoking habits of both men and women. The risk increases with the number of cigarettes smoked and the duration of the habit. There are other contributory causes and co-factors as well, and more should be done to explore and control these. But tobacco is responsible for between 80 and 90 percent of all lung cancers, and a host of other diseases as well.

Other cancers - for example, of the larynx, mouth and esophagus - are also associated with tobacco use. The risk of bladder and cervical cancer is similarly greater among smokers. In fact, according to the Centers for Disease Control and Prevention (CDC) more deaths are caused each year in the US by tobacco use than by all deaths from human immunodeficiency virus (HIV/AIDS), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined. On average, adults who smoke cigarettes die 14 years earlier than nonsmokers. Cigarette smoking results in a two- to three-fold increased risk of dying from coronary heart disease and a ten-fold increase in the risk of dying of chronic obstructive pulmonary disease (COPD).

Young people who are tempted to take up the habit (and currently 28 percent of high schoolers do) should know the odds: while early-stage lung cancer is sometimes curable through surgery, later-stage disease is usually not amenable to surgical cure, even with added radiation or chemotherapy. The five-year survival rate for all stages of lung cancer combined is 16 percent. However, patients with advanced lung cancer have a five-year survival of between 2 and 15 percent.

Given these grim facts, there is simply no excuse for us as a society to tolerate the introduction of ever-more-alluring tobacco products into the marketplace. At what point do we say "enough"? Maybe Camel No. 9 will be the straw that breaks the camel's back.

Granted, the US government has already banned TV and radio advertising of tobacco. However, this worked to the advantage of the biggest companies, for it made it virtually impossible for new brands to break into the market. There are also so many other media outlets at Madison Avenue's disposal that the TV and radio advertising ban has hardly made a dent in the overall problem. Nor have the warnings on tobacco packs made much of an impact. Young people just ignore them.

Better late than never, on Thursday, Feb. 15, 2007, a bipartisan group of Congressmen introduced legislation to give the FDA authority over tobacco products. This bill would, among other things, prevent advertising aimed at children and young adults; prevent the sale of tobacco products to minors; reduce tobacco product toxicity; and prevent misleading claims about smoking's many dangers. A similar Senate bill passed the Senate in 2004, but its companion measure failed to pass in the House of Representatives. However, this time, with the Democrats in control on Capitol Hill, observers feel the bill could indeed become law.

Not only are Edward Kennedy (D-MA) and John Cornyn (R-TX) sponsoring the bill in a bipartisan way in the Senate, along with Henry Waxman (D-CA) and Tom Davis (R-VA) in the House, but the Altria Group, manufacturer of Marlboro, the world's leading brand of cigarettes, wants the FDA to have authority over tobacco.

"We wholeheartedly support the FDA legislation introduced today in its entirety," said Marlboro (Altria) spokesman Steven Parris. "This thoughtful legislative approach offers the best way to advance real solutions to the many complex issues involving tobacco." This seems counterintuitive. But, apparently "Big Tobacco" yearns for a peaceful, albeit regulated, environment in which to pursue its long-term business strategy. The numerous lawsuits against tobacco interests threaten to undermine or even bankrupt the tobacco companies. Of course, once this legislation is passed, Big Tobacco may find ways to go on killing people out of the public eye, and without as much hubbub. On the other hand, at that point the struggle will pass to the Congress, to get them to tighten up regulatory loopholes.

I know that some people involved in complementary and alternative medicine (CAM) will rankle at this, since they distrust anything that empowers the FDA. But the real enemies here are lung cancer and other deadly smoking-related diseases, along with all those who promote tobacco usage; the FDA is the main regulatory weapon we have in this fight. Until recently, the tobacco industry flaunted scientific opinion with their claims that tobacco is not addictive. But it is addictive - highly addictive - and when you are dealing with addictive substances the ordinary rules of the free marketplace simply do not apply. You need vigilant regulation.

Unless blocked by the government, thousands of today's young women will start buying alluring "feminine" brands like Camel No. 9 in the same spirit in which they now buy Chanel No. 19. But cigarettes are not sexy. For many, those hot-pink fuchsia and minty-green teal smokes will deliver a devastating surprise in the form of lung cancer or other fatal diseases. And many young girls of the future will be missing their own mothers and grandmothers because they fell for the allure of Camel No. 9. Some women's liberation!

--Ralph W. Moss, Ph.D.

References:

Bach PB, Jett JR, Pastorino U, et al. Computed tomography screening and lung cancer outcomes. JAMA. 2007 Mar 7;297(9):953-61.

Henschke C, Yankelevitz DF, Libby DM, et al. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med. 2006 Oct 26;355(17):1763-71.

Kolata Gina. Researchers dispute benefits of CT scans for lung cancer. New York Times, Mar 7 2007. Available at:
http://www.nytimes.com/2007/03/07/health/07lung.html