Tobacco Documents Online

by Gio B. Gori, Ph.D. Deputy Director Division of Cancer Cause and Prevention National Cancer Institute Epidemiological studies indicate that a direct dose response relation- ship exists between cigarette smoking and risk of certain forms of cancer, cardiovascular and pulmonary disease. 90Z of lung cancer incidence is esti- mated to-be smoking related, 30% of coronary disease incidence, 75% of all chronic bronchitis cases and 80% of emphysema incidence. Current educational efforts have been unsuccessful at inducing people to refrain from smoking and increased consumption is-most apparent in young people and women. It is unrealistic_to expect a society of non-smokers in a short-time period: strong economic and cultrual pressures exist to aaintain the habit.- Family, state and federal incomes are dependent on tobacco growth, marketing and taxation. Tobacco use cannot be abolished easily; therefore, alternative solutions for disease prevention_are necessary. Two such solutions are the selective removal of toxic elements from smoke and the reduction of total smoke intake. Of the- ; 3,000'compounds identified in tobacco smoke, only a few have been related -to specific health hazards. Hydrogen cyanide is known to promote toxic effects on ciliated respiratory epithelium. Development of emphysema appears effected by nitrogen oxides. Cigarette tar contains known carcinogens, cocarcinogens, and promotors-that affect a variety of sites - bladder, kidney, pancreas, esophagus, larynx,-and the respiratory system. High levels of carbon monoxide in the blood have been related to the development of cardiovascular disorders and acute toxicity phenomena. Nicotine has been recognized as a dangerous alkaloid, but its chronic effects are still less than clear. The technology . required to reduce hazardous components in cigarette smoke has been established, and includes new growth, harvesting and_curing practices, use of smoke dilution devices, and tobacco extraction and transformation-methods. The tobacco industry is beginning to utilize these procedures. Consumer acceptability of'low hazard cigarettes can lead-to intake limits that could make the resulting riski smoker as for a-nonsmoker. Dose response analyses of several epidemiologft- • studies allow estimates of these critical limits. Critical values for daily intake limits of selected smoke components are in the order of 150mg tar, 10 mg nicotine, an increase of 4.8% over baseline carboxyhemoglobin values, 950 ug nitrogen oxides, 1500 ug hydrogen cyanide and 450 ug acrolein. These values are in the range of feasible market and manufacturing realities. Thus, ~ short of outlawing cigarettes, it should be possible to reduce the incidence rates of smoking-related diseases, although a shift in general cigarette con- ~y sumption patterns towards critical limits would reduce morbidity and mortality ~ ~ progressively over future decades.- Effective_disease prevention programs must educate the American public, particularly young people to stop smoking, or at N least to accept less hazardous cigarettes and to limit cigarette consumption. Cost estimates indicate that a prevention program for diseases related to tobacco abuse would cost substantially less over a 10 year period than the amount currently being spent annually for tobacco-related disease treatment. of disease virtually undetectable. These limits are defined as the smoke intake dose that would result in approximately the same disease risk for a . ETIOLOGY AND PREVENTION OF SMOKING kET.ATE6 DISEASES .,,,- s