Tobacco Documents Online

TESTIMONY on Behalf of THE AMERICAN CANCER SOCIETY Before The Subcommittee on Health and the Environment Committee on Energy and Commerce u.S. House of Representatives WILLIAM G. CAHAN, M.D. Professor of Surgery, Cornell University Medical College;, Attending Surgeon, Thoracic Service, Memorial Hospital, The Memorial Sloan-Kettering Cancer Center, New York City Member, American Cancer Society Ad Hoc Committee on Tobacco Habituatiom March 5, 1982 For'further informatiorn,, contact: Alan Davi:s. The American Cancer Society 7'77' Third Avenue New York, New York 10017 (212) 371-2900

TESTIMONY OF WILLIAM G- CAH3N,, M.D. -8- Further, the OTA repor.t adds, "tobacco is know to contribute more heavily to the number of cancer deaths than any other single substance." Members of this Committee, I' urge you and your colleagues in both Houses of the Congress to pass this measure into public law as quickly as your considerations and processes will allow. The:Americaa Cancer Society and I believe this,bi'Il can make a difference to. the health.of our country. We look to yau to help us in this crusade:' 1/The Health Consequences of Smoking -- Cancer --„ A Report of' the Surgeon General, U.S. D.epartment of Health and Human Services, OFfice on Smoking, and Health, February 22, 1982, p. 4-7. 2/ 1982 Cancer Facts & Figuses, American Cancer Society, Inc., p. 19. I 3/ Dangers of Smoking, American Cancer Society, Inc., 1980, p. 57 & 66-68. 4/ Staff Report on the Cigarette Advertising Investigation, Federal Trade Commission, May, 1981, p. 3-45.

TESTIidONY. OF WILLIAM G'.. CAHAN, . M.D. -7'- We have an obli5ation to fill those gaps, especially for the young. Amanda Blake has told us she would not have smoked had she known clearly what could happen to her. How many of' those 17 year old girls who are lighting up a cigarette today comprehend that they could get oral cavity cancer and would' have to undesgo the,difficult and painful rehabilitation that is necessary to overcome the disabilities assoc,iated.with that disease. Not enough5 Mr. Chairman, the Congress's own research agency, the, Office of' Technology Assessment, in its ASSESSMENT'OF TECHNOLOGIES FOR'DETER.MINING CANCER RISKS FROM THE ENVIRONMENT, dated June 1981, states that tobacco smoking "is the single most important,preventable environmental factor contributing to iLlness, disability, and death in the United States." The OTA, report sites a.WHO reference stating "smoking-related diseases are such important causes of disability and premature death in. developing countries that,the control of c3garette smoking could do more to improve health and prolong life in these countries than any single action in the whole field of preventive medicine."

TESTIMONY OF WILLIAM G. CAHAN, M.D. -2- I would like to commend you, Mr. Chairman, for yourr leadership and you'r foresight in sponsoring this important preventive health care measure. I would also like to say how pleased I' am to be.abSe to testify as part of this distinguished panel. The work that the American Cancer S'ociety will be doing on.this bill together with the, American Heart Association, the American Lung Association and the, National interagency Council on Smoking and HeaIlth,, is, I hope, just the beginning of a coalition dedicated to educating Americans to the dangers of smoking. We are all extremely excited about the potential impact on t}ie smoking problem in.this country resulting fromthe joining of forces of our organizations. The reason we are testifying, together is to underscore the amount of energy that our organizations are willing to exert to encourage,this vital health efffort.. The reasons for our dedication are clear. Today, 54 million Americans w.ill light up a cigarette and' we know that smoking will contribute to~the death of'over 300,000' of them, this year alone. 430,000 Americans will die from all forms of cancer in 1982'. According to the February 22 Surgeon General's report on the Health.C'onseauences of Smoking 129,0'.00' of those deaths will be.caused.by the use of tobacco praducts.l.

TESTIMONY OF WILLIAM G. CAHAN, M.D. -5- for boys, and, 2'6.2'8, for giirls. A1so, the percentage of girls age, 17and 18 who smoke has risen sharply since 1974. One further. point, by 198:3, according to statistics from the National Cancer Institute, lung cancer will outdistance breast cancer as the number one cancer killer of women.3' Our children are risking their lives, possibly because of, clever advertising, combined with the various reasons that influenced so many people to begin smoking years ago: peer pressure, peer im,itation, saying it Ilooks so sophisticated, grown-up, etc. At the very least,. we must give them the best information about the hazards of cigarettes to permit them to make an informed,decision. An FTC,staff study, came to the following conclusion: "...many (smokers) are unaware ofthe existence of the relationship between smoking and some of its most serious and widespread health conse- qiuences, such as heart d'isease....Some of thee health consequences of smoking, such as lung cancer and emphysema, are more well known. However, even for lung cancer, the most we11l known health effect, some substantial gaps, in consumer knowledge are evident.."4

TESTIMONY OF WILLIAM G. CAHAN,, M.D. -4- "When we hear of a.bad accident involving 201 or 30 people everyone is horrified and:off'i- cials start clamoring for more consumer pro- tection. Here,we have a situation in which two to three hundred people a day are being killed by tobacco-related cancers and'e these people have been given virtually no protec- tion at a11." As a physician who must care for victims of cigarette smoking, I can state with conviction to the members of this committee th,at dying from lung. cancer is~one of the most awful, experiences a human being can go through.. To permit people to~ kill themselves this way without making the hazards amply clear isan irresponsible act that we,, as doctors, and you, as legislators, must not allow to continue. The American Cancer Society strongly supports the efforts of the sponsors.of this legislation to maintain a formal Office of Smoking and Health. Such: an office dedicated solely to educatingiAmericans to the dangers of'smoking and„ in additiion,, workingo to eliminate the American smoking habit is vital to the voluntary health sector in real terms as well as symbolically. ~ We need: a group of knowledgabie professionals at the federal level in such an office committed to this cause.

TEST'I'MONY: OF' WI'LLSAM G. CAHAN, M4D.. -3- 85% of the 111,000 lung cancer deaths this year w.ill be smoking related. We know from!the Sutgeon General's report that the overall cancer death rates of male smokers are, approximately double those of no.n.smokers and for female smokers the death rate is approximately 30 percent higher. The Surgieon General found that cigarette smoking was a major cause of' lung, laryngeal, oral cavity, and esophageal cancer. It wasalso found to be a contributory factor to bladder, kidney'and pancreatic cancer. IIn, addition, he noted that epidemiological studlies suggest an association between cigarette smoking and stomach cancer to a possible association between.smoking and uterine and cervical cancer. What is even worse, those cancers most closely associated with cigarette smoking (lung, esophageal, laryngeal, oral cavity and,pancreatic cancer), can be the most difficult ones. to treat, the cancers with the least hope for survival.. For example, the overall 5-year survival rate for lung cancer is only 10%; for cancer of esophagus, 4% and for, cancer of.the pancreas, 2%.,2 O W 09, F+ When the Surg;eon General released his report on Fe~bruary 22' w1 G.7 of this year, the President of the American Cancer Society, Dr. 0 Robert Hutter, said:

TESTIMONY OF WILLIAM G. CAfDAN, M.D. Mr. Chairman., members of the Committee,, I feel privileged to be here today to testify on behalf of the American Cancer Society, a voluntary health organization with over 2 million active volunteers, dedicated to fighting cancer. Because of the mandate: of the I-ierican Cancer Society it is most fitting' that we offer our testimony in strong support of H.R. 4957,, the Comprehensive Smoking Prevention Education Act of 19'81. I am,Professor of Surgery at the Cornell University Medical College, and serve as attending surgeon, The Thoracic Service of Memorial Hospital, in the Memorial Sloan-Kettering Cancer Center. I amia long-time active volunteer of the American- Cancer Society. I have served as a Member of the Committees on Tobacco and.Cancer of the S'ociety"s National Board of D'irectors., and currently serve on the Society's Ad Hoc Committee on Tobacco Habituation. I feel that I can address the problem of tobacco and cancer from a rather speci!al,perspective. In addition to my interest in Thoracic surgery, I have also had an intense interest in clinical research. I conducted some of the early research experiments in animals which established the causal relationships between smokingi and cancer.

TESTTMONY'OF WILLIAM G., CAHAN, M.D. -5- We are also, pleased that the Chairman has shown an interest in adding to his legisLation an amendment which would require that all cigarette companies list with the Secretary of'H,HS all tobacco additives'.. Sn'e are not asking that the trade secrets inn th.e tobacco industry be revealed. However, the ACS questions why the cigarette industry has, for so long been. exempt from any requirement to~List their additives when most other consumable consumer goods have not had sach an exemption. In a:ddition,, we are well aware that cigarette smoking is dangerous. It is vital, that at the very least, government scientists be given an opportunity to test the health impacts of burning and inhaling such flavoring additives as cocoa husks. The scientific and medical communities must also be allowed to; test these additives: so as too protect the 54',milliom smokers and for those other millions whom we are not reaching through education efforts who, may yet start to smoke. I know the labeling provisions of the legislation raise some questions. I cannot.say for sure thatsix rotating labels listing exactly the ill effects of cigarette smoking will make the difference. I' can say that in 1979 13.5% of boys aged 15 and' 16' and 11..88 of' girls that age are regular smokers_. I can say that at ages 17 and 18, the incidence increases to 19.3%