Alexander V. Prokhorov, M.D., Ph.D.
Assistant Professor,Department of Behavioral Science

Cancers of the upper aerodigestive tract significantly contribute to cancer-related morbidity and mortality in the United States (an estimated 52,900 new cases and 24,500 deaths in 1999 alone). From the early 1970s to the early 1990s, the death rates from esophageal cancer increased 24% among men and 7% among women.

The use of tobacco and alcohol are considered to be the most important risk factors for these cancers (oral cavity, pharynx, larynx, and esophagus). Studies have shown that alcohol and tobacco appear to be independent and synergistic risk factors. Consumption of tobacco and alcohol are frequently concomitant behaviors; tobacco use is higher among those who drink alcohol, and the consumption of alcohol is higher among tobacco users.

Findings from a French investigation suggest that even heavy smokers may reduce their risk of cancer by quitting smoking.

Clinicians are in an excellent position to help their patients quit smoking, but to do so effectively requires familiarity with the basic principles of smoking cessation counseling and pharmacological treatment. Nicotine gum and patches have been proven to increase smoking cessation rates by 60% and 100%, respectively. The nicotine inhaler and nasal spray are also now available by prescription, and the Food and Drug Administration has recently approved the smoking cessation drug bupropion.

This year, a revised edition of The Smoking Cessation Clinical Practice Guideline, which summarizes the most effective methods of treating nicotine dependence, will be published by the Agency for Healthcare Research and Quality (AHRQ), and we highly recommend that every clinician become familiar with it. The guideline urges clinicians to follow five steps: (1) systematically identify all smokers; (2) strongly advise all smokers to quit; (3) determine a smoker's willingness to quit; (4) motivate smokers who are not willing to quit smoking immediately and assist those who are willing to quit by having them set a quit date, offering pharmacological quitting aids, and providing self-help materials and skill training; and (5) schedule a follow-up contact. More information about the AHRQ guideline can be found on the World Wide Web (http://www.ahcp r.gov/research/apr96/dept8.htm).

Helping patients stop smoking is the single most important step physicians can take to reduce the burden of cancer mortality.
 

M. D. ANDERSON ONCOLOG
Volume 45, Number 4 (April 2000)
Copyright 2000 The University of Texas M. D. Anderson Cancer Center, Houston, Texas