Thursday, April 18, 2013

The American Cancer Society’s Anti-Tobacco Campaign Ignores Its Own Research

The American Cancer Society continues to misinform smokers about vastly safer options.  With chapters in nearly every county across the nation, the ACS is a powerful tobacco harm reduction opponent.

Since it cannot argue against tobacco harm reduction on the facts, the ACS resorts to false and deceptive claims.  For example, last week the House Consumer Protection Committee of the Illinois General Assembly scheduled a hearing on tobacco harm reduction.  Heather Eagleton, Illinois Director of Public Policy and Government Relations for the ACS Cancer Action Network, issued a press release replete with false statements; it was reported in a popular capitol blog that previewed the event (here).

False Statement 1.  “This is a new twist on the old tobacco marketing campaigns of the 1960s, 1970s, and 1980s that falsely promised health benefits to be derived from filtered, ‘light’, and ‘less tar’ tobacco product alternatives that were ‘more safe’ versus ‘less safe.’ These ‘harm reduction’ messages were false then and are false now.”

Ms. Eagleton is apparently unaware that the ACS was responsible for some of the “false promises.”  In 1976 (here)  and in 1979 (here), the organization documented and promoted the health advantages of light cigarettes compared with full-flavor brands.  The ACS president said in the latter year that “findings of the new study suggest a way for smokers to reduce their lung cancer risk by switching to low tar-nicotine cigarettes if they find it impossible to quit entirely.”

False Statement 2.  “There is research, however, to show these products cause cancer of the mouth, pancreas and esophagus, as well as other serious health conditions.”

This is a completely false assertion by Ms. Eagleton.  It ignores the 2009 results of the most comprehensive analysis of relevant research (discussed here).  More importantly, Ms. Eagleton ignores research from her own organization.  In 2005, ACS investigators published results from the first and second Cancer Prevention Studies (abstract here), two of the largest studies of smokeless tobacco use and deaths in the U.S.  Here are the ACS-reported noteworthy risks for smokeless tobacco users:

Relative Risks (95% Confidence Interval) of Death From Selected Diseases Among Smokeless Tobacco Users in the American Cancer Society’s Cancer Prevention Studies (CPS)
All Cancers1.07 (0.95 – 1.20)1.19 (1.02 – 1.40)
−Oropharynx2.02 (0.53 – 7.74)0.90 (0.12 – 6.71)
−Digestive system1.26 (1.05 – 1.52)1.04 (0.77 – 1.38)
−Lung1.08 (0.64 – 1.83)2.00 (1.23 – 3.24)
−Urinary system0.97 (0.77 – 1.22)1.15 (0.85 – 1.56)
−Other cancers0.90 (0.71 – 1.14)1.49 (1.04 – 2.14)
Cardiovascular diseases1.18 (1.11 – 1.26)1.23 (1.09 – 1.39)
Respiratory diseases1.28 (1.03 – 1.59)1.11 (0.84 – 1.45)
Emphysema1.86 (1.12 – 3.06)1.28 (0.71 – 2.32)

First, note that the excess risk for oral cancer among smokeless tobacco users in both ACS studies was ZERO.  In fact, there was only one death from oropharyngeal cancer among smokeless users in CPS-II, compared with 45 deaths among nonusers of tobacco.  ACS staff certainly would have spotlighted increases in cancers of the pancreas or esophagus; this report never mentions these cancers, which is virtual confirmation that risks weren’t increased.

There are some elevated risks in this table.  For example, smokeless users in CPS-I had slightly increased deaths from digestive system cancers, and CPS-II smokeless users had small increases for other cancers and cardiovascular diseases.  The reasons for these findings are obvious: CPS-I smokeless users had significant elevation in emphysema, and CPS-II users had a two-fold elevation in lung cancer, both of which are caused by smoking.  So, while the ACS tried to study exclusive smokeless users, the subjects were also smoking.

In summary, the ACS harm reduction messages were false then and are false now. The organization continues to deny almost 60 million American tobacco users truthful information about smokeless tobacco and e-cigarettes.  Tobacco users, and their families and friends are responsible for at a portion of the nearly $900 million the ACS collects in contributions annually (here).  They, and the public at large, deserve more honest and forthright public health messaging from such an influential organization.


Chris Price said...

An observation on these studies, then, is essentially that: as smoking was proven among subjects who falsely self-reported as exclusive ST users (since emphysema and lung cancer are present and cannot be caused by ST), then most/all the results are contaminated? It is not easy for non-scientists to follow the reasoning. Maybe we also don't have enough information to go on.

For example in CPS-1 the oropharyngeal cancer rr of 2.02 (but with a very wide CI) could perhaps be explained? Not all of us are familiar with the issues. (Assuming it is worth bothering at all, if the results are demonstrated as unreliable.)

Thanks Brad.

Brad Rodu said...

Your interpretation is on target. Although the American Cancer Society tried to study exclusive smokeless tobacco use, the elevated risks for emphysema in CPS-I and for lung cancer in CPS-II are evidence that smokeless users also smoked. But the residual confounding by smoking did not produce a significantly elevated risk for oral cancer in either cohort.
Bottom line: The American Cancer Society's campaign against smokeless tobacco is based on false and deceptive claims, and it ignores its own research.