To the American Cancer Society: Fill in the Blanks

In April, I wrote that the American Cancer Society (ACS) is withholding important information on the health risks of smokeless tobacco use (post here). Here’s how the ACS can fill in the blanks on the missing information.

In 1997 the ACS published death rates among non-smokers and smokers from their Second Cancer Prevention Study (CPS II), which the organization promoted as “the largest and most recent prospective study of smoking and disease.” (Available here). According to ACS at the time, “relative risk estimates from CPS-II already have been used extensively to estimate smoking attributable mortality in the United States, Latin America, and nearly 50 other developed countries.”

CPS II involved monumental effort. In 1982, ACS recruited almost 1.2 million Americans, and collected information on smoking, smokeless tobacco use and other lifestyle factors. During the next six years, it meticulously recorded deaths among participants, so that it could determine to what extent smoking and smokeless use influenced death rates

Death rates among smokers from CPS II are the basis for the entire American anti-smoking crusade. For 20 years, this data has served as the basis for estimates by the Centers for Disease Control of how many Americans die from smoking. As seen in the table, smoking is responsible for a two- to three-fold increase in death rates for male smokers compared with nonsmokers.

All Cause Mortality Rates (Deaths per 100,000 per year) Among Men Who Are Nonsmokers, Cigarette Smokers and Smokeless Tobacco Users, 1982-1988
Age (years)	Nonsmokers Rate	Smokers Rate	Relative Risk	ST Users Rate	Relative Risk
35-39	73	219	3.0
40-44	94	304	3.2
45-49	152	427	2.8
50-54	221	679	3.1
55-59	368	1,084	3.0
60-64	673	1,824	2.7
65-69	1,097	2,885	2.6
70-74	1,847	4,665	2.5
75-79	3,441	7,322	2.1
80+	5,467	10,448	1.9

Let’s interpret just one line in the table. Over the six year period, there were 368 deaths among 100,000 nonsmoking men who were 55-59 years at the start of the study. In contrast, there were 1,084 deaths among 100,000 smokers -- 2.95 times more (rounded to 3.0). That is a big difference.

But the table is incomplete. The Cancer Society has never released death rates among smokeless tobacco users for the period 1982-88. ACS has this information, but it refuses to release it. I believe that ACS is withholding death rates from smokeless tobacco use because they are not significantly different from those for nonusers.

The FDA should be required to address this appalling information gap. The agency mandates that smokeless tobacco packages carry this warning, among others: “This product is not a safe alternative to cigarettes.” It is outrageous that the FDA lacks hard data to support the statement. Potentially life-saving comparable risk information is being withheld from smokeless tobacco users, smokers and the FDA by the American Cancer Society.