The 1982 United States Surgeon General's Report stated that "Cigarette smoking is the major single cause of cancer mortality in the United States." This statement is as true today as it was in 1982.

Smoking is responsible for nearly 1 in 5 deaths in the United States. Because cigarette smoking and tobacco use are acquired behaviors -- activities that people choose to do -- smoking is the most preventable cause of premature death in our society.

This document gives a brief overview of cigarette smoking: who smokes, how smoking affects health, what makes it so hard to quit, and what some of the many benefits of quitting are. For more information on this topic, see the American Cancer Society document, Guide to Quitting Smoking.

Who Smokes?

According to the Centers for Disease Control and Prevention (CDC), 44.5 million US adults were current smokers in 2006 (the most recent year for which numbers are available). This is 20.8% of all adults (23.9% of men, 18.0% of women) -- more than 1 out of 5 people.

When broken down by race/ethnicity, the numbers were as follows:

Whites 21.9%
African Americans 23.0%
Hispanics 15.2%
American Indians/Alaska Natives 32.4%
Asian Americans 10.4%

The numbers were higher in younger age groups. In 2006, CDC reported almost 24% of those 18 to 44 years old were current smokers, compared to 10.2% in those aged 65 or older.

Nationwide, 22.3% of high school students and 8.1% of middle school students were smoking in 2004. More White and Hispanic students smoked cigarettes. (For more information, see the American Cancer Society document, Child and Teen Tobacco Use.)

Health Effects of Smoking

About half of all Americans who continue to smoke will die because of the habit. Each year about 438,000 people in the United States die from illnesses related to cigarette smoking. Cigarettes kill more Americans than alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs combined.

Cancer

Cigarette smoking accounts for at least 30% of all cancer deaths. It is a major cause of cancers of the lung, larynx (voice box), oral cavity, pharynx (throat), esophagus (swallowing tube connected to the stomach), and bladder, and it contributes to the development of cancers of the pancreas, cervix, kidney, stomach, and also some leukemias.

Smoking is responsible for about 87% of lung cancer deaths. Lung cancer is the leading cause of cancer death in both men and women, and is one of the most difficult cancers to treat. Lung cancer is a disease that can in many cases be prevented. Groups that promote non-smoking as part of their religion, such as Mormons and Seventh-day Adventists, have much lower rates of lung cancer and other smoking-related cancers.

Other Health Problems

Only about half of the deaths related to smoking are from cancer. Smoking is also a major cause of heart disease, aneurysms, bronchitis, emphysema, and stroke, and it makes pneumonia and asthma worse.

Using tobacco can also damage a woman's reproductive health. Tobacco use is linked with reduced fertility and a higher risk of miscarriage, early delivery (premature birth), stillbirth, infant death, and is a cause of low birth-weight in infants. It has also been linked to sudden infant death syndrome (SIDS).

Smoking has also been linked to other health problems, including gum disease, cataracts, bone thinning, hip fractures, and peptic ulcers. It is also linked to macular degeneration, an eye disease that can cause blindness.

Furthermore, the smoke from cigarettes (called secondhand smoke or environmental tobacco smoke) has a harmful health effect on those exposed to it. (See the American Cancer Society documents, Secondhand Smoke and Women and Smoking.)

Effects on Quantity and Quality of Life

Based on data collected from 1995 to 1999, the CDC estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking.

But not all of the health problems related to smoking result in deaths. Smoking generally affects a smoker's health, harming nearly every organ of the body, and causing many diseases. According to the CDC in 2000, about 8.6 million people had at least one chronic disease because they smoked or had smoked. Many of these people were suffering from more than one smoking-related condition. The diseases that occurred most often were chronic bronchitis, emphysema, heart attacks, strokes, and cancer. These diseases can steal away a person's quality of life long before death. Smoking-related illness can limit a person's activities by making it harder to breathe, get around, work, or play.

Taking Care of Yourself

If you have used tobacco in any form, now or in the past, tell your health care provider so he or she can be sure that you have right preventive health care. It is well known that smoking puts you at risk for certain health-related illnesses. This means part of your health care should focus on related screening and preventive measures to help you stay as healthy as possible. For example, you will want to regularly check the inside of your mouth for any changes and have an oral exam by your doctor or dentist if you do find any changes or problems. The American Cancer Society recommends that periodic check-ups should include oral cavity (mouth) exams. By doing this tobacco users may be able to find oral changes and leukoplakia (white patches on the mouth membranes) early. This may help prevent oral cancer.

You should also be aware of any of the following:

• any change in a cough (for example, you cough up more phlegm than usual) 
• a new cough 
• coughing up blood 
• hoarseness 
• trouble breathing 
• wheezing 
• headaches 
• chest pain 
• loss of appetite 
• weight loss 
• general fatigue (feeling tired all the time) 
• repeated respiratory infections

Any of these could be signs of lung cancer or a number of other lung conditions and you should report any symptom to your doctor. Although these can be signs of a problem, many lung cancers do not cause any noticeable symptoms until they are advanced and have spread to other parts of the body.

If you have any health concerns that you think may be related to your cigarette smoking, please see your health care provider as quickly as possible. Taking care of yourself and getting treatment for small problems will give you the best chance for successful treatment. The best way, though, to take care of yourself and decrease your risk for life-threatening lung problems is to quit smoking.

Ingredients in Tobacco

Cigarettes, cigars, and spit and pipe tobacco are made from dried tobacco leaves, as well as ingredients added for flavor and other properties. More than 4,000 individual chemicals have been identified in tobacco and tobacco smoke. Among these are more than 60 chemicals that are known carcinogens (cancer-causing agents).

There are hundreds of substances added to cigarettes by manufacturers to enhance the flavor or to make the smoking experience more pleasant. Some of the compounds found in tobacco smoke include ammonia, tar, and carbon monoxide. Exactly what effects these substances have on the cigarette smoker’s health is unknown, but there is no evidence that lowering the tar content of a cigarette improves the health risk. Manufacturers do not usually give out information to the public about the additives used in cigarettes, so it is hard to know the health risks.

Nicotine Addiction

Addiction is characterized by the repeated, compulsive seeking or use of a substance despite its harmful effects and consequences. Addiction is defined as physical and psychological dependence on the substance. Nicotine is the addictive drug in tobacco. Regular use of tobacco products leads to addiction in a high proportion of users.

In 1988, the US Surgeon General concluded the following:

• Cigarettes and other forms of tobacco are addicting.
• Nicotine is the addicting drug in tobacco.
• The ways people become addicted to tobacco are similar to those that for addiction to other drugs such as heroin and cocaine.

Nicotine is found in substantial amounts in all forms of tobacco. It is absorbed readily through the lungs with cigarette smoking and through the mouth or nose with oral tobacco. From these entry points, nicotine quickly spreads throughout the body.

Tobacco companies are required by law to report nicotine levels in cigarettes to the Federal Trade Commission (FTC), but in most states they are not required to show the amount of nicotine on the cigarette package label. The actual amount of nicotine available to the smoker in a given brand of cigarettes is often different from the level reported to the FTC. In one regular cigarette, the average amount of nicotine the smoker gets ranges between about 1 mg and 2 mg.

Although 70% of smokers want to quit and more than 40% try to quit each year, fewer than 5% succeed. This is because smokers not only become physically addicted to nicotine; there is a strong emotional (psychological) aspect and they often link smoking with many social activities. All of these factors make smoking a hard habit to break.

Benefits of Quitting Smoking

Nicotine is a very addictive drug. People usually try to quit many times before they are successful. In September 1990, the US Surgeon General outlined the benefits of quitting smoking:

• Quitting smoking has major and immediate health benefits for people with and without smoking-related disease. 
• Former smokers live longer than continuing smokers. For example, people who quit smoking before age 50 have one-half the risk of dying in the next 15 years compared with people who keep smoking. 
• Quitting smoking decreases the risk of lung cancer, other cancers, heart attack, stroke, and chronic lung diseases such as emphysema and chronic bronchitis. 
• Women who stop smoking before pregnancy or during the first 3 to 4 months of pregnancy reduce their risk of having a low birth-weight baby to that of women who never smoked. 
• The health benefits of quitting smoking are far greater than any risks from the small weight gain (usually less than 10 pounds) or any emotional or psychological problems that may follow quitting.

Your risk of having lung cancer and other smoking-related cancers is affected by how much you have been exposed to cigarette smoke over your lifetime. This is measured by the number of cigarettes you smoked each day, how old you were when you started smoking, and the number of years you have smoked. There is no way to accurately calculate a person's risk of getting cancer, but the more you smoke and the longer you do it, the greater your risk.

The good news is that the risk of having lung cancer and other smoking-related illnesses can be reduced if you stop smoking. The risk of lung cancer is less in people who quit smoking than in people who continue to smoke the same number of cigarettes every day, and the risk decreases as the number of years since quitting increases.

People who stop smoking when they are young get the greatest health benefits from quitting. Those who quit in their 30s may avoid most of the risk due to tobacco use. However, even smokers who quit after age 50 largely reduce their risk of dying early. The argument that it is too late to quit smoking because the damage is already done is not true. It is never too late to quit smoking!

For more information, see the American Cancer Society document, Guide to Quitting Smoking.

Additional Resources

More Information from Your American Cancer Society

The following information may also be helpful to you. These materials may be ordered from our toll-free number, 1-800-ACS-2345 (1-800-227-2345).

Child and Teen Tobacco Use (also available in Spanish)

Cigar Smoking (also available in Spanish)

Guide to Quitting Smoking (also available in Spanish)

Double Your Chances of Quitting Smoking

Helping a Smoker Quit: Dos and Don'ts

Questions About Smoking, Tobacco, and Health (also available in Spanish)

Quitting Smoking - Help for Cravings and Tough Situations (also available in Spanish)

Secondhand Smoke (also available in Spanish)

Women and Smoking (also available in Spanish)

National Organizations and Web Sites

In addition to the American Cancer Society, other sources of information and support include:

American Heart Association & American Stroke Association
Heart Association: 1-800-AHA-USA-1 (1-800-242-8721)
Internet Address: www.americanheart.org
Stroke Association: 1-888-4-STROKE (1-888-478-7653)
Internet Address: www.strokeassociation.org

American Lung Association
1-800-LUNG-USA (1-800-586-4872)
Internet Address: www.lungusa.org

Centers for Disease Control and Prevention (CDC)
Office of Smoking And Health
Telephone: 1-800-232-4636 (1-800-CDC-INFO)
Internet Address: www.cdc.gov/tobacco/quit_smoking/index.htm

National Cancer Institute
1-800-4-CANCER (1-800-422-6237) – Answers as "Cancer Information Service"
Internet Address: www.cancer.gov

Nicotine Anonymous
1-877-TRY-NICA (1-877-879-6422)
Internet Address: www.nicotine-anonymous.org

Smokefree.gov
(Info on state Quitlines)
Telephone: 1-800-QUITNOW (1-800-784-8669)
Internet Address: www.smokefree.gov

*Inclusion on this list does not imply endorsement by the American Cancer Society.

The American Cancer Society is happy to address almost any cancer-related topic. If you have any more questions, please call us at 1-800-ACS-2345 any time, 24 hours a day.

References

American Cancer Society. Cancer Facts & Figures 2008. Atlanta, GA. 2008.

American Lung Association. Trends in Tobacco Use. 2007. Available from: http://www.lungusa.org/site/apps/s/content.asp?c=dvLUK9O0E&b=34706&ct=67648. Accessed October 4, 2007.

American Lung Association. COPD Fact Sheet. 2006. Available at: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35020. Accessed October 5, 2007.

Centers for Disease Control and Prevention (CDC). Annual smoking-attributable mortality, years of potential life lost, and economic costs - United States, 1995-1999. MMWR. 2002;51:300-303. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5114a2.htm. Accessed October 9, 2007.

Centers for Disease Control and Prevention (CDC). Annual smoking-attributable mortality, years of potential life lost, and productivity losses - United States, 1997-2001. MMWR. 2005;54:625-628. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5425a1.htm. Accessed October 9, 2007.

Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults --- United States, 2006. MMWR. 2007;56(44):1157-1161. Available at: http://www.cdc.gov/mmwr//preview/mmwrhtml/mm5444a2.htm. Accessed November 8, 2007.

Chakravarthy U, Augood C, Bentham GC, et al. Cigarette smoking and age-related macular degeneration in the EUREYE Study. Ophthalmology. 2007 Jun;114(6):1157-63.

Centers for Disease Control and Prevention (CDC). Cigarette smoking-attributable morbidity - United States, 2000. MMWR. 2003;52:842-844. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5235a4.htm. Accessed October 15, 2007.

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion. Toxic chemicals in tobacco products. Available at: http://www.cdc.gov/tobacco/research_data/product/objective21-20.htm. Accessed September 21, 2006.

Centers for Disease Control and Prevention (CDC). Tobacco Use, Access, and Exposure to Tobacco in Media Among Middle and High School Students -- United States, 2004. MMWR. 2005;54(12):297-301. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5412a1.htm. Accessed October 8, 2007.

Centers for Disease Control and Prevention (CDC). Youth Risk Behavior Surveillance -- United States, 2005. Morbidity and Mortality Weekly Report. 2006; 55(SS-5). Available at: http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf. Accessed September 28, 2007.

Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004;328:1519-1528.

National Cancer Institute (NCI). Cigarette Smoking and Cancer: Questions and Answers. 2004. Available at: http://www.cancer.gov/cancertopics/factsheet/Tobacco/cancer. Accessed October 10, 2007.

Office of the US Surgeon General. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1990. Available at: http://profiles.nlm.nih.gov/NN/B/B/C/T. Accessed October 5, 2007.

Office of the US Surgeon General. The Health Consequences of Smoking: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 2004. Available at: http://www.surgeongeneral.gov/library/smokingconsequences/. Accessed October 5, 2007.

Office of the US Surgeon General. The Health Consequences of Smoking: Cancer: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1982. Available at: http://profiles.nlm.nih.gov/NN/B/C/D/W/. Accessed October 5, 2007.

Office of the US Surgeon General. The Health Consequences of Smoking: Nicotine Addiction: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1988. Available at: http://profiles.nlm.nih.gov/NN/B/B/Z/D/. Accessed October 5, 2007.

Office of the US Surgeon General. Reducing Tobacco Use: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 2000. Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2000/index.htm. Accessed October 10, 2007.

Peto R, Darby S, Deo H, Silcocks P, Whitley E, Doll R. Smoking, smoking cessation, and lung cancer in the UK since 1950: Combination of national statistics with two case-control studies. BMJ. 2000;321:323-329.

Revised: 10/23/2007