The Ongoing Struggle Against Tobacco: Past Accomplishments, Future Steps

A Conversation With John Seffrin, PhD, CEO of the American Cancer Society

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John Seffrin, PhD

One and a half million Americans who would have died of cancer did not, due to the work that’s been done in the fight against the disease.

—John Seffrin, PhD

In 1913, 10 doctors and 5 laypersons in New York founded the American Cancer Society (ACS). At that time, a cancer diagnosis was almost always fatal and was rarely discussed in public. The Society’s original charter was to raise awareness about cancer, and although that mission has remained firm, over the past century, the ACS has also become the nation’s foremost advocate for research into the detection, treatment, and prevention of cancer. The ASCO Post recently spoke with John Seffrin, PhD, who has been the Chief Executive Officer of the ACS since 1992.

The Century’s Number 1 Health Problem

You recently gave the keynote address at the annual meeting of the Society for Research on Nicotine and Tobacco. What was the gist of your address?

My main point was that tobacco will become the number 1 public health challenge and opportunity of this century. This is based on evidence. We know that tobacco killed 100 million people over the past century and is on track to kill more than 1 billion people this century. Most people are not aware of the devastating price we’ll pay in human suffering and economic loss unless we intervene. The tobacco problem is a scientific and public health issue, but it is also a moral issue.

Moreover, tobacco use is a shared risk factor, and arguably the most preventable, for the four leading noncommunicable diseases in the world: heart disease and stroke, cancer, diabetes, and chronic lung disease. It’s interesting to note that leading up to Y2K, the United Nations Millennium Development Goals discussed HIV/AIDS, tuberculosis, and malaria, but there was no mention of cancer.

Fast forward a decade or so and during a high-level meeting with the United Nations on noncommunicable diseases, they passed a 13-page declaration in which cancer was the centerpiece of action, because of the global threat it presents for this century. The United Nations declaration states that cancer and other noncommunicable diseases will be the century’s number 1 health challenge.

We have proven interventions against this impending disaster that can be implemented for $3 to $5 per person, per year; failings to deploy these interventions will cost the world $47 trillion in lost economic output over the next 2 decades. Addressing tobacco alone in nations that desperately need it—low- and middle-income countries—would cost just 11 cents a day per capita, according to the most recent version of The Tobacco Atlas, released in March from my organization and the World Lung Foundation.

Efforts to Clear Secondhand Smoke

We’ve just passed the 25th anniversary of the airline-smoking ban. Please shed light on what it took to get initiatives like this and others accepted and put into policy.

Remember, it has been a long, hard fought battle against Big Tobacco. It has resulted in major policy and cultural changes, which reduced the incidence of tobacco use from more than 40% of the country down to about 18% today.

The next battle was putting policies in place that would protect people from the dangers of secondhand smoke, such as on commercial airlines. When I got involved in this issue, no state in this country had implemented a smoke-free workplace law; now about half of the nation’s population lives in an area that prohibits smoking in all workplaces, including bars and restaurants.

That said, about 42,000 Americans die of the effects of secondhand smoke each year. So we’re not there yet; we have to persuade legislators to pass smoke-free air laws in the other states so all our citizens get equal protection from the dangers of secondhand smoke.

We worked closely with Senator Dick Durbin from Illinois to get the airline-smoking ban legislation passed. We testified on behalf of the ACS, showing evidence that flight attendants regularly exposed to secondhand smoke were put at risk for heart and lung diseases. We also pointed out that this was an issue of human rights; in other words, you have a right to throw your fist out as long as it doesn’t hit my nose. The tobacco industry fights hard to keep selling its product, so it’s satisfying to celebrate the 25th anniversary of the airplane smoking ban legislation that the ACS helped make happen.

Using ‘All the Arrows in the Quiver’

What methods work in smoking ­cessation?

Raising the excise tax on tobacco is one of the only public health initiatives that has immediate measurable success in reducing smoking. We can predict with uncanny accuracy how many people will stop smoking according to the economic burden of increased cigarette taxes. Since 2002, 47 states, the District of Columbia, and several U.S. territories have increased their cigarette tax rates more than 110 times. Those changes are saving lives.

Using U.S. Food and Drug Administration–approved cessation medication along with counseling can also be effective in certain populations. And the new National Comprehensive Cancer Network smoking cessation guidelines make a substantial contribution. They provide oncologists with all the information they need to help their patients who smoke to stop. As we know, continuing to smoke, even when one has been diagnosed with cancer, can interfere with proper treatment and is associated with the development of second primary tumors.

But, certainly, we don’t have all the answers and we need more research. We must use all the arrows in our quiver to put an end to tobacco-related deaths in our country.

Further, on the international level, we have developed the World Health Organization Framework Convention on Tobacco Control (FCTC), which is the first global public health treaty on record. So far, there are about 180 parties to the FCTC. Unfortunately, the United States is not one of them. A few years ago, I was at a World Health Organization conference in Geneva and said that if we knew where and when the next major tsunami was about to hit and we did not send out a warning, would that not be immoral?

We know that over the next couple of decades, the world will experience a tsunami of noncommunicable diseases, with cancer leading the way. For us not to send a clear warning would be immoral. Plus, we have the tools to at least avert a direct hit, which would save countless millions of lives. Our overall goal is “25 by 25”—reducing premature mortality from noncommunicable diseases such as cancer by 25% by 2025.

In short, we have to get even more serious-minded about smoking cessation advocacy and make more noise on this issue. We can walk up the steps of Capitol Hill and work with state and local lawmakers to say if you help us pass tougher cigarette excise taxes and clean air acts and put more money into research, we’ll guarantee a hefty return on that investment.

For example, we’ve had 22 successive years in declining rates of cancer mortality. And for most of my career until 1991, the mortality rates were rising. This success is an admixture of prevention, early detection, and improved cancer therapies. Simply put, we’ve published data showing that 1.5 million Americans who would have died of cancer did not, due to the work that’s been done in the fight against the disease. Moreover, we have a greater responsibility than did our predecessors, because they didn’t have the scientific knowledge and tools we have today.

Not the Healthiest Nation in the World

What do you think about the direction of American health care?

Well, it’s a work in progress. The passage of the Affordable Care Act, although far from perfect, was a step in the right direction toward building a better health-care system. And I’m not sure that the change we’re seeing would have happened without the work of the ACS and our American Cancer Society Cancer Action Network, which we created about 14 years ago.

On the larger picture, I believe prevention and public health will have to become the preeminent health-care specialty of this century for the United States to become the healthiest nation in the world, which, sadly, we are not today.

Closing Thoughts

The ACS has announced that you’ll soon be stepping down as the Society’s CEO. On behalf of The ASCO Post and the oncology community at large, thank you for your selfless service and estimable contributions to our cancer patients. Please share some last thoughts with the readers.

Thank you. I was recently at the World Conference on Tobacco or Health in Abu Dhabi and presented the Luther Terry award for global tobacco control, which is the most prestigious tobacco-control award in the world. It was an honor and a fitting way to close out my tenure because, as you know, Dr. Terry’s Surgeon General’s report on smoking was a landmark in the ongoing struggle against ­tobacco.

I am so proud of having served the ACS, and largely due to the leadership of my organization, we are now saving nearly 500 lives each day that would have otherwise been lost to cancer. We shouldn’t be satisfied, because that number of lives saved can reach a thousand each day if the right effort is levied. We realized several years ago at the Society that we needed a stem-to-stern transformation on how we operated, if we wanted to realize our full lifesaving potential as an organization and achieve that 1,000 lives per day goal. At the American Cancer Society, we are never satisfied with the status quo. And today, we’ve probably had more positive change at the Society in the past 5 years than in the previous 95 years.

I’m very proud of the ACS, whose volunteers and staff members are second to none in terms of dedication to their mission. There are about 1,000 not-for-profit organizations across the country involved in some form of cancer advocacy, but the ACS stands alone in its comprehensive breadth and mission to prevent and treat cancer. ■

Disclosure: Dr. Seffrin reported no potential conflicts of interest.