world cancer report - iarc

However the challenge posed is daunting.
Cigarette smoking is an addiction, as powerful
in many respects as cocaine or opiate
dependence. The rates of dependence for
nicotine in the general population are higher
than for alcohol, cocaine or marijuana.
Among those who have ever tried even a
single cigarette, almost one-third develop
nicotine dependence. Although most
smokers want to quit, they experience
well-characterized barriers and withdrawal
symptoms during their attempts and they
are largely unsuccessful in quitting. In fact,
spontaneous quit rates without any cessation
intervention range from 2% to 5% [19].
The efficacy of a range of interventions
calculated to increase the spontaneous
quit rates have been evaluated, and for
many options the results of ten or more
trials have been published. Simple advice
from doctors in the course of routine
care in the context of primary care, hospital
wards, outpatient consultations and
industrial clinics increases the quit rate
by a factor of 1.69. Nurses providing individual
counselling, as distinct from general
health promotion, are also effective.
Likewise, counselling provided through
quit clinics is effective whether provided
on an individual or group basis. The relative
efficacy of different psychological
approaches that might be used in such a
situation is poorly understood. In the
absence of face-to-face contact, the efficacy
of self-help material is not as great
but is discernable. Increasingly, such
self-help materials may be delivered
through the Internet, though whether this
will be more effective than publications,
audiotapes or videotapes remains to be
seen.
Nicotine replacement therapy is intended
to provide the nicotine otherwise
obtained from cigarettes, thereby reducing
withdrawal symptoms associated with
quitting. On the basis of more than 90 trials,
this increases the chances of quitting
up to two-fold (Fig. 4.4). The therapy is
most effective if accompanied by at least
some counselling. Nicotine may be delivered
by various means (patch, inhaler,
nasal spray, gum) and none has been
identified as most effective; many protocols
involve a combination of such prod-
Fig. 4.6 Posters from smoking cessation campaigns in France, Italy, Tunisia, Japan and China.
ucts. Apart from nicotine, a range of
pharmacological agents have been proposed
as expediting smoking cessation.
Anxiolytics are not effective, but some
antidepressants, specifically including
bupropion, are. The drug may be used
alone, or in combination with nicotine,
and quit rates are increased by a factor of
approximately 2.75. In more limited
investigations, similar results have been
claimed for the tricyclic antidepressant
nortriptyline. Relevant mechanisms have
not been demonstrated. A range of other
pharmacological interventions are under
evaluation and, not surprisingly, the field
is one of intense activity.
Reduced exposure to environmental
tobacco smoke
A tangential benefit of smoking cessation
is decreased exposure of individuals
apart from the smoker to tobacco
Fig. 4.7 Declining lung cancer rates in California
by comparison with rates in other parts of the
USA. Centers for Disease Control and Prevention (2000)
Mortality and Morbidity Weekly Report, 49:1066-1069.
Tobacco control 133