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Improved understanding of carcinogenesis has allowed cancer prevention and early detection to expand beyond the identification and avoidance of carcinogens. Specific interventions to reduce cancer mortality by preventing cancer in those at risk, and effective screening for early detection of cancer, are the goals.

Carcinogenesis is a process that usually extends over years, a continuum of discrete tissue and cellular changes over time resulting in aberrant physiologic processes. Prevention concerns the identification and manipulation of the biologic, environmental, social, and genetic factors in the causal pathway of cancer.


Public education on the avoidance of identified risk factors for cancer and encouraging healthy habits contributes to cancer prevention. The clinician is a powerful messenger in this process. The patient-provider encounter provides an opportunity to teach patients about the hazards of smoking, features of a healthy lifestyle, and use of proven cancer screening methods.


Tobacco smoking is a strong, modifiable risk factor for cardiovascular disease, pulmonary disease, and cancer. Smokers have an ∼1 in 3 lifetime risk of dying prematurely from a tobacco-related cancer, cardiovascular, or pulmonary disease. Tobacco use causes more deaths from cardiovascular disease than from cancer. Lung cancer and cancers of the larynx, oropharynx, esophagus, kidney, bladder, colon, pancreas, and stomach are all tobacco-related.

The number of cigarettes smoked per day and the level of inhalation of cigarette smoke are correlated with risk of lung cancer mortality. Light- and low-tar cigarettes are not safer, because smokers tend to inhale them more frequently and deeply.

Those who stop smoking have a 30–50% lower 10-year lung cancer mortality rate compared to those who continue smoking, despite the fact that some carcinogen-induced gene mutations persist for years after smoking cessation. Smoking cessation and avoidance would save more lives than any other public health activity.

The risk of tobacco smoke is not limited to the smoker. Environmental tobacco smoke, known as secondhand or passive smoke, causes lung cancer and other cardiopulmonary diseases in nonsmokers.

Tobacco use prevention is a pediatric issue. More than 80% of adult American smokers began smoking before the age of 18 years. Approximately 13% of Americans in grades 9 through 12 reported using two or more tobacco products in the past month. Electronic cigarettes have been advanced as a tool to achieve smoking cessation in adult smokers, but there is concern that they serve as a “gateway” to cigarette uptake in adolescents and are increasing in use. Counseling of adolescents and young adults is critical to prevent smoking. A clinician’s simple advice can be of benefit. Providers should query patients on tobacco use and offer smokers assistance in quitting.

Current approaches to smoking cessation recognize smoking as an addiction (Chap. 448). The smoker who is quitting goes through identifiable ...

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