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As the population of cancer survivors increases and their expected time of survival lengthens, attention to the health behaviors of these individuals is becoming an important focus of attention. Adoption or maintenance of healthy lifestyles after cancer has the potential to reduce both cancer and non-cancer related morbidity. In some cases, lifestyle choices such as smoking may also affect survival. Tracking these behaviors permits evaluation of how well cancer control efforts are working to reduce unnecessary disability and death among those with a history of cancer. Examination of survivors’ smoking status is new to the Cancer Trends Progress Report this year.
Rates of smoking among cancer survivors are based on the self-reporting of individuals with a cancer history who are interviewed as part of the annual population-based National Health Interview Survey (NHIS). Participants were asked whether or not they were a current smoker.
Based on estimates adjusted for the age distribution of cancer patients diagnosed in the SEER program (figure LCS1), the percent of adult cancer survivors who currently smoke is decreasing over time, and the rate of decline is similar for both men and women. However, Figure LCS2 presents estimates of smoking prevalence, age-adjusted to the 2000 U.S. standard population to permit comparison with the U.S. population at large. These graphs show that cancer survivors aged 18-44 report smoking at rates higher than those reported for the rest of the population. Cancer survivors over age 44 report smoking rates similar to those of the rest of the population.
There is no Healthy People 2010 target for smoking rates among cancer survivors. However, it is reasonable to set this at the goal determined for the general population, which is to decrease to 12 percent the proportion of people who smoke.
Analysis of NHIS data (2000–2008) by age suggests that younger survivors (those below age 40) are at greater risk for being current smokers than either older cancer survivors or those in the general population. Survivors of lung, head and neck, and cervical cancers—cancers for which there is a known association between smoking and cancer risk—are at higher risk of being current smokers than survivors of other cancer sites.
Despite the known association between smoking and cancer incidence and mortality, a significant number of survivors continue to smoke after diagnosis. Further, because these figures are based on self-report, they may underestimate the actual proportion of survivors who smoke.
Efforts are needed to ensure all individuals diagnosed with cancer are asked about their smoking status and provided evidence-based smoking cessation programs, including counseling and medications as appropriate. Screening of smoking status among family members and caregivers of cancer survivors is also important as their behaviors can adversely affect survivors’ health.