1. The hazards of smoking and the benefits of stopping

2. The hazards of smoking and the benefits of stopping Particular emphasis is given to the risk of death in middle age (defined as ages 35-69) Available on www.deathsfromsmoking.net This presentation provides evidence from the UK and the USA, where the health effects of smoking have been studied over a long period, but these findings apply to many other countries

3. Main messages for the individual smoker –Even in early middle age, those who stop (before they have lung cancer or some other fatal disease) avoid most of their risk of being killed by tobacco www.deathsfromsmoking.net Those killed in middle age lose many years Stopping smoking works –Stopping before middle age works even better The risk is big: about half are killed

4. Stopping smoking: avoiding lung cancer % dead from lung cancer Continued smoking: 16% dead from lung cancer Stopped age 50: 6% Stopped age 30: 2% Never smoked: <1% 15 10 5 0 45556575 Age Cumulative risk at UK male 1990 rates BMJ 2000; 321: 323-9

5. Delay between cause and effect: cigarettes, then lung cancer deaths Cigarettes per adult per day 10 5 0 190019201940196019802000USA: lung cancer cigarette consumption + Lung cancer deaths per million per year 0 500 1,000

6. Long-term study of persistent smoking They were studied for 50 years by Richard Doll Source: “Mortality in relation to smoking: 50 years’ observations on male British doctors” Doll R, Peto R et al. BMJ 2004; 328: 1519-28 www.deathsfromsmoking.net UK men born in the 20 th century: first population in the world exposed to really prolonged cigarette smoking

7. Study of smoking and death in male British doctors Recorded all deaths for 50 years (1951-2001) Main findings (for men born in the 20 th century) –Smokers lose, on average, 10 years of healthy life www.deathsfromsmoking.net Asked all UK doctors in 1951, and periodically thereafter, what they themselves smoked –Stopping smoking works

8. Survival to age 70 and beyond: effect of smoking in male British doctors 0 20 40 60 80 100 % survival from age 35 405060708090100 Age 97 94 91 81 59 26 24 4 2 10 years 58% Cigarette smokers Non-smokers 81%

9. Effect of stopping smoking at about age 40 % survival from age 40 0 20 40 60 80 100 40506070 80 90100 Age Non-smokers Cigarette smokers and gained about 9 years Ex-smokers stopped at 35-44

10. Decrease in smoking prevalence In 1950, about 80% of UK men smoked United Kingdom, 1950-2002 195019601970198019902000 0 20 40 60 80 % at ages 35-59 70% 50% 28% 26% % smoked In 1970, UK male death rates from smoking were the worst in the world 1970-2000, decrease in male death rates from smoking was the best in the world

11. Looking back to 1970 death rates: of 100 men aged 35 … www.deathsfromsmoking.net United Kingdom, 1970 www.deathsfromsmoking.net *risks at year 1970 death rates for ages 35-69 42 would have died in middle age* 42% 20 of these 42 deaths would have been from smoking 20

12. Male death in middle age: changing hazards* www.deathsfromsmoking.net United Kingdom, 1950-2000 *risks at period-specific death rates for ages 35-69 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 44% 43% 42% 43% 42% 39% 37% 35% 31% 28% 25% All causes 15 18 19 20 17 16 14 11 8 6 Smoking

13. Male death in middle age: changing hazards* www.deathsfromsmoking.net Poland, 1955-2000 *risks at period-specific death rates for ages 35-69 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 44% All causes 40% 39% 41% 46% 47% 45% 41% 6 8 9 12 13 16 19 20 19 16 Smoking

14. Main messages for the individual smoker Those killed in middle age may well lose 10, 20, 30 or more good years Stopping smoking works www.deathsfromsmoking.net The risk is big: about half are killed

15. Richard Doll (1912-2005), who stopped smoking cigarettes at age 37, photographed aged 91 at the 2004 BMJ press conference on the 50-year results from his study of British doctors Michael Crabtree, copyright Troika Photos

16. Deaths from smoking: an electronic resource www.deathsfromsmoking.net Published by International Union Against Cancer (UICC), Geneva: Switzerland, 2006 Funded by Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), University of Oxford International Union Against Cancer (UICC) Fogarty International Center, US NIH UK Medical Research Council Cancer Research UK Project team Richard Peto, Judith Watt, Jillian Boreham Project managementSinéad Jones Advice and support Steve Woodward, Konrad Jamrozik, Lesley Walker, Trish Cotter Design bwa-design.co.uk