Lung cancer 'increasing' in Wales, latest figures show

Lung cancer cases are rising in Wales, with the rate among women growing more quickly than among men, latest public health figures have shown.

Lung cancer is the second-most common cancer but the biggest killer, and a lung charity says more needs to be done to raise awareness and tackle smoking.

In 2008, there were 2,384 cases, a rise of 5% on 2004 figures.

The British Lung Foundation said early reporting of symptoms and more smoking cessation services were necessary.

The figures released by Wales Cancer Intelligence and Surveillance Unit, part of Public Health Wales, showed a 10% increase in the rate of lung cancer in women between 2004 and 2008, compared to just over 1% for men.

The rise was particularly striking in south west Wales, covering from Neath Port Talbot to Pembrokeshire as well as Powys and Ceredigion, which went up by over a third from 231 to 318.

The highest rate of the cancer is in south east Wales, with 69 men per 100,000 developing the disease and 44 per 100,000 for women.

Dr Emrys Evans, chair of the British Lung Foundation (BLF) Wales, said: "These figures show that lung cancer remains a huge problem in Wales.

"It's the second most common cancer for both men and women, and the general trend in incidence is going up. Yet lung cancer doesn't always get the attention it deserves.

"We need to encourage anyone showing symptoms - such as a troublesome cough - to get checked out straight away. Early diagnosis is absolutely crucial."

Chris Mulholland, head of the BLF, said tackling smoking was still the key to reducing lung cancer rates.

At present, just under a quarter of adults in Wales smoke, with slightly higher levels (25%) reported in the south Wales valleys health board areas.

He called for all health boards in Wales produce an action plan for integrating smoking cessation services with lung patient care.

"Whilst there's lots of good work going on around Wales, many of our district general hospitals still don't offer a full service locally to help people stop smoking," he said.

"Giving people a leaflet on its own isn't enough."

"BLF Wales wants to see all health boards ensure that their hospitals can offer a proper "stop smoking" service to help people give up."

Chief Medical Officer for Wales, Dr Tony Jewell, said they welcomed the BLF's efforts to raise awareness of the dangers of smoking and its link with lung cancer.

"We are determined to do all we can to educate people about the dangers of smoking so they don't start in the first place, and to provide help and support for smokers to quit," he said.

"The ban on smoking in enclosed public places which was introduced in 2007, has reduced exposure to secondhand smoke and acted as a stimulus for smokers to quit. This will bring benefits in terms of reduced risk of heart attacks and respiratory illnesses and, in the longer term, of cancers such as lung cancers."

"People are also reporting that they're smoking less and thinking more about quitting."

Source: BBC News, 08 February 2010
Link: http://bit.ly/9xLbX4

Smuggled tobacco is a source of ill-health on the cheap

Poor people and children are most at risk from contraband tobacco. But now one city is taking tough action to stub out the problem. Denis Campbell joins a raid in Liverpool.

It is just gone 10 on a cold Thursday morning, inside a furniture shop in inner-city Liverpool. Even at prices that reflect the permanent hard times in this deprived community – sofas from £299, double divan beds at £109 – trade is slow. Suddenly, a garish yellow Merseyside police van pulls up outside the front door. Within seconds, a team of uniformed police, specialist trading standards officers from the city council's alcohol and tobacco unit (ATU) and several HM Revenue & Customs (HMRC) personnel – all wearing stabproof vests – has begun searching through the scores of beds, chairs, ­mattresses and sofas.

They are looking for one of the great scourges of life in Liverpool: illegal tobacco. Several minutes later, one of the searchers makes the first find: 10 packs of 20 Russian-made L&M cigarettes, Cello­phaned together in a makeshift "carton", stashed in a footstool; more tubes reveal 2,600 cigarettes in the footstool alone. This is no surprise. An hour earlier, an undercover trading standards officer had bought one of these cartons of 200 for £30, about half the price such a quantity sells for in news­agents and supermarkets.

During the raid, another officer finds yet more L&Ms in a blue plastic bag buried among racks of everyday items – gloves, kitchen rolls, scouring pads – on sale at the front of the shop. A pack of 20 is just £3, and that is a huge mark-up for whoever bought them originally – probably in Russia – for about 50p a packet.

The team's initial impression is that the L&Ms are real, rather than counterfeit. However, they carry none of the health warnings that are required on cigarettes sold legally in the UK, and they have been smuggled in, so no duty has been or will be paid on them – hence HMRC's involvement. In addition, the furniture shop is not licensed to sell tobacco.

The raid shows how black market tobacco flouts laws, the Treasury loses out on revenue, and, most importantly, health is being put at risk.

Cigarette use has been falling steadily for the last decade as a result of changing social attitudes and tough government action, such as hefty price rises, an advertising ban, graphic picture warnings on packets, the switch to smoke-free enclosed public buildings in 2007, and improved NHS services for those wanting to quit. Just 21% of people in England now have a nicotine habit. However, that figure masks huge socio-economic disparities in consumption, with up to 80% of people in some lower-income groups and certain ethnic minorities still hooked.

Illegal tobacco feeds and deepens this glaring health inequality because poor people are its keenest customers. It is a major public health danger nationally also because it can play a key role in starting or sustaining smoking among children and young people, undermines official efforts against cigarettes, and encourages smokers to puff even more than usual, because it is so cheap. Counterfeit tobacco has also been found to contain arsenic, rat droppings and far more tar and carbon monoxide than legal products.

Liverpool's port makes it an inevitable recipient for contraband tobacco, but it is doing more than most to tackle what is a major social harm in the city. Last year, it became the first place in the UK to have a dedicated ATU, which has been funded by NHS Liverpool, the local primary care trust (PCT), for three years, for a total of £1.1m, in a partnership with the city council.

"Funding the ATU is a bit outside what most PCTs do, but the problem of smoking in Liverpool is so bad, and the death and disability associated with it so great, and illicit tobacco such a big contributor to that, that we had to take every action we could to tackle smoking," explains Paula Grey, the PCT's director of public health.

"We have got enormous problems with tobacco-related diseases in the city. Smoking is falling in line with the national picture, but still 28% of people here smoke, against the national average of 21%. We have the highest rates of death from lung cancer and heart ­disease in the country. Some smokers get smoking-related chronic lung conditions, such as bronchitis and emphysema. Smoking causes about 1,000 people a year to die in the city. People here are 86% more likely to die from lung cancer than other parts of England."

The city's standardised mortality rate – the proportion of deaths that are to be expected, given a range of socio-economic factors – is 38% higher than the national average. On the north side, where the furniture shop is located, it is 52%. "Smoking is an issue of health inequalities," Grey explains. "Although 28% of people in Liverpool smoke, it can be as high as 40% or more in some of the poorer parts of the city. We decided in 2008 to fund the ATU in order to tackle illicit tobacco because it is a source of very cheap and unregulated tobacco coming into the city, targeted in particular at poorer areas where a lot of people already smoke, and because it encourages younger people to smoke. There's good evidence that if you cut off supply, people smoke less."

Gary Baskott, ATU manager, has a team of eight people (including himself), three enforcement officers – including Mark Wainwright, a retired police constable, who took the lead role in the raid – plus two serving police officers on attachment, an intelligence analyst, and an enforcement assistant. It became fully operational only last spring, but since then has instigated 33 prosecutions.

"Over the last year, we have found [tobacco] on sale at cafes, newsagents, off-licences, storage units, homes, greengrocers, takeaways, market stalls, street traders, pubs, and at one high street shop they were concealed in mail sacks in the cellar," Baskott says. "These people are hardened sellers of illicit tobacco. They operate outside any of the tobacco control legislation – for example, by selling illicit cigarettes that don't have health warnings on them."

The ATU, sometimes working jointly with the police and HMRC, has confiscated cigarettes and handrolling tobacco with a street value of about £1.1m. Some of the tobacco is smuggled and some is counterfeit. "We are seeing more and more counterfeit tobacco packaged in cigarette packets to make them look as if they are smuggled, when in actual fact they are counterfeit," Baskott says.

Deborah Arnott, the Chief Executive of Action on Smoking and Health (ASH), the anti-­smoking campaign group, says: ­"People think tobacco smuggling is a crime without victims, but that's just not true. Smuggled tobacco is sold indiscriminately to anyone, and so it's a major source of cigarettes for children – particularly in poorer communities in the north of England, where smuggling is rife and it's cheap and easy to buy."

She adds that the profits from tobacco smuggling are used to fund terrorism – for example, in Northern Ireland and the ­Middle East – to buy guns and explosives.

A container of 10m so-called "transit" cigarettes, on which duty has not been paid, can be bought for less than £175,000, but sold for 10 times that, according to Luk Joossens, an expert on tobacco smuggling.

Black market products account for about 10% of the 47bn cigarettes sold in the UK every year. Given the scale of unpaid duty involved, the problem is one of HMRC's priorities. "Tobacco smuggling undermines honest retail businesses, but it also undermines the government's health objectives," says an HMRC spokesman. "A recent survey shows that while one in five adult smokers admits to buying cheap illicit tobacco, the figure was one in three among smokers aged 14 to 17."

Concerted action since the government's tobacco smuggling strategy was unveiled in 2000 has reduced the proportion of illicit tobacco sold; it was as high as 16% of cigarettes and 53% of all handrolling tobacco. But a new problem is "cheap whites" – cigarettes that are created by organised crime gangs and have no legitimate market anywhere, and made-up brands with names such as Jin Ling, Richman and Raquel. They are, in effect, made specifically for smuggling and then sold in the UK through the sort of premises that the ATU tries to keep in check.

In 2008, two Liverpool men who smuggled more than 22m counterfeit cigarettes into the UK from Greece, Cyprus and China were jailed for four and five years each. The 6,000 L&Ms found in the furniture shop was a tiny amount by comparison, but it is just one of the many outlets involved in this harmful underground trade.

None of the ATU's prosecutions has yet reached court, and few are likely to result in custodial sentences. "There's a certain amount of firefighting involved in what we do," Baskott admits. But the determination to tackle illicit tobacco is growing. A north-west team to combat the same problem is being set up, and councils and PCTs from around Britain have visited the ATU to see what can be done.

Liverpool has previously pushed for films shown in the city that contain smoking to be automatically classed as an 18, and voted to ban smoking in workplaces locally almost three years before the 2007 ban came into force in England. Grey applauds the latest approach: "The ATU's work is a key part of our strategy to tackle smoking, as it's trying to stop young people from starting and helping adults to quit."

But she is more pragmatic than fellow Liverpudlian Andy Burnham, the health secretary, who last week said he wants to see smoking down to 10% of the population by 2020. In contrast, Grey says: "Our aim in the next five years is to get smoking down to the national average. That would be a big achievement. Even doing that would save many lives."

Source: The Guardian, 10 February 2010
Link: http://bit.ly/ajRf2o

Study: Smoking not good for the brain

The tobacco industry worked for two decades to skew research into smoking and Alzheimer's disease, to promote the wrong belief it could prevent the degenerative condition, a review of research has found.

US based scientists have reviewed more than 40 research papers published since 1984, to highlight those with industry links which also suggested smoking could be good for the brain.

A quarter of the papers were found to have industry influence - either through direct funding or using researchers who were also consultants to the industry or who had other ties.

In many cases these relationships were not disclosed, according to the analysis, which found industry linked papers dotted through the scientific literature up to 2003.

Professor Jurgen Gotz, from the University of Sydney's Brain & Mind Research Institute, welcomed the review, saying it should help to set the record straight on nicotine's effect on the brain.

"There have been many studies looking at the incidence of Alzheimer's disease in general, and dementia in general, and the role of nicotine," Prof Gotz said.

"Some of these studies showed, or claimed to show, that smoking, in a sense, protects from Alzheimer's disease.

"It turns out when one takes these (industry-linked) studies into consideration the bottom line is smoking indeed is associated with an increased risk of Alzheimer's disease."

The review, by scientists at the University of California, found the industry linked papers tended to suggest smoking was either not a risk factor or that it protected against Alzheimer's disease.

The independent studies, which outnumbered the industry-linked studies, showed how smoking posed nearly double the risk of developing the disease.

Studies into tobacco and Alzheimer's got underway in the late 1970s in response to anecdotal reports of lower rates of the condition among older smokers.

The beneficial claim continues to circulate via the internet and occasionally it pops up in the mainstream press - including in a 2008 article published in the US' top selling Oprah Magazine.

Prof Gotz said it was time to end the myth that smoking could be good for the brain.

"This has been disproved both in humans, as studies show, and in animals and cell culture systems," Prof Gotz said.

Source: news.com.au, 09 February 2010
Link: http://bit.ly/d3yMHH

Study claims willpower works better than patches if you want to quit smoking

Smokers desperate to quit should put their faith in willpower rather than expensive patches and gums, Australian researchers have claimed.

A review of hundreds of studies into smoking cessation has revealed that the overwhelming majority of ex-smokers gave up without resorting to nicotine replacement therapies.

Old-fashioned willpower alone was enough to make them quit their habit.

What is more, studies which extol the virtues of nicotine patches, gums and pills are more than twice as likely to have been funded by drug companies than others, the Australian researchers said.

Simon Chapman, a professor of public health, said that governments were also guilty of medicalising smoking cessation and of making giving up sound harder than it actually is.

The Sydney University team's analysis of 511 studies on quitting smoking published in recent years showed that two-thirds to three-quarters of ex-smokers stopped unaided and that most said they had found it easier to quit than they had expected.

Research also showed that 51 per cent of trials funded by drug companies found nicotine replacement therapies such as patches and gums to be of 'significant' benefit - compared with just 22 per cent of independent studies.

Writing in the journal PLoS Medicine, the professor said it was wrong to argue that so many smokers have quit in the past that those who remain are a 'hard-core' that need extra help.

Advising smokers to try cutting down or going 'cold-turkey' rather than relying on pharmaceuticals, he said: 'Next time you hear the message that various drugs "double the quit rate", understand that these results come from clinical trials where participants get their drugs free, where they are often called up with reminders and questions, where they develop relationships with the researchers and often want to please them, and where we know that many using the active drug are able to correctly guess they are on it or on the dummy drug.

'Studies of the use of quit drugs in "real world" settings have not demonstrated that they have such success. A serious attempt at stopping need not involve using nicotine replacement therapy or other drugs or getting professional support.'

The professor, who has received drug company funding in the past, said that although his review focused on nicotine replacement therapies, he also has concerns about the value of medicines such as Champix and Zyban which work by cutting nicotine cravings.

But Amanda Sandford, of anti-smoking group ASH, disagreed with Professor Chapman's interpretation of the research.

She said that studies into the benefits of nicotine patches and gums were 'robust' and that 'all the evidence points to relying on willpower alone is not terribly successful'.

She added: 'Where we would agree is that a smoker really has to want to stop. People are very different and tackle their addictions in different ways.'

A spokesman for the Department of Health said: 'This study is inconsistent with a very well established evidence-base. Smokers that attempt to quit without assistance are significantly less likely to quit successfully than those who quit with support.

'The unsupported quit rate is around 4 per cent at one year. This is doubled when a smoker uses stop smoking medicines, and quadrupled when a smoker uses the NHS Stop Smoking Services - where smokers get both medicine and behavioural support.

'Smokers who quit with NHS support can get stop smoking medicine on prescription, including nicotine replacement therapy.

'The decision on whether to use a stop smoking medicine, and which medicine is best for an individual smoker will be made by the smoker with their health professional.'

Link to the study: http://bit.ly/9rpAO6

Source: Daily Mail, 09 February 2010
Link: http://bit.ly/aLEJQ6