Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
PLENARY SESSIONS
SESSION PL02b: TOBACCO CONTROL
MONDAY, DECEMBER 5, 2016 - 09:00-10:20
PL02B.04 TOBACCO CONTROL
Luke Clancy
Tobaccofree Research Institute Ireland, Dublin/Ireland
Tobacco Control Tobacco is the biggest preventable cause of cancer in the
world. Estimates suggest that approximately one-third of all cancers are
caused by tobacco use. Although 80%–90% of all lung cancers are attributable
to tobacco, it also has a causative role in malignancies of the mouth, larynx,
pharynx, nose and sinuses, oesophagus, stomach, liver, pancreas, kidney,
bladder, cervix, and bowel as well as on one type of ovarian cancer and some
types of leukaemia. Tobacco is a widely and legally available product which,
through the drug nicotine, is highly addictive and is promoted by a powerful
and highly profitable industry. It has several marketing advantages over
other addictive drugs. Other addictive drugs are mostly illegal, their method
of administration is often by injection, they are socially disruptive, and they
have very low social acceptability. In contrast, tobacco use has been the norm
in the past and still has social acceptability in certain societies. Thousands
of harmful chemicals are present in tobacco and particularly in tobacco
smoke, which has documented serious adverse health effects. There are 70
known carcinogens in cigarette smoke including nitrosamines, polycyclic
aromatic hydrocarbons, benzene, cadmium, toluidine, and vinyl chloride
Industry access to policymakers Tobacco control policies, and therefore the
health of the public, suffer when policy-makers maintain connections with
the Transnational Tobacco Companies (TTC), as this provides a direct avenue
for policy influence. TTCs still meet with and hope to influence government
officials responsible for tobacco control policy in many countries. This is in
direct violation of those countries commitments under the FCTC which is
a legally binding WHO treaty. Through these contacts, industry has been
able to offer ‘help’ to national governments to negotiate e.g. a later excise
harmonization deadline and influence the speed of increase to meet these
requirements. Political links such as this contravene the FCTC Article 5.3,
which seeks to protect policymaking from industry influence. What can we
do to reduce death and disability from Tobacco use? The prevalence—at
approximately 29% of the adult population—remains stubbornly high in
Europe and is increasing among females in some European countries. This
despite the fact that effective and cost effective interventions to control
and eliminate tobacco use exist and are well known. The World Health
Organization (WHO) has validated several strategies which are effective
in curtailing the use of tobacco .These approaches include using increased
price, through taxation, as a tool to reduce tobacco use. The use of smokefree
legislation to prevent exposure to second-hand smoke (SHS) in the
workplace is also important in preventing cancer because SHS is also a known
carcinogen. The banning of advertising, sponsorship, and promotion of
tobacco is an effective and a widespread intervention to help reduce tobacco
use and the use of strong antismoking advertising has also been shown to be
effective. WHO recommends the monitoring of smoking and the provision of
cessation programs to help smokers stop smoking. This treatment of tobacco
dependence is particularly covered by Article 14 of the FCTC. In Art.14 of the
FCTC governments are urged to ‘facilitate accessibility and affordability
for treatment of tobacco dependence’ (World Health Organization, 2015).
According to the 2014 FCTC implementation report, the implementation
of services to support cessation of tobacco use in line with Article 14 can
and should be significantly improved (World Health Organization, 2014).
Yet there seems to date to be little progress. Price as a control intervention
The relationship between a rise in price and a fall in tobacco consumption
is clear; however, a number of important aspects of this relationship must
be considered. Lower socioeconomic groups and younger people are most
sensitive to price increase as a deterrent, whereas in higher socioeconomic
groups, price is not necessarily a determining factor. The use of price as an
instrument to reduce tobacco use is usually opposed by the tobacco industry
and its allies. The industry and its representatives usually try to persuade
finance ministers that a price increase will lead to a loss of revenue through
an increase in smuggling, although the evidence from many studies is that
a rise in tobacco price leads to an increase in revenue and a reduction in
cigarette consumption. Taxation is an effective, highly cost-effective and very
powerful tool available to governments if they want to prevent cancer and
the many other diseases which are caused by tobacco. Smoke free policies
Since Ireland introduced its comprehensive national smoke-free legislation
in 2004, many European countries have followed Ireland’s lead, but not all of
those have introduced laws as comprehensive as Ireland’s. Nevertheless, all 27
EU member state countries have initiated some form of smokefree strategy.
To date, 14 EU member states have enacted laws which ban smoking in all
indoor workplaces including bars, restaurants, and clubs; however, a number
of countries with significant populations such as Germany and Poland have
only limited smoke-free laws. It is encouraging that Russia, where smoking
prevalence is very high (more than 50%), introduced its smoke-free measure
on June 1, 2013, banning smoking in airports, train stations, stadiums, schools,
playgrounds, hospitals, government institutions, beaches, and places of
employment. Tougher smoking fines were signed into law by President
Vladimir Putin on October 21, 201 The importance of smoke-free policies for
cancer prevention is high. SHS is a definite cause of cancer and is defined as
Class 1 carcinogen by the International Agency for Research on Cancer. The
number of cancers caused by SHS can be calculated, but smoke-free policies
have other cancer prevention benefits. They discourage young people from
starting to smoke, encourage smokers to quit, and help former smokers stay
off smoking and promote an attitude of denormalisation of smoking. Smoking
has often been regarded as a normal social activity despite the fact that it
is addictive, is a cause of great inequality, and contributes significantly to
disease, disability, and death. Smoke-free policies can achieve their positive
effect by educating about the health benefits, limiting opportunities to
smoke, and promoting an attitude of denormalisation of smoking.
Keywords: Tobacco Contro, Smokefree, Tobacco Taxation, Smoking Cessation
SESSION PL03: PRESIDENTIAL SYMPOSIUM
TUESDAY, DECEMBER 6, 2016 - 08:35-10:25
PL03.02 LUNG CANCER STAGING – CHANGING THE CLINICAL
PRACTICE
Ramon Rami-Porta
Thoracic Surgery, Hospital Universitari Mutua Terrassa, and Ciberes Lung Cancer
Group, Terrassa/Spain
Introduction At the time of the 17 th World Conference on Lung Cancer, the 8 th
edition of the tumor, node and metastasis (TNM) classification of lung cancer
will have been published by the Union for International Cancer Control, the
American Joint Committee on Cancer and the International Association for
the Study of Lung Cancer (IASLC) in their respective staging manuals. The
innovations introduced, based on the analyses of the new IASLC database
that includes 70,967 evaluable patients with non-small cell lung cancer
and 6,189 with small cell lung cancer are described in the table. (1-9) These
innovations will lead to some changes in clinical practice that are worth
reflecting on. Table. Innovations introduced in the 8 th edition of the TNM
classification of lung cancer.
Descriptor
T component
>/= 1cm T1a
>1 – 2cm T1b
>2 – 3cm T1c
>3 – 4cm T2a
>4 – 5cm T2b
>5 – 7cm T3
>7cm
Brochus