A special report in the January 15, 2004, New England Journal of Medicine (NEJM) titled "Tobacco Control in the Wake of the 1998 Master Settlement Agreement" marks the 40th anniversary of the first Surgeon General's report, Smoking and Health. The 1964 Surgeon General's report was America's first widely publicized official recognition that cigarette smoking is a cause of cancer and other serious diseases.
In this NEJM report, Dr. Steven Schroeder, past president of the Robert Wood Johnson Foundation and current director and chair of the board of directors of the American Legacy Foundation, reviews and evaluates the 1998 Master Settlement Agreement (MSA) and summarizes the effectiveness of current tobacco control policies, including cigarette taxation, clean-indoor-air initiatives, smoking cessation programs, and international trade policies. The special report demonstrates that while the MSA was a landmark event for tobacco control, it was far from a panacea.
In 1998, the attorneys general of 46 states and five U.S. territories reached an agreement with four tobacco companies to recover the costs of the states' Medicaid programs for treating tobacco-related illnesses and to settle other types of lawsuits, such as consumer protection and antitrust litigation. The MSA awarded the states $206 billion, to be paid over 25 years. The MSA also required the elimination of youth-targeted advertising and increased the public disclosure of internal industry documents, among other provisions.
In general, the MSA did not specify how states must spend their funds. Schroeder explores how states have chosen to use their funds - most of which have not gone toward tobacco control-related programs. The only MSA funds specifically earmarked were for the creation of the American Legacy Foundation, to develop national programs that address the health effects of tobacco use. Legacy is responsible for the "truth" campaign, which Schroeder calls "the most important national counter-marketing effort in 30 years."
It now has been 40 years since the first Surgeon General's report on smoking and health and over five years since the MSA. Although much progress has been made, there are still 46 million current smokers in the United States, and 440,000 of them die each year from smoking, making it the single largest preventable cause of death. Another 8.6 million people suffer from tobacco-related diseases such as emphysema and heart disease. Smoking is currently the leading cause of cancers of the lung, bladder, larynx, esophagus, and mouth and is highly associated with the development of cancers of the pancreas, cervix, and kidney. And smoking is increasingly concentrated in populations with low incomes and relatively little education, further increasing the health disparities gap that NCI - and the Department of Health and Human Services as a whole - seek to eliminate.
"While overall U.S. smoking-rates have slightly declined in recent years, substantial work remains in order to reach the department's health goals for the nation," said Dr. Cathy Backinger, acting branch chief of NCI's Tobacco Control Research Branch (TCRB).
For more information on smoking-related research and findings, visit TCRB's Web page at http://tobaccocontrol.cancer.gov. For more information on the MSA, go to http://www.naag.org/issues/tobacco/index.php?sdpid=919. For help with smoking cessation,please go to http://smokefree.gov or call the NCI's Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
NCI's Mouse Models of Human Cancers Consortium (MMHCC) has provided support for the following studies of mouse models that may provide insight into pancreatic cancer in humans. (See this week's Director's Update for more information on pancreatic cancer research.)
In the December 17, 2003, Genes & Development, scientists led by Dr. Ronald DePinho at the Dana-Farber Cancer Institute, reported that they had developed a bioengineered mouse model containing two "signature mutations": an activated form of the Kras gene and a deletion of the Ink4a tumor suppressor gene. The resulting mice develop very aggressive PDA that is lethal in about three months. Because the two genetic changes are so common in human PDA, these researchers are now using the mice to try combinations of available therapies and to identify and test novel interventions.
Meanwhile, in the December 2003 Cancer Cell, researchers led by Dr. David Tuveson, from the Abramson Cancer Center of the University of Pennsylvania, describe a mouse model they developed by engineering a mutation in the Kras gene. This mutation "recapitulates the cardinal features" of PDA, the scientists report. These researchers have already examined blood serum from the mice with initial stages of PDA for reproducible patterns of protein changes that may herald the presence of very early disease. Studies are under way to identify the proteins and determine if they are informative for detection of human PDA, said Dr. Cheryl Marks, NCI program director for the MMHCC.
NCI's Clinical Genetics Branch is conducting the Breast Imaging Study, which evaluates the use of several new and promising breast cancer screening techniques in women at high genetic risk of breast cancer. The study is critical to improve screening for breast cancer among women who have mutations in breast cancer susceptibility gene BRCA1 or BRCA2. New techniques being evaluated include breast scanning using magnetic resonance imaging (MRI), positron emission tomography (PET), and breast ductal lavage. Women who carry BRCA1 or BRCA2 mutations are eligible to join the study, as well as women who have a first- or second-degree relative with breast or ovarian cancer related to BRCA mutations. More information can be found at http://breastimaging.cancer.gov.