The French coined the name ‘cigarette’ which means ‘little cigar’ in 1830. Since then the little cigar has enjoyed massive fame and an ever-changing image. During the 20th century alone, it first was seen as a sign of wealth, then a precious ration during both World Wars and then associated with high-profile sporting events and the stand-alone hero on the big screen.

Yet, despite its rise in popularity, as early as the 1920s, there were signs linking smoking to lung cancer. In 1929, German physician Fritz Lickint published a paper on the dangers of smoking and embarked on a determined anti-smoking public awareness campaign. The next decades saw much research conducted on smoking and lung cancer, but it was only as late as 1960 when the US Surgeon General, unable to ignore the findings anymore, finally declared that smoking causes lung cancer that the public sat up and took notice. From that day on, the image of smokers and smoking has been, well, tarred. Today the link between smoking and lung cancer is irrefutable, according to pharmaceutical company and leading oncology research house AstraZeneca, smoking accounts for at least 30% of all cancer-related deaths and 87% of lung cancer deaths. Approximately 50% of new lung cancers are diagnosed in former smokers. The risk of lung cancer increases with an increase in the total number of cigarettes smoked, referred to as pack-years (number of packs smoked per day times the number of years smoked). Yet, despite their modern reputation as “coffin nails” and “cancer sticks” and the over-whelming medical evidence linking smoking to cancer and especially lung cancer, smoking is still commonplace and in some countries it is even on the increase. Developing countries are increasingly targeted as growth markets for the tobacco industry. In Africa, according to the World Health Organisation (WHO), tobacco consumption has increased by approximately 30% and in South Africa alone 44 000 people die from tobacco-related diseases annually. AstraZeneca statistics indicate that worldwide around 1.3 million people are diagnosed with lung cancer each year. Lung cancer is the most common cancer diagnosed in men and the fourth most common cancer diagnosed in women.

While much has been done in terms of government legislation, public awareness campaigns and restrictions on tobacco marketing, these initiatives are not having much long-term impact. Driving tobacco advertising underground has just forced the tobacco marketing executives to think a bit deeper, shifting ad spend to a more direct, and unfortunately more effective approach.

Let’s take a deeper look at the public service messages that can be found on cigarette packs. The most direct method of anti-smoking messaging is the use of the cigarette pack. Bleak warning messages in bold type declaring that smoking kills, smoking is addictive and smoking while pregnant harms your child are well-known and were once quite shocking. Some research indicates that these messages helped level off the number of smokers by the end of the last century, but many believe that stronger messaging and visuals are now needed.

In 2000 Canada was the first country to decide that a picture really is worth a thousand words. Australia and New Zealand followed suit a few years later with graphic images that show, rather than say, the negative health effects of smoking. Studies have been done comparing the impact of warning text messages versus graphics on cigarette packs and the latter win hands down. The emotional reaction invoked by the often disturbing images is very powerful and stimulates far more concern and caution. The only problem is that the impact of the graphics, like with the text warnings, wears off with repeated viewing.

Brazil, the first developing country to go graphic, has pushed the envelope further amid massive controversy hoping to target teens before they start smoking. Described as horror shots, these cigarette packs feature bloody images of heads and hearts cut open, a dead baby in an ash-try, a junkie lying in their own vomit and a woman with half her face beautiful and the other half ghoulish. The accompanying words finish it off: “this product is addictive and can cause cerebral damage, cardiac arrest, bronchitis, pneumonia, emphysema, premature ageing and death.” The images are so gruesome that a reactive trend has emerged with smokers sticking stickers over them that read, for example, “You could be hit by a bus tomorrow”. There has also been an increase in the sale of cigarette cases – proving that the impact of the campaign has been felt, but will it actually make the Brazilian youth think twice before lighting up (According to WHO 17% of all 13 to 15 year old Brazilians smoke.) And once the shock factor has worn off, where to next? In the online discussion raging around this campaign, one blogger commented that the only next step possible is for the government to punch you in face when you ask for cigarettes.

The truth is, regardless of the proven health dangers; we still don’t have the right tactics to prevent smoking and help smokers quit. It’s clearly much more complicated than placing images on cigarette boxes. The solutions lie beyond pricing, packaging and policing in the domain of other more mysterious p – psychology.

As both cigarettes and the habit of reaching for a smoke is addictive, it’s up to smokers to take personal responsibility for their health and know the facts associated with this habit. According to Dr Alison Armour, trained oncologist and Global Medical Science Director for AstraZeneca, new scientific advances in treatments for lung cancer mean that patients now have many more options for how they fight the disease. Key to the fight against lung cancer is early detection – if diagnosed early enough lung cancer can be successfully treated. Unfortunately non-smokers can’t be complacent as 1 in 4 lung cancer patients are non-smokers. Warning signs like a persistent cough or constant chest pain should not be ignored.

Facts

If you go back in history you’ll come across some rather unpleasant examples of how far rulers would go to keep the shock factor going. The first Romanov Czar Michael Feodorovitch declared smoking a deadly sin and smokers were brutally punished by having their lips slit and being flogged, sometimes fatally. In countries like Turkey, Persia and India, the death penalty was seen as the only ‘cure’ for the evils of tobacco smoking. The stigma around smoking is clearly not a new thing.

Early signs that might indicate lung cancer include:

• Chest pain.
• A cough that doesn’t go away within three weeks or gets over time.
• Coughing up more spit or phlegm, especially if there is blood in it.
• Shortness of breath, wheezing or hoarseness.
• Repeated chest infections that don’t respond to antibiotics.
• Swelling of the face and neck or fingertips.
• Weight loss for no obvious reason, or loss of appetite.
• Loss of voice without a sore throat.

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