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, there were signs linking smoking to lung cancer in as early as the 1920s. 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 and the public sat up and took notice. From that day on, the image of smokers and smoking has been, well, tarred.

Lung cancer and smoking

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.

Warning messages

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.

A picture is worth a thousand words

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.

Psychology and Science

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.

Fact Box

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.

AstraZeneca is a leading global pharmaceutical company which employs over 65,000 people in more than 100 countries across the Americas, Europe, Asia, Africa and Australasia. Its 2008 sales totalled over USD32 billion, with R&D budgets of over USD5 billion. AstraZeneca’s goal is to work with patient advocacy groups and charities across the globe to provide information that raises awareness of the truth about lung cancer and encourage patients to get the best care for their individual needs.

For further information, please contact:

Victoria Williams/Laurel Holmes          
Corporate Communications Consultants (Pty) Ltd              
Tel: (011) 783 8926                                               
Cell: 072 452 1772/082 480 4210                           
Email: victoria@corpcom.co.za / laurelh@corpcom.co.za

JOHANNESBURG 31 May 2010 – This year’s World No Tobacco Day 2010 takes a direct hit at tobacco marketing companies who are increasing their focus on targeting women and girls.

Lung cancer is the world’s leading cause of cancer death, claiming the lives of 1.1 million people across the globe every year – more than prostate cancer and breast cancer combined.¹ In South Africa lung cancer affects 1 in 69 men and 1 in 210 women with over 42 000 South Africans a year dying of tobacco-related diseases, including lung cancer.²

“As the most common form of cancer in men, awareness of the lung cancer has been primarily targeted at them rather than women. The reality is that the disease affects both sexes and in many countries around the world, lung cancer is a leading cause of cancer death in women,” comments Dr Alison Armour, trained oncologist and global medical science director AstraZeneca.

According to the World Health Organisation (WHO), 20% of the world’s more than 1 billion smokers are women of which 7% are adolescent girls.³ Increased tobacco use in women could result in an increasing incidence of lung cancer among females in years to come, attributable in part to tobacco companies marketing directly to women.

About 250 million women in the world are daily smokers. 22% of women in the developed world smoke versus 9% in developing countries. However, cigarette smoking among women in the developed world, most notably Australia, Canada, UK and USA, is on the decline while being on the increase in areas of South America, Africa and Asia. ⁴

Quitting smoking reduces the risk of developing lung cancer and other diseases, such as heart disease and lung disease. People who quit smoking, regardless of their age, are less likely than those who continue to smoke to die from smoking-related illness. Studies have shown that quitting at about age 30 reduces the chance of dying from smoking-related diseases by more than 90 percent.⁵ “Although smoking cessation lowers the risk of developing lung cancer, the risk never decreases to the level of people who have never smoked,” adds Armour.

Apart from lung cancer, women need to be aware that smoking will expose them to potential health complications including premature menopause, menstrual problems (abnormal bleeding, amenorrhea, vaginal infections) and pelvic inflammatory disease which is a contributing factor in ectopic pregnancies. Women smokers who use oral contraceptives risk serious consequences including increased risk of developing cardiovascular diseases such as blood clots, heart attacks, and strokes. ⁶

World No Tobacco Day held every 31st of May is an initiative created by the member states of the WHO in 1987. This year WHO’s focus is on encouraging governments to pay attention to protecting women from the tobacco companies' marketing initiatives while tightening control of tobacco use in general.

Resources and additional information about World No Tobacco Day can be found on the WHO website www.who.int

References

1. This information is according to the Lung Cancer Coalition and can be found on www.lungcancercoalition.org/en/pages/facts
2. These figures are according to the Cancer Association of South Africa (CANSA) and can be found on www.cansa.org.za
3. This information is available on the World Health Organisation (WHO) website www.who.int/tobacco
4. This information is available on the World Health Organisation (WHO) website www.who.int/tobacco/en/atlas6.pdf
5. This information is available on the US National Cancer Institute website www.cancer.gov/cancertopics/factsheet/Tobacco/cessation
6. This information is available on http://womenshealth.about.com/cs/azhealthtopics/a/smokingeffects.htm. The website content is controlled and checked by the Medical Review Board. .

Medical Chronicle spoke to Dr Alan Barge, Vice President and Head of Oncology and Infection at AstraZeneca about the company’s research in targeted cancer treatment at the AstraZeneca Oncology Academy symposium that was held in Cape Town this past March.

Dr Barge believes that a radical change in mindset is needed in order to treat cancer more effectively. “Cancer is often seen as one homogenous disease, but in fact the disease area is much more complex than previously imagined. For example, in breast cancer there may be 20 to 30 subsets of breast cancers that will respond very differently to treatment and it is highly unlikely that any single treatment would be effective here,” commented Barge. An already complex disease area, treating cancer is further complicated by the fact that different genetic populations develop different types of the same cancer and therefore respond differently to treatment. “This means that while we have made progress in treating cancer, we have to go back to the drawing board and start with a deep understanding of the molecular pathology of the various types of cancer,” said Barge.

This approach means that the main thrust of AstraZeneca’s oncology research is to redefine all types of cancers on a molecular level. Of course, mapping each cancer subset for common mutations or variations, for example lung cancer, is a major undertaking which is why the company has embarked on various collaborations with universities and other cancer research centres. “No one single company or medical institution will be able to provide a complete solution to cancer treatment, which is why we have entered into various academic collaborations throughout the world. We are looking to collaborate even more broadly, even with other pharmaceutical companies,” commented Barge.

The major portion of these projects is based in the United States and in Asia. In the States these include such centres such as the MD Anderson Cancer Centre, University of Colorado and the National Cancer Institute. In Asia, the research takes place at organisations such as the Shanghai Innovation Centre and the Singapore Cancer Syndicate. The AstraZeneca oncology pipeline includes projects in the pre-clinical phase right through to advanced clinical trials.

The development of targeted therapies requires the identification of good targets—that is, targets that are known to play a key role in cancer cell growth and survival. By focusing on molecular and cellular changes that are specific to cancer, targeted cancer therapies may be more effective than other types of treatment, including chemotherapy and radiotherapy, and less harmful to normal cells. The challenges in indentifying these targets are immense; most patients participating in trials are in the advanced stages of the disease and typically aren’t the best candidates to study. In some cases, for instance with lung cancer, biopsies aren’t readily available. This means that from identification stage to bringing a targeted therapy to market can take anything between 8 to 15 years. “Fortunately, we have developed a large tissue bank which we can use to study the tumours’ reaction to biological compounds. Also, it is incredibly heartening to see patients willing to undergo procedures, even though they add to their treatment time and discomfort, to further research in targeted therapy,” he added.

AstraZeneca’s ultimate goal with regards to oncology is ambitious. “In time we would like cancer to be treated as a chronic manageable illness and not a terminal disease and offer patients a longer life-span and better quality of life, in much the same way as diabetes is managed today.” Barge noted that this will take decades but it is something he would hope to see in his lifetime.

Dr Barge is a haematologist/oncologist; he graduated from Oxford University in 1979 and the London Hospital Medical College in 1982. He has over 18 years’ experience working in international oncology and drug development in both biologicals and small molecules. Dr Barge was in South Africa to address oncologists and the broader oncology community at AstraZeneca’s Oncology Academy symposium. The academy was formed in November 2009, with the intention of providing South African oncologists with access to the latest international information about clinical trials and new treatment options for cancer. For more information about taking part in AstraZeneca’s Oncology Academy please contact Leon Spamer, Brand Manager for Oncology at AstraZeneca at leon.spamer@astrazeneca.com, tel: (011) 797 6000, fax: (011) 797 6001.