Lung Cancer

Basic Information About Lung Cancer

Lung cancers are cancers that begin in the lungs. Other types of cancers may spread to the lungs from other organs. However, these are not lung cancers because they did not start in the lungs. When cancer cells spread from one organ to another, they are called metastases.

Research has found several risk factors for lung cancer. A "risk factor" is anything that changes risk of getting a disease. Different risk factors change risk by different amounts.

The risk factors for lung cancer include—

• Smoking and being around others' smoke.
• Things around us at home or work (such as radon gas).
• Personal traits (such as having a family history of lung cancer).

Symptoms

Different people have different symptoms for lung cancer. Some people don't have any symptoms at all. About 25% of people with lung cancer do not have symptoms from advanced cancer when their lung cancer is found.1 Lung cancer symptoms may include—

• Shortness of breath.
• Coughing that doesn't go away.
• Wheezing.
• Coughing up blood.
• Chest pain.

Other changes that can sometimes occur with lung cancer may include repeated bouts of pneumonia, changes in the shape of the fingertips, and swollen or enlarged lymph nodes (glands) in the upper chest and lower neck.

These symptoms can happen with other illnesses, too. People with symptoms should talk to their doctor, especially if they smoke, but even if they don't. Doctors can help find the cause.2 3

References

• Humphrey LL, Teutsch S, Johnson MS. Lung cancer screening with sputum cytologic examination, chest radiography, and computed tomography: An update for the U.S. Preventive Services Task Force. Annals of Internal Medicine 2004;140:740–753.
• Harrison's Principles of Internal Medicine, Chapter 88: Neoplasms of the lung. Clinical Manifestations. P.3. The McGraw-Hill Companies, Inc., 2008.
• Beckles MA, Spiro SG, Colice GL, Rudd RM. Initial evaluation of the patient with lung cancer: Symptoms, signs, laboratory tests and paraneoplastic syndromes. Chest 2003;123:97S–104S.

Diagnosis and Treatment

A person's lung cancer diagnosis depends on the type of lung cancer present. The two main types of lung cancer are small cell lung cancer and non-small cell lung cancer. Non-small cell lung cancer is more common than small cell lung cancer. These categories refer to what the cancer cells look like under a microscope.

The extent of disease is referred to as the stage. Information about how big a cancer is or how far it has spread is often used to determine the stage. Doctors use information about stage to plan treatment and to monitor progress.

For more information about stages of lung cancer, visit the National Cancer Institute's (NCI) Physician Data Query (PDQ) sites on Stages of Non-Small Cell Lung Cancer and Stages of Small Cell Lung Cancer.

Types of Treatment

There are several ways to treat lung cancer. The treatment depends on the type of lung cancer and how far it has spread. Treatments include surgery, chemotherapy, and radiation. People with lung cancer often get more than one kind of treatment.

• Surgery: Doctors cut out and remove cancer tissue in an operation.
• Chemotherapy: Chemotherapy involves the use of drugs to shrink or kill the cancer. The drugs could be pills or medicines given through an IV (intravenous) tube. Sometimes chemotherapy includes both IV drugs and pills.
• Radiation: Radiation uses high-energy rays (similar to X-rays) to try to kill the cancer cells. The rays are aimed at the part of the body where the cancer is.

Visit NCI's PDQ for more information about treatments for Non-Small Cell Lung Cancer and Small Cell Lung Cancer. These treatments may be provided by different doctors on your medical team. Pulmonologists are doctors who are experts in diseases of the lungs. Surgeons are doctors who perform operations. Medical oncologists are doctors who are experts in cancer and treat cancers with medicines. Radiation oncologists are doctors who treat cancers with radiation.

Clinical Trials

People with lung cancer may want to take part in a clinical trial. Clinical trials study new potential treatment options. Visit the sites listed below for more information about clinical trials.

• Clinical Trials (NCI)
• ClinicalTrials.gov
• Clinical Trials (American Cancer Society)

Complementary and Alternative Medicine

For information, visit NCI's Complementary and Alternative Medicine.

Survivorship

People with lung cancer may experience symptoms caused by the cancer or by cancer treatments (side effects). Common symptoms caused by lung cancer include shortness of breath, coughing, wheezing, coughing up blood, pain, fever, and weight loss. Side effects vary depending on the type of treatment. People who want information about symptoms and side effects and those that can occur with their treatment plan should talk to their doctors. Also those with symptoms or concerns should discuss them with their doctors. Doctors can help answer questions and make a plan to control symptoms.

For more information about symptoms and side effects, visit the National Cancer Institute's Coping with Cancer and the American Cancer Society's Symptoms and Side Effects.

For information about finding or providing support for people with lung cancer and their caregivers, visit CDC's Cancer Survivorship and the Lung Cancer Alliance's Support.

A study suggested that people diagnosed with lung cancer sometimes feel stigmatized by others.1 That is, because smoking is associated with lung cancer, some people feel blamed for causing their illness. Even some people who never smoked had similar feelings. For some, these feelings interfered with relationships or made them not want to talk to others about their cancer. To learn more, visit the American Cancer Society's Many Lung Cancer Patients Feel Stigmatized.

Reference

• Chapple A, Ziebland S, McPherson A. Stigma, shame and blame experienced by patients with lung cancer: A qualitative study. British Medical Journal 2004;328:1470.

Risk Factors

Research has found several risk factors for lung cancer. A risk factor is anything that changes the chance of getting a disease. Different risk factors change risk by different amounts.

The risk factors for lung cancer include—

• Smoking and being around others' smoke.
• Things around us at home or work, such as radon gas.
• Personal traits, such as having a family history of lung cancer.

Smoking and Secondhand Smoke

Cigarette smoking causes lung cancer. In fact, smoking tobacco is the major risk factor for lung cancer. In the United States, about 90% of lung cancer deaths in men and almost 80% of lung cancer deaths in women are due to smoking. People who smoke are 10 to 20 times more likely to get lung cancer or die from lung cancer than people who do not smoke. The longer a person smokes and the more cigarettes smoked each day, the more risk goes up. ^{[1][2][3][4][5][6][7][8]}

People who quit smoking have a lower risk of lung cancer than if they had continued to smoke, but their risk is higher than the risk for people who never smoked.^[9] As more people quit smoking, lung cancer rates will continue to fall, the percentage of lung cancers that occur in smokers will decrease, and the percentage of lung cancers that occur in people who have quit will rise.

Smoking also causes cancer of the voicebox (larynx), mouth and throat, esophagus, bladder, kidney, pancreas, cervix, and stomach, and causes acute myeloid leukemia.

More information about cigarette smoking and lung cancer is available in CDC's Smoking and Tobacco Use fact sheets, the 2004 Surgeon General's Report, and the National Cancer Institute's (NCI) Cigarette Smoking and Cancer: Questions and Answers.

Using cigars or pipes also increases risk for lung cancer, but not as much as smoking cigarettes. For more information, visit NCI's Questions and Answers About Cigar Smoking and Cancer.^{[10][11][12][13][14][15][16]}

Smoke from other people's cigarettes (secondhand smoke) causes lung cancer as well. Secondhand smoke contains more than 4,000 chemicals, more than 50 of which cause cancer in people or animals. Every year, about 3,000 nonsmokers die from lung cancer due to secondhand smoke.^{[17][18][19][20][21][22]}

For more information, visit Secondhand Smoke.

Things at Home and Work That May Cause Lung Cancer

Several things may cause lung cancer in the workplace or even in the home—

• Radon gas causes lung cancer and is sometimes found in people's homes. Radon is an odorless, colorless gas that comes from rocks and dirt and can get trapped in houses and buildings. Radon is the number one cause of lung cancer among non-smokers, according to EPA estimates. Overall, radon is the second leading cause of lung cancer.
• Examples of substances found at some workplaces that increase risk include asbestos, arsenic, and some forms of silica and chromium. For many of these substances, the risk of getting lung cancer is even higher for those who also smoke.^{[23][24][25][26][27][28]}
• Other substances may increase lung cancer risk as well.

For more information on carcinogens and cancer in the workplace, visit the links below.

• Agency for Toxic Substances and Disease Registry ToxFAQs™
• National Toxicology Program's 11th Report on Carcinogens
• National Institute for Occupational Safety and Health

Family History

Risk of lung cancer may be higher if a person's parents, siblings (brothers or sisters), or children have had lung cancer. This increased risk could come from one or more things. They may share behaviors, like smoking. They may live in the same place where there are carcinogens such as radon. They may have inherited increased risk in their genes. ^{[29][30][31][32]}

For more information, visit CDC's National Office of Public Health Genomics.

Diet

Scientists are studying many different foods to see how they may change the risk of getting lung cancer. However, any effect diet may have on lung cancer risk is small compared with the risk from smoking. Eating a lot of fat and cholesterol might increase risk of lung cancer. Drinking a lot of alcohol may raise risk as well. However, it's hard to tell how much of the risk in people who drink is actually due to tobacco smoke, since many people both smoke and drink.

Some foods may actually help prevent lung cancer. Diets high in fruits and vegetables likely decrease cancer risk. Diets high in vitamin C, vitamin E, or selenium also may help protect against lung cancer. The effect of eating foods with carotenoids like beta-carotene on lung cancer risk is uncertain. Carotenoids can be found in carrots, sweet potatoes, and some green vegetables. Eating these foods may lower chances of lung cancer. Taking beta-carotene supplements (pills) is not recommended, however, since it may actually increase risk in some smokers. ^{[33][34][35][36][37]}

For more information, visit NCI's Diet and Cancer.

Prevention

There may be several ways to reduce your risk of developing lung cancer.

Don’t Smoke

Tobacco use is the major cause of lung cancer in the United States. About 90% of lung cancer deaths in men and almost 80% of lung cancer deaths in women in this country are due to smoking. The most important thing a person can do to prevent lung cancer is to not start smoking, or to quit if he or she currently smokes.

Quitting smoking will lower risk of lung cancer compared to not quitting. This is true no matter how old one is or how much he or she smokes. The longer a person goes without smoking, the more his or her risk will improve compared to those who continue to smoke. However, the risk in people who have quit is still higher than the risk in people who have never smoked. For more information, visit Quit Smoking.^{[38][39][40][41][42][43]}

CDC helps support a national network of quitlines that makes free "quit smoking" support available by telephone to smokers anywhere in the United States. The toll-free number is 1-800-QUITNOW (1-800-784-8669), or visit smokefree.gov.

For smokers, avoiding other things that increase risk for lung cancer may help lower risk, but not as much as quitting smoking.

Avoid Secondhand Smoke

CDC's Office of Smoking and Health has information about secondhand smoke.

Make Your Home and Workplace Safer

The Environmental Protection Agency (EPA) recommends that all homes be tested for radon. Radon detectors can be purchased or arrangements can be made for qualified testers to come into the home. Visit EPA's radon Web site for more information about radon and radon testing.^[44]

Health and safety guidelines in the workplace can help workers avoid things that can cause cancer (carcinogens).

Eat Lots of Fruits and Vegetables

Eating a diet high in fruits and vegetables may help protect against lung cancer. For more information, visit Fruits & Veggies - More Matters.

Screening

Screening means testing for a disease when there are no symptoms or history of that disease. Doctors give a screening test to find a disease early on, when treatment may work better. Scientists have studied several types of screening tests for lung cancer. A review of these studies by experts shows that more information is needed. It is not known if these tests can help prevent deaths from lung cancer.1

Examples of screening tests for lung cancer include—

• Chest X-rays.
• Sputum cytology (looking for cancer cells in phlegm under a microscope).
• CAT scans of the lungs (CAT scans are detailed images of the inside of the body, made by a computer that combines X-ray images taken from different angles).^[45]

There is fair evidence that low-dose CAT scans, chest X-rays, and sputum cytology can find cancers earlier than they would be found without screening, but there is little evidence that these screening tests actually prevent people from dying from lung cancer.^[46]

Screening also has its downside. Screening tests may find spots (abnormalities) in the lungs that are not cancers. However, a screening test does not always show the difference between cancers and other abnormalities that are not cancers. More tests may be needed to find out if the spot is a cancer. These tests might include removing a small piece of lung tissue for more testing (biopsy). This means that some people might have a surgical procedure even though they don't have cancer. These procedures have risks associated with them. They also can cause anxiety and cost money.

Experts do not know if the benefits of screening outweigh the potential harms. For these reasons, experts do not currently recommend for or against lung cancer screening. Screening for lung cancer with chest X-rays was once promoted by some experts, but researchers found out that people who were screened did not have a lower death rate than people who were not screened.

Studies are underway that will help provide more information about the effectiveness of more modern screening tests. To learn more, visit the National Lung Screening Trial and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.^[47][48]

Lung Cancer Statistics

More people die from lung cancer than any other type of cancer. This is true for both men and women. In 2005 (the most recent year for which statistics are currently available), lung cancer accounted for more deaths than breast cancer, prostate cancer, and colon cancer combined.† In that year,

• 107,416 men and 89,271 women were diagnosed with lung cancer*†
• 90,139 men and 69,078 women died from lung cancer*†

Among men in the United States, lung cancer is the second most common cancer among white, black, Asian/Pacific Islander, American Indian/Alaska Native, and Hispanic men. Among women in the United States, lung cancer is the second most common cancer among white, black, and American Indian/Alaska Native women, and the third most common cancer among Asian/Pacific Islander and Hispanic women.† For more information, visit Cancer Data and Statistics by Demographic.

• Note: Incidence counts cover 96% of the U.S. population and death counts cover 100% of the U.S. population. Use caution in comparing incidence and death counts.

†U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2005 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2009. Available at: http://www.cdc.gov/uscs.

Lung Cancer Rates by Race and Ethnicity

Lung cancer rates differ for different racial and ethnic populations. Differences in lung cancer death rates as of 2005 (the most recent year for which statistics are currently available) are shown in the graphs below.

Rate of Lung Cancer by Race and Ethnicity

"Incidence rate" means how many people out of a given number get the disease each year. The graph below shows how many people out of 100,000 got lung cancer each year during the years 1975–2005. The year 2005 is the most recent year for which numbers have been reported. The lung cancer incidence rate is grouped by race and ethnicity.

For example, you can see that black people had the highest incidence rate for lung cancer. White people had the second highest incidence of getting lung cancer, followed by American Indian/Alaska Native, Asian/Pacific Islander, and Hispanic people.

Lung and Bronchus Cancer SEER Incidence Rates* by Race and Ethnicity, U.S., 1975–2005

Incidence source: Surveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute (NCI) 1975–1991 = SEER 9; 1992–2005 = SEER 13.

• Rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population (19 age groups - Census P25-1130).

†Rates for American Indians/Alaska Natives are based on the CHSDA (Contract Health Service Delivery Area) counties. ‡Hispanics are not mutually exclusive from whites, blacks, Asians/Pacific Islanders, and American Indians/Alaska Natives. Incidence data for Hispanics are based on NHIA and exclude cases from the Alaska Native Registry.

Deaths from Lung Cancer by Race and Ethnicity

From 1975–2005, the rate of people dying from lung cancer has varied, depending on their race and ethnicity. The graph below shows that in 2005, black people were more likely to die of lung cancer than any other group. White people had the second highest rate of deaths from lung cancer, followed by people who are American Indian/Alaska Native, Asian/Pacific Islander, and Hispanic.

Lung and Bronchus Cancer U.S. Death Rates* by Race and Ethnicity, U.S., 1975–2005

Mortality source: U.S. Mortality Files, National Center for Health Statistics, CDC.

• Rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population (19 age groups - Census P25-1130).

†Rates for American Indians/Alaska Natives are based on the CHSDA (Contract Health Service Delivery Area) counties. ‡Hispanics are not mutually exclusive from whites, blacks, Asians/Pacific Islanders, and American Indians/Alaska Natives. Mortality data for Hispanics do not include cases from Connecticut, Maine, Maryland, Minnesota, New Hampshire, New York, North Dakota, Oklahoma, and Vermont.

Lung Cancer Rates by State

Risks of getting lung cancer vary from state to state in the United States. The maps below show how the states compare on lung cancer rates as of 2005 (the most recent year for which statistics are currently available).

Lung and Bronchus Cancer Incidence Rates* by State, 2005

Deaths from Lung and Bronchus Cancer by State

Rates of dying from lung and bronchus cancer also vary from state to state.

Lung and Bronchus Cancer Death Rates* by State, 2005†

• Rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population.

†U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2005 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2009. Available at: http://www.cdc.gov/uscs.

Lung Cancer Risk by Age

The risk of getting lung cancer increases with age and is greater in men than in women. The tables below shows the percentage of men or women (how many out of 100) who will get lung cancer over different time periods. The time periods are based on the person's current age.

For example, go to the men's current age 60. The table shows 2.35% of men who are now 60 years old will get lung cancer sometime during the next 10 years. That is, 2 or 3 out of every 100 men who are 60 years old today will get lung cancer by the age of 70.

†Source: Horner MJ, Ries LAG, Krapcho M, Neyman N, Aminou R, Howlader N, Altekruse SF, Feuer EJ, Huang L, Mariotto A, Miller BA, Lewis DR, Eisner MP, Stinchcomb DG, Edwards BK (eds). SEER Cancer Statistics Review, 1975–2006, National Cancer Institute. Bethesda, MD, based on November 2008 SEER data submission, posted to the SEER Web site, 2009.

Lung Cancer Trends

Among men in the United States, the number of new lung cancer cases and the number of deaths from lung cancer have decreased over the last several decades because the number of men who smoke has declined. Death rates for U.S. men are lower than death rates for men in several other countries, but more men die from lung cancer than women.

Among women in the United States, reductions in smoking are more recent, beginning in the late 1970s. Lung cancer death rates for U.S. women are among the highest in the world. For more information about lung cancer rates in different countries, visit CANCERMondial, a project of the International Agency for Research on Cancer).

Programs and policies that discourage smoking are vital to keep reducing the number of lung cancer cases and deaths.^[49][50][51]

Incidence Trends^[52]

In the United States, incidence of lung cancer has—

• Decreased significantly by 1.8% per year from 1991 to 2005 among men.
• Increased significantly by 0.5% per year from 1991 to 2005 among women.

Among African Americans, incidence has—

• Decreased significantly by 2.9% per year from 1996 to 2005 among men.
• Remained level from 1996 to 2005 among women.

Among Asians/Pacific Islanders, incidence has—

• Decreased significantly by 1.7% per year from 1996 to 2005 among men.
• Remained level from 1996 to 2005 among women.

Among Hispanics, incidence has—

• Decreased significantly by 2.4% per year from 1996 to 2005 among men.
• Remained level from 1996 to 2005 among women.

Death Trends^[53]

In the United States, deaths from lung cancer have—

• Decreased significantly by 1.9% per year from 1993 to 2005 among men.
• Remained level from 2003 to 2005 among women.

Among African Americans, deaths have—

• Decreased significantly by 2.8% per year from 1996 to 2005 among men.
• Remained level from 1996 to 2005 among women.

Among Asians/Pacific Islanders, deaths have—

• Decreased significantly by 1.6% per year from 1996 to 2005 among men.
• Remained level from 1996 to 2005 among women.

Among American Indians/Alaska Natives, deaths have—

• Decreased significantly by 2.3% per year from 1996 to 2005 among men.
• Increased significantly by 2.9% per year from 1996 to 2005 among women.

Among Hispanics, deaths have—

• Decreased significantly by 2.5% per year from 1996 to 2005 among men.
• Remained level from 1996 to 2005 among women.

What CDC Is Doing About Lung Cancer

Ongoing Work

CDC's ongoing work to encourage the prevention and control of lung cancer includes—

Lung Cancer Web Site. CDC maintains this Web site to increase awareness of and knowledge about lung cancer, and to provide resources for preventing and controlling lung cancer. The site presents information about disease burden, risk factors, and risk modification, as well as screening recommendations, a review of CDC's activities in lung cancer control, and links to additional resources. The site offers definitions and links to information about diagnosis, staging, treatment, supportive care, management of side effects, clinical trials, and support groups.

National Program of Cancer Registries (NPCR). CDC's Division of Cancer Prevention and Control (DCPC) and the National Cancer Institute's (NCI) Surveillance, Epidemiology and End Results (SEER) Program, in collaboration with the North American Association of Central Cancer Registries, produce the annual United States Cancer Statistics (USCS) Web-based report. CDC's National Center for Health Statistics/National Vital Statistics System provides nationwide cancer death statistics.

Office on Smoking and Health (OSH). CDC's OSH created the National Tobacco Control Program in 1999 to reduce tobacco-related diseases through community interventions, counter-marketing, program policy and regulation, surveillance, and evaluation. The program provides funding and technical support to state and territorial health departments.

Division of Nutrition, Physical Activity and Obesity (DNPAO). CDC's DNPAO supports states by offering programs that promote a healthy diet. These programs include Fruits and Veggies: More Matters, which encourages people to eat more fruits and vegetables.

National Institute for Occupational Safety and Health (NIOSH). CDC's NIOSH is the federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness, including lung cancer caused by workplace exposures.

National Center for Environmental Health (NCEH) and the Agency for Toxic Substances and Disease Registries (ATSDR). ATSDR and CDC's NCEH support environmental health tracking programs and conduct activities to prevent or control exposures and diseases related to the environment. For lung cancer, examples include exposures to asbestos, radon, ionizing radiation, and other cancer-causing substances at home, in the general environment, or from toxic waste sites.

Guide to Community Preventive Services. CDC supports the Guide to Community Preventive Services, a Web site that recommends ways to improve tobacco control at the community level. The Guide also offers evidence-based recommendations about other disease prevention and health promotion programs.

Cancer Control P.L.A.N.E.T. CDC contributes to Cancer Control P.L.A.N.E.T., a Web site that offers research-tested tools and programs for tobacco control, as well as many other resources for the prevention and control of cancer.

1-800-QUITNOW. CDC and NCI support a national network of "quitlines" that smokers in the United States can use for help with quitting smoking. 1-800-QUITNOW (1-800-784-8669) is a single-access point to the National Network of Tobacco Cessation Quitlines. Callers are routed automatically to a state-run quitline if one exists in their area. If there is no state-run quitline, the call goes to the NCI quitline.

Future Directions

CDC will continue to support and contribute to the activities listed above, and will maintain its lung cancer Web site.

With additional funding, CDC's DCPC would enhance lung cancer surveillance activities, and evaluate potential research efforts related to lung cancer screening and early detection, community-based programs related to lung cancer prevention and control, and the public health needs of cancer survivors and their families.

Links Related to Lung Cancer

General Information

• Lung Cancer (National Cancer Institute (NCI))
• What You Need To Know About™ Lung Cancer (NCI)
• Lung Cancer (Medline Plus)

Smoking and Tobacco Use

• Surgeon General's Reports on Smoking and Tobacco Use
• Women and Tobacco (CDC)
• Smoking and Tobacco Use (CDC)

Other Risk Factors

• Secondhand Smoke (CDC)
• Secondhand Smoke: Questions and Answers (NCI)
• Respiratory Health Effects of Passive Smoking (Environmental Protection Agency (EPA))
• 2006 Surgeon General's Report: The Health Consequences of Involuntary Exposure to Tobacco Smoke
• Health Risks: Exposure to Radon Causes Lung Cancer in Non-Smokers and Smokers Alike (EPA)
• Asbestos Exposure and Cancer Risk (NCI)
• Asbestos (EPA)
• Lung Cancer: Prevention, Genetics, Causes (NCI)

Help to Quit Smoking

• Quit Smoking (CDC)
• Smoke Free

Clinical Trials

• Search for Clinical Trials (NCI)
• Lung Cancer Trial Results (NCI)
• Clinical Trials (National Institutes of Health)
• Clinical Trials (American Cancer Society (ACS))

Screening and Testing

• Lung Cancer Screening (U.S. Preventive Services Task Force)
• Lung Cancer: Screening and Testing (NCI)
• Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) (NCI)
• National Lung Screening Trial (NLST) (NCI)

Survivorship

• CDC's Cancer Survivorship Partners
• Links Related to Cancer Survivorship (CDC)

Prevention and Control

• Quick Reference Guide for Clinicians: Treating Tobacco Use and Dependence (Office of the Surgeon General)
• Tobacco Use (Guide to Community Preventive Services)
• Tobacco Control: 5 Steps to Effective Cancer Control Planning (Cancer Control P.L.A.N.E.T.)
• Tobacco Intervention Programs (NCI)

Other

• The Tobacco Atlas, Second Edition (ACS)
  The Tobacco Atlas provides the latest information on the global tobacco pandemic, including information on disease and death associated with tobacco, and how tobacco control advocates worldwide are implementing measures to reduce tobacco's harmful effects.
• Asian and Pacific Islander Cancer Education Materials Web Tool (APICEM) (ACS)
  The APICEM is designed to help Asians and Pacific Islanders with limited English-speaking abilities gain access to information on how to reduce their risks of preventable malignancies, including cancers of the breast, cervix, colon, liver, lung, and stomach.

References

1. ↑ American Cancer Society. Cancer Facts and Figures 2005 (PDF-1.7MB).
2. ↑ International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans and their Supplements: A complete list. Tobacco Smoking. Monograph Volume 38 (1986).
3. ↑ International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans and their Supplements: A complete list. Tobacco Smoking and Tobacco Smoke Volume 83 (2002) (PDF-48KB).
4. ↑ U.S. Department of Health, Education and Welfare. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service (1964).
5. ↑ U.S. Department of Health and Human Services. 2001 Surgeon General's Report: Women and Smoking.
6. ↑ Alberg AJ, Samet JM. Epidemiology of lung cancer. Chest 2003;123(1 Suppl):21S–49S.
7. ↑ U.S. Department of Health and Human Services. 2004 Surgeon General's Report: The Health Consequences of Smoking.
8. ↑ Institute of Medicine (IOM) National Cancer Policy Board. Fulfilling the Potential of Cancer Prevention and Early Detection. Curry SJ, Byers T, Hewitt M (eds). National Academies Press. Washington, D.C., 2003.
9. ↑ U.S. Department of Health and Human Services. 2004 Surgeon General's Report: The Health Consequences of Smoking.
10. ↑ International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans and their Supplements: A complete list. Tobacco Smoking. Monograph Volume 38 (1986).
11. ↑ International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans and their Supplements: A complete list. Tobacco Smoking and Tobacco Smoke Volume 83 (2002) (PDF-48KB).
12. ↑ U.S. Department of Health, Education and Welfare. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service (1964).
13. ↑ Institute of Medicine (IOM) National Cancer Policy Board. Fulfilling the Potential of Cancer Prevention and Early Detection. Curry SJ, Byers T, Hewitt M (eds). National Academies Press. Washington, D.C., 2003.
14. ↑ National Institutes of Health, National Cancer Institute Smoking. Tobacco control monograph 9: Cigars; health effects and trends. NIH Publication No. 98-4302. Bethesda, MD: U.S. Department of Health and Human Services, 1998.
15. ↑ Boffetta P, Pershagen G, Jöckel KH, Forastiere F, Gaborieau V, Heinrich J, Jahn I, Kreuzer M, Merletti F, Nyberg F, Rösch F, Simonato L. Cigar and pipe smoking and lung cancer risk: A multicenter study from Europe. Journal of the National Cancer Institute 1999;91(8):697–701.
16. ↑ U.S. Department of Health and Human Services. Smoking and Health: A Report of the Surgeon General (1979).
17. ↑ U.S. Department of Health and Human Services. 2001 Surgeon General's Report: Women and Smoking.
18. ↑ U.S. Department of Health and Human Services. The Health Consequences of Involuntary Smoking: A Report of the Surgeon General (1986).
19. ↑ National Institutes of Health (NIH), National Cancer Institute. Smoking and Tobacco Control Monograph 10 (1999): Health Effects of Exposure to Environmental Tobacco Smoke.
20. ↑ National Research Council (NRC), Committee on Passive Smoking. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects (1986).
21. ↑ U.S. Environmental Protection Agency. Respiratory Health Effects of Passive Smoking. (1992).
22. ↑ International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans and their Supplements: A complete list. Involuntary Smoking Volume 83 (PDF-45KB) (2002).
23. ↑ International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans and their Supplements: A complete list. Tobacco Smoking. Monograph Volume 38 (1986).
24. ↑ International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans and their Supplements: A complete list. Tobacco Smoking and Tobacco Smoke Volume 83 (2002) (PDF-48KB).
25. ↑ Alberg AJ, Samet JM. Epidemiology of lung cancer. Chest 2003;123(1 Suppl):21S–49S.
26. ↑ International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans and their Supplements: A complete list. Overall Evaluations of Carcinogenicity: An Updating of IARC Monographs Volumes 1 to 42 (PDF-1MB) (1987).
27. ↑ U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Report on Carcinogens, Eleventh Edition (2004).
28. ↑ International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans and their Supplements: A complete list. Some Metals and Metallic Compounds (PDF-28KB): Arsenic and Arsenic Compounds (PDF-1MB) Volume 23 (1980).
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31. ↑ Bromen K, Pohlabeln H, Jahn I, Ahrens W, Jockel KH. Aggregation of lung cancer in families: Results from a population-based case-control study in Germany. American Journal of Epidemiology 2000;152(6):497–505.
32. ↑ Mayne ST, Buenconsejo J, Janerich DT. Familial cancer history and lung cancer risk in United States nonsmoking men and women. Cancer Epidemiology, Biomarkers and Prevention 1999;8(12):1065–1069.
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34. ↑ Institute of Medicine (IOM) National Cancer Policy Board. Fulfilling the Potential of Cancer Prevention and Early Detection. Curry SJ, Byers T, Hewitt M (eds). National Academies Press. Washington, D.C., 2003.
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36. ↑ Institute of Medicine (IOM), Food and Nutrition Board, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. A Report of the Panel on Dietary Antioxidants and Related Compounds: Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium and Carotenoids (2000).
37. ↑ Institute of Medicine (IOM), Food and Nutrition Board, Committee on Examination of the Evolving Sciences for Dietary Supplements. Evolution of Evidence for Selected Nutrient and Disease Relationships (2002).
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41. ↑ U.S. Department of Health and Human Services. 2001 Surgeon General's Report: Women and Smoking.
42. ↑ Alberg AJ, Samet JM. Epidemiology of lung cancer. Chest 2003;123(1 Suppl):21S–49S.
43. ↑ Institute of Medicine (IOM) National Cancer Policy Board. Fulfilling the Potential of Cancer Prevention and Early Detection. Curry SJ, Byers T, Hewitt M (eds). National Academies Press. Washington, D.C., 2003.
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50. ↑ Jemal A, Thun MJ, Ries LA, Howe HL, Weir HK, Center MM, Ward E, Wu XC, Eheman C, Anderson R, Ajani UA, Kohler B, Edwards BK. Annual report to the nation on the status of cancer, 1975–2005, featuring trends in lung cancer, tobacco use, and tobacco control. Journal of the National Cancer Institute 2008;100(23):1672–1694.
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52. ↑ Jemal A, Thun MJ, Ries LA, Howe HL, Weir HK, Center MM, Ward E, Wu XC, Eheman C, Anderson R, Ajani UA, Kohler B, Edwards BK. Annual report to the nation on the status of cancer, 1975–2005, featuring trends in lung cancer, tobacco use, and tobacco control. Journal of the National Cancer Institute 2008;100(23):1672–1694.
53. ↑ Jemal A, Thun MJ, Ries LA, Howe HL, Weir HK, Center MM, Ward E, Wu XC, Eheman C, Anderson R, Ajani UA, Kohler B, Edwards BK. Annual report to the nation on the status of cancer, 1975–2005, featuring trends in lung cancer, tobacco use, and tobacco control. Journal of the National Cancer Institute 2008;100(23):1672–1694.