The COVID-19 pandemic may have brought to the forefront the increase in dependencies on drugs, alcohol, smart devices, and the internet, however, we must not sideline another “timeless,” legal, yet insidious dependence that affects physical health: smoking. Fifty-eight years ago, on January 11, 1964, in a room filled with journalists at the State Department in Washington, the U.S. Surgeon General, Leroy Edgar Burney, a smoker himself, presented a report entitled “Smoking and Health,” a renowned report comprised of a twelve-member committee of top scientists. The message of the 357-page report was simple: Smoking causes cancer. At that time, 46% of American adults smoked. “The Surgeon General’s Report,” as it became known, contained the following conclusions:

• Smoking is causally related to lung cancer in men; the impact of smoking outweighs all other factors.
• Smoking is much more significant than occasional exposure to risk factors in the general population.
• Smoking is the most important cause of chronic bronchitis in the U.S. and increases the risk of death from chronic bronchitis and emphysema.
• Although the causal role of smoking in coronary artery disease was not yet fully proven at that time, from a public health perspective, it was deemed more appropriate to assume a causal relationship rather than suspend judgment until all doubt was eliminated.

Smoking is the largest preventable cause of premature death and disability in the U.S., responsible for nearly 390,000 deaths each year. The average smoker in the early 21st century was reported to spend almost $1,000 a year, smoking 1.5 packs a day. Today, 20 years later, this amount exceeds $3,400, while smoking-related health expenses amount to $22 billion annually.

Lung cancer is the leading cause of cancer mortality worldwide. Although the incidence of lung cancer in men is decreasing alongside the decline in smoking in the Western world, its incidence in women is increasing at the same rate observed in men 40 years ago. For this reason, lung cancer will maintain its position as the deadliest cancer of the 21st century. It is not well understood why the outcomes of anti-smoking campaigns differ between men and women. However, we must all keep in mind that lung cancer is a preventable form of cancer.

*Christos H. Liapis MD, MSc, PhD, is a Psychiatrist, Doctor of the University of Athens, Chairman of the Board of KETHEA, and a Member of the Public Health Expert Committee.