I am concerned about omissions and lost opportunities in two recent articles in the BCMJ. One article is about cancer in BC males [Cancer among males in BC and Canada, BCMJ 2011;53:541-546 [9]] and the other is about breast cancer prevention, entitled A model of cancer prevention in British Columbia: The Breast Cancer Prevention and Risk Assessment Clinic, BCMJ 2012;54:130-135 [10]]. 

The first article mentions the issue of stopping smoking in a section on tobacco use, but does not mention what can be done to prevent smoking. 

Activities in the area of prevention have achieved a lot as far as children are concerned, but we should not be complacent. Current smoking rates have fluctuated around 12% in BC for the past 6 years. We should also focus interest on what to do about the 20- to 25-year-olds who start to smoke after leaving school and where the rates, although dropping, are still 5% higher than children’s rates for each age cohort. That is a significant number of smokers who are becoming addicted long term. 

The Figure [11] shows where the problem lies. “Preventing Tobacco Use Among Youth and Young Adults” is the subtitle of the 900-page 2012 Surgeon General’s Report.[1] The messages aimed at smokers (i.e., those on cigarette packages) are not seen by nonsmokers and some have forgotten the information they received at school. They are, however, often exposed to the subtle marketing activities of the tobacco industry, which spends nearly $10 billion per year in the US on advertising and promotion efforts in spite of restrictions on marketing.[1]

In the article about reducing the risk of breast cancer there is no mention of smoking as a risk factor. The second report of the Canadian Expert Panel on Tobacco Smoke and Breast Cancer Risk[2] concluded, as a result of reviewing 30 studies since 2002, that the association between active smoking and breast cancer is consistent with causality. 

Physician advice is recognized as one of the strongest factors influencing a patient’s decision to stop smoking and to succeed. The same will ap­ply to a physician’s advice not to start smoking. Messages that will strike a chord with young adults include the unattractive smell and taste associated with tobacco, the number of apartments that don’t permit smoking, the limitations on choices for social interactions, the effect on teeth and hair color, and, most importantly, nicotine’s awful addictive properties. “Down the road” health problems are apt to be ignored by this age group. 
—Peter Coy, MB
Victoria

References

1.    Reid JL, Hammond D, Burkhalter R, et al. Tobacco Use in Canada: Patterns and Trends. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo; 2012.
2.    Johnson KC, Miller MD, Collishaw NE, et al. Active smoking and second hand smoke increase cancer risk: The report of the Canadian Expert Panel on Tobacco Smoke and Breast Cancer Risk (2009). Tob Control 2011;20:e2. Epub 2010. Doi:10.1136/tc.2010.035931.