The 1982 United States Surgeon General's report stated that"Cigarette smoking is the major single cause of cancer mortality in the United States." This statement is as true today as it was then.

Tobacco use is responsible for nearly 1 in 5 deaths in the United States. Because cigarette smoking and tobacco use are acquired behaviors -- activities that people choose to do -- smoking is the most preventable cause of death in our society.

Here is a brief overview of cigarette smoking: who smokes, how smoking affects health, what makes it so hard to quit, and what some of the many rewards of quitting are. For more on this topic, see our Guide to Quitting Smoking.

Who smokes?

Adults

The Centers for Disease Control and Prevention (CDC) reported that 46 million U.S. adults were current smokers in 2008 (the most recent year for which numbers are available). This is 20.6% of all adults (23.1% of men, 18.3% of women) -- about 1 out of 5 people.

When broken down by race/ethnicity, the numbers were as follows:

There were more cigarette smokers in the younger age groups. In 2008, the CDC reported almost 23.7% of those 25 to 44 years old were current smokers, compared with 9.3% of those aged 65 or older.

High school and middle school students

Nationwide, 20% of high school students were smoking cigarettes in 2007. The most recent survey of middle school students shows that about 6% were smoking cigarettes. In both high schools and middle schools, white and Hispanic students were more likely to smoke cigarettes than other races/ethnicities. (For more information, see our document, Child and Teen Tobacco Use.)

How does smoking cause illness and death?

About half of all Americans who keep smoking will die because of the habit. Each year about 443,600 people in the United States die from illnesses related to tobacco use. Smoking cigarettes kills more Americans than alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs combined.

Cancer caused by smoking

Cigarette smoking accounts for at least 30% of all cancer deaths. It is linked with an increased risk of the following cancers:

• lung
• larynx (voice box)
• oral cavity (mouth, tongue, and lips)
• pharynx (throat)
• esophagus (tube connecting the throat to the stomach)
• stomach
• pancreas
• cervix
• kidney
• bladder
• acute myeloid leukemia

Smoking is responsible for almost 9 out of 10 lung cancer deaths. Lung cancer is the leading cause of cancer death in both men and women, and is one of the hardest cancers to treat. Lung cancer is a disease that can often be prevented. Some religious groups that promote non-smoking as part of their religion, such as Mormons and Seventh-day Adventists, have much lower rates of lung cancer and other smoking-related cancers.

Other health problems caused by smoking

As serious as cancer is, it accounts for less than half of the deaths related to smoking each year. Smoking is a major cause of heart disease, aneurysms, bronchitis, emphysema, and stroke.

Using tobacco can damage a woman's reproductive health and hurt babies. Tobacco use is linked with reduced fertility and a higher risk of miscarriage, early delivery (premature birth), and stillbirth. It is also a cause of low birth-weight in infants. It has been linked to sudden infant death syndrome (SIDS), too.

Smoking can make pneumonia and asthma worse. It has been linked to other health problems, too, including gum disease, cataracts, bone thinning, hip fractures, and peptic ulcers. Some studies have also linked smoking to macular degeneration, an eye disease that can cause blindness.

Smoking can cause or worsen poor blood flow in the arms and legs (peripheral vascular disease or PVD.) Surgery to improve the blood flow often doesn't work in people who keep smoking. Because of this, many surgeons who work on blood vessels (vascular surgeons) won't do certain surgeries on patients with PVD unless they stop smoking.

Some studies have found that male smokers may be more likely to be sexually impotent (have erectile dysfunction).

The smoke from cigarettes (called secondhand smoke or environmental tobacco smoke) can also have harmful health effects on those exposed to it. Adults and children can have health problems from breathing secondhand smoke. (See our documents, Secondhand Smoke and Women and Smoking.)

Effects of smoking on how long you live and your quality of life

Based on data collected from 1995 to 1999, the CDC estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking.

But not all of the health problems related to smoking result in deaths. Smoking affects a smoker's health in many ways, harming nearly every organ of the body and causing diseases. According to the CDC, in 2000 about 8.6 million people had at least one chronic disease because they smoked or had smoked. Many of these people were suffering from more than one smoking-related problem. The diseases seen most often were chronic bronchitis, emphysema, heart attacks, strokes, and cancer. These diseases can steal away a person's quality of life long before death. Smoking-related illness can limit a person's daily life by making it harder to breathe, get around, work, or play.

Taking care of yourself

If you have used tobacco in any form, now or in the past, tell your health care provider so he or she can be sure that you have right preventive health care. It is well known that smoking puts you at risk for certain health problems. This means part of your health care should focus on related screening and preventive measures to help you stay as healthy as possible.

For example, your doctor may recommend that you check the inside of your mouth regularly for any changes. If you do find any changes or problems, you should have an oral exam done by your doctor or dentist. The American Cancer Society recommends that medical check-ups should include mouth (oral cavity) exams. By doing this, tobacco users may be able to find changes such as leukoplakia (white patches on the membranes in the mouth) early. This may help prevent oral cancer.

You should also be aware of any of the following:

• any change in a cough (for example, you cough up more phlegm or mucus than usual)
• a new cough
• coughing up blood
• hoarseness
• trouble breathing
• wheezing
• chest pain
• loss of appetite
• weight loss
• feeling tired all the time (fatigue)
• frequent lung or respiratory infections (like pneumonia or bronchitis)

Any of these could be signs of problems with the lungs or other parts of the respiratory system and should be reported to a doctor right away.

Smokers are at higher risk for lung cancer. But lung cancer often doesn't cause symptoms until it is advanced (has spread), and at this time there are no widely recommended screening tests for this cancer. The American Cancer Society recommends that people who are at increased risk for lung cancer, such as smokers, former smokers, or people who have been exposed to secondhand smoke, be aware of their lung cancer risk. If you are in this group, talk with your doctor about your likelihood of developing lung cancer and about the potential benefits and risks of lung cancer screening. After discussing what is and is not known about the value of early lung cancer detection, if you and your doctor decide in favor of testing, then be sure to have it done at a center that has experience in all aspects of testing people at high risk.

If you have any health concerns that you think may be caused by your cigarette smoking, please see a health care provider right away. Taking care of yourself and getting treatment for problems before they get worse will improve your chances for successful treatment. Still, the best way to take care of yourself and decrease your risk for life-threatening lung problems is to quit smoking.

What is in tobacco?

Cigarettes, cigars, and spit and pipe tobacco are made from dried tobacco leaves, as well as ingredients added for flavor and other reasons. More than 4,000 different chemicals have been found in tobacco and tobacco smoke. Among these are more than 60 chemicals that are known to cause cancer (carcinogens).

Many substances are added to cigarettes by manufacturers to enhance the flavor or to make smoking more pleasant. Some of the compounds found in tobacco smoke include ammonia, tar, and carbon monoxide. Exactly what effects these substances have on the cigarette smoker's health is unknown, but there is no evidence that lowering the tar content of a cigarette lowers the health risk.

As of now, cigarette manufacturers are not required to give out information to the public about the additives used in cigarettes, which has made it harder to determine their possible health risks. But with the passage of a new federal law, manufacturers must submit lists of ingredients to the Food and Drug Administration (FDA) starting in 2010. The FDA will make lists of harmful ingredients available to the public by or before June 2013.

Nicotine addiction

Addiction is marked by the repeated, compulsive seeking or use of a substance despite its harmful effects and unwanted consequences. Addiction is defined as physical and psychological (mental and emotional) dependence on the substance. Nicotine is the addictive drug in tobacco. Regular use of tobacco products leads to addiction in many users.

In 1988, the U.S. Surgeon General concluded the following:

• Cigarettes and other forms of tobacco are addicting.
• Nicotine is the addicting drug in tobacco.
• The ways people become addicted to tobacco are much like those that lead to addiction to other drugs such as heroin and cocaine.

These statements are as true today as they were then. All forms of tobacco have a lot of nicotine. It is easily absorbed through the lungs with smoking and through the mouth or nose with oral tobacco (spit, snuff, or smokeless tobacco). From these entry points, nicotine quickly spreads throughout the body.

Tobacco companies are required by law to report nicotine levels in cigarettes to the Federal Trade Commission (FTC). But in most states they are not required to show the amount of nicotine on the cigarette package label. The actual amount of nicotine available to the smoker in a given brand of cigarettes is often different from the level reported to the FTC. In one regular cigarette, the average amount of nicotine the smoker gets ranges between about 1 mg and 2 mg. But the cigarette itself contains more nicotine than this. The amount people actually take in depends on how they smoke, how many puffs they take, how deeply they inhale, and other factors.

How powerful is nicotine addiction?

About 70% of smokers say they want to quit and about 40% try to quit each year, but only 4% to 7% succeed without help. This is because smokers not only become physically addicted to nicotine; there is a strong emotional (psychological) aspect and they often link smoking with many social activities. All of these factors make smoking a hard habit to break.

Why quit smoking?

Nicotine is a very addictive drug. People usually try to quit many times before they are successful. But the struggle can be worth the effort. In September 1990, the U.S. Surgeon General outlined what you gain when you quit smoking:

• Quitting smoking has major health benefits that start right away. This is true for people who already have a smoking-related disease as well as those who don't.

• Former smokers live longer than people who keep smoking. For example, people who quit smoking before age 50 have one-half the risk of dying in the next 15 years compared with people who keep smoking.

• Quitting smoking lowers the risk of lung cancer, other cancers, heart attack, stroke, and chronic lung diseases such as emphysema and chronic bronchitis.

• Women who stop smoking before they get pregnant, or even during the first 3 to 4 months of pregnancy, reduce their risk of having a low birth-weight baby to that of women who never smoked.

• The health benefits of quitting smoking are far greater than any risks from the weight gain or any emotional or psychological problems that may follow quitting.

Your risk of having lung cancer and other smoking-related cancers depends on how much you have been exposed to cigarette smoke over your lifetime. This is measured by the number of cigarettes you smoked each day, how you smoked them, how young you were when you started smoking, and the number of years you have smoked. There is no way to precisely measure a person's risk of getting cancer, but the more you smoke and the longer you do it, the greater your risk.

The good news is that the risk of having lung cancer and other smoking-related illnesses can be reduced if you stop smoking. The risk of lung cancer is less in people who quit smoking than in people who keep smoking the same number of cigarettes every day. The risk decreases as the number of years since quitting increases.

People who stop smoking while they are young get the greatest health benefits from quitting. Those who quit in their 30s may avoid most of the risk due to tobacco use. But even smokers who quit after age 50 largely reduce their risk of dying early. The argument that it is too late to quit smoking because the damage is already done is not true. It is never too late to quit smoking!

For more information, see our Guide to Quitting Smoking.

Additional resources

More information from your American Cancer Society

The following information may also be helpful to you. These materials may be ordered from our toll-free number, 1-800-227-2345.

• Guide to Quitting Smoking (also available in Spanish)

• Double Your Chances of Quitting Smoking

• Quitting Smoking -- Help for Cravings and Tough Situations (also available in Spanish)

• Helping a Smoker Quit: Do's and Don'ts

• Questions About Smoking, Tobacco, and Health (also available in Spanish)

• Women and Smoking (also available in Spanish)

• Secondhand Smoke (also available in Spanish)

• Cigar Smoking (also available in Spanish)

• Child and Teen Tobacco Use (also available in Spanish)

National organizations and Web sites*

Along with the American Cancer Society, other sources of information and support include:

American Heart Association & American Stroke Association
Toll-free number: 1-800-242-8721 (1-800-AHA-USA-1)
Web site: www.americanheart.org
Toll-free number: 1-888-478-7653 (1-888-4-STROKE)
Web site: www.strokeassociation.org
Quitting tips and advice can be found at everydaychoices.org or by calling 1-866-399-6789

American Lung Association
Toll-free number: 1-800-548-8252
Web site: www.lungusa.org
Printed quit materials are available, some in Spanish. Also offers the tobacco cessation program "Freedom from Smoking Online" at www.ffsonline.org

Centers for Disease Control and Prevention (CDC)
Office of Smoking and Health
Toll-free number: 1-800-232-4636 (1-800-CDC-INFO)
Web site: www.cdc.gov/tobacco
Free quit support line: 1-800-784-8669 (1-800-QUIT-NOW)
TTY: 1-800-332-8615

Environmental Protection Agency (EPA)
Telephone: 202-272-0167
Web site: www.epa.gov
Has advice on how to protect children from secondhand smoke, a Smoke-free Homes Pledge, and other tobacco-related materials on the direct Web site, www.epa.gov/smokefree, or at 1-866-766-5337 (1-866-SMOKE-FREE)

National Cancer Institute
Toll-free number: 1-800-422-6237 (1-800-4-CANCER)
Web site: www.cancer.gov
Toll-free tobacco line: 1-877-448-7848
Tobacco quit line: 1-800-784-8669 (1-800-QUITNOW)
Direct tobacco Web site: www.smokefree.gov
Quitting information, cessation guide, and counseling is offered, as well as information on state telephone-based quit programs

Nicotine Anonymous
Toll-free number: 1-877-879-6422 (1-877-TRY-NICA)
Web site: www.nicotine-anonymous.org
For free information, meeting schedules, printed materials, or information on how to start a group in your area

QuitNet
Web site: www.quitnet.com
Offers free, cutting edge, effective tobacco cessation services to people worldwide

*Inclusion on this list does not imply endorsement by the American Cancer Society.

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

References

American Cancer Society. Cancer Facts & Figures 2009. Atlanta, Ga. 2009.

Centers for Disease Control and Prevention (CDC). Annual smoking-attributable mortality, years of potential life lost, and economic costs --- United States, 1995--1999. 2002;51(14);300–303. MMWR Morb Mort Wkly Rep. Accessed at www.cdc.gov/mmwr/preview/mmwrhtml/mm5114a2.htm on September 17, 2009.

Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults --- United States, 2007. MMWR Morb Mort Wkly Rep. 2008;57(45):1221-1226. Accessed at www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a2.htm on September 16, 2009.

Centers for Disease Control and Prevention (CDC). Cigarette Smoking Among Adults and Trends in Smoking Cessation --- United States, 2008. MMWR Morb Mort Wkly Rep. 2009;58(44):1227-1232. Accessed at www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a2.htm on November 24, 2009.

Centers for Disease Control and Prevention (CDC). Smoking-attributable mortality, years of potential life lost, and productivity losses, United States, 2000--2004. MMWR Morb Mort Wkly Rep. 2008;57(45):1226-1228. Accessed at www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm on September 18, 2009.

Centers for Disease Control and Prevention (CDC). Cigarette smoking-attributable morbidity - United States, 2000. MMWR Morb Mort Wkly Rep. 2003;52(35):842-844. Accessed at www.cdc.gov/mmwr/preview/mmwrhtml/mm5235a4.htm on September 17, 2009.

Centers for Disease Control and Prevention (CDC). Smoking and Tobacco Use: National Youth Tobacco Survey, 2006 NYTS Data and Documentation. Accessed at www.cdc.gov/tobacco/Data_statistics/surveys/nyts/index.htm on September 16, 2009.

Centers for Disease Control and Prevention (CDC). Youth Risk Behavior Surveillance --- United States, 2007. MMWR Surveill Summ. 2008;57(SS-04);1-31. Accessed at www.cdc.gov/mmwr/preview/mmwrhtml/ss5704a1.htm on September 16, 2009.

Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004;328:1519–1528.

Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service 2008. Accessed at www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf on September 17, 2009.

Food and Drug Administration. Frequently Asked Questions on the Passage of the Family Smoking Prevention and Tobacco Control Act (FSPTCA). 2009. Accessed at www.fda.gov/TobaccoProducts/NewsEvents/ucm173174.htm on September 17, 2009.

Gades NM, Nehra A, Jacobson DJ, et al. Association between smoking and erectile dysfunction: a population-based study. Am J Epidemiol. 2005;161:346–351.

National Cancer Institute (NCI). Cigarette Smoking and Cancer: Questions and Answers. 2004. Accessed at www.cancer.gov/cancertopics/factsheet/Tobacco/cancer on September 18, 2009.

Office of the U.S. Surgeon General. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1990. Accessed at http://profiles.nlm.nih.gov/NN/B/B/C/T on September 18, 2009.

Office of the U.S. Surgeon General. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services. 2006. Accessed at www.surgeongeneral.gov/library/secondhandsmoke/ on September 17, 2009.

Office of the U.S. Surgeon General. The Health Consequences of Smoking: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 2004. Accessed at www.cdc.gov/tobacco/data_statistics/sgr/2004/index.htm on September 17, 2009.

Office of the U.S. Surgeon General. The Health Consequences of Smoking: Cancer: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1982. Accessed at http://profiles.nlm.nih.gov/NN/B/C/D/W/ on September 18, 2009.

Office of the U.S. Surgeon General. The Health Consequences of Smoking: Nicotine Addiction: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1988. Accessed at http://profiles.nlm.nih.gov/NN/B/B/Z/D/ on September 17, 2009.

Peto R, Darby S, Deo H, et al. Smoking, smoking cessation, and lung cancer in the UK since 1950: Combination of national statistics with two case-control studies. BMJ. 2000;321:323–329.

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Last Medical Review: 10/01/2009
Last Revised: 11/24/2009