Fewer Smokers, Fewer Prostate Cancer Deaths

Roxanne Nelson, BSN, RN

April 18, 2016

There is no shortage of reasons to stop smoking, but a new one might have just been added to the list.

From 1999 to 2010, declines in prostate cancer mortality were concurrent with declines in smoking prevalence in select American states, according to a study published in the April 16 issue in Preventing Chronic Disease.

Smoking trends and prostate cancer mortality in four states with very different rates of tobacco use — California, Kentucky, Maryland, and Utah — were assessed by lead investigator Miranda Jones, PhD, and her colleagues from Johns Hopkins University in Baltimore.

Over the 11-year study period, declines in prostate cancer mortality were greatest in Kentucky and Maryland. In both states, smoking dropped by 3.0% per year and prostate cancer mortality rates declined by 3.5% per year.

In California and Utah, smoking rates dropped by 3.5% per year. However, rates of prostate cancer mortality declined by only 2.5% in California and 2.1% in Utah.

Dr Jones and her colleagues note that prostate cancer mortality rates have been dropping since the 1990s, in part because of screening and improvements in treatment. But other factors are at play.

Because current cigarette smoking has been established as a risk factor for aggressive types of prostate cancer and disease recurrence, the team assessed whether declines in smoking rates contribute to decreases in rates of prostate cancer mortality.

Their ecological study looked at prostate cancer mortality rates in relation to changes in cigarette smoking in white and black men 35 years and older.

The four states evaluated were chosen because of the diversity of their smoking rates. As of 2010, the rate of adults who were current smokers in Kentucky was 24.8%, in Maryland was 15.2%, in California was 12.1%, and in Utah was 9.1%.

Smoking decreased from 1999 to 2010 in all four states. In California, Kentucky, and Maryland, which had separate data on race, smoking prevalence was higher in black than in white men.

Over the study period, the prevalence of smoking declined significantly in white men in all four states, but declined significantly in black men only in Maryland.

In black men in Maryland, the significant decrease in smoking was 5.0% per year and in prostate cancer mortality was 4.0%.

In black men in California, the decrease in smoking, at 1.8%, was not significant, but the decrease in prostate cancer mortality, at 2.7%, was.

In black men in Kentucky, there were no significant changes in either smoking prevalence or prostate cancer mortality.

The decrease in mortality from external causes (unrelated to smoking) was significant for black men in both Maryland and Kentucky, but was not significant for California.

"These findings support the need for targeted smoking-cessation efforts, which could reduce prostate cancer mortality rates in this population burdened by both higher rates of prostate cancer and an elevated prevalence of cigarette smoking," Dr Jones and her colleagues write.

"Finally, these findings support population-wide reductions in smoking as a potential strategy to reduce deaths from prostate cancer," they conclude.

This study was supported in part by a Cancer Center Support Grant. Dr Jones was supported by a National Cancer Institute National Research Service Award. Coauthor Corinne Joshu, PhD, was partially supported by the Prostate Cancer Foundation and the Seraph Foundation.

Prev Chronic Dis. 2016;13:150454. Full text

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