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ACS Research Highlights

Study Finds 20% of Cancer Deaths Linked to Smoking in 147 Cities

In Appalachia and the South, ACS researchers found 4 in 10 deaths from cancer are linked with smoking.

The Challenge

Cigarette smoking remains the leading cause of death from cancer in the United States. Previous research reported that almost 30% of cancer deaths in the US were attributable to smoking, with considerable variation across states, ranging from almost 17% in Utah to 34% in Kentucky.

Yet, there is limited data on the burden of cancer attributable to cigarette smoking in smaller geographical areas.

The Research

Farhad Islami, MD, PhD, the Scientific Director of Cancer Disparity Research at the American Cancer Society (ACS), and his team estimated the proportion of cancer deaths attributable to cigarette smoking (or population attributable fraction [PAF]) in 152 US cities considered to be either metropolitan or micropolitan statistical areas (MMSAs). Here’s an overview of their findings.

Research shows that variations in total cigarette tax rates and other tobacco-control initiatives likely contribute to differences in smoking-related cancer deaths in the same regions. For example, there’s a smaller proportion of deaths from cancer related to cigarette smoking in the New York City area compared to the rest of the state likely because of the dual tax on cigarettes there--$1.50/pack city tax plus $4.35/pack state tax. Broad and equitable implementation and enforcement of proven tobacco control intervention at all government levels could avert many deaths from cancer across the US.”

Farhad Islami, MD, PhD

Scientific Director, Cancer Disparity Research

American Cancer Society

close up portrait of Farhad Islami Gomeshtapeh, MD, PhD Scientific Director, Surveillance Research ACS

The proportion of cancer deaths attributable to cigarette smoking was greater in men than in women in all evaluated locations.

  • In men the proportion of deaths ranged from 11.7% to 43.0%
  • In women it ranged from 5.2% to 31.7%.
  • For both sexes combined, it ranged from 8.8% to 35.7%.

Cities with the highest proportions of cancer deaths from smoking were:

  • Mostly in the South and Appalachia for both sexes combined and for men. As many as 4 out of 10 deaths from cancer in these regions were attributable to smoking.
  • Scattered throughout the South, Midwest, and Northeast for women.

The proportion of cancer deaths linked with cigarette smoking in cities within the same region or state had substantially varying ranges:

  • In the Northeast from 24.2% in the area of Jersey City-White Plains, NY to 33.7% in Utica-Rome, NY.
  • In the Midwest from 24.0% in Rochester, MN to 32.6% in Cincinnati, OH.
  • In the West from 8.8% in Logan, UT to 30.3% in Salem, OR.
  • In the South from 20.0% in El Paso, TX to 35.7% in region of Lexington-Fayette, KY.

In addition to Dr. Islami, authors on this study include current ACS researchers, Priti Bandi, PhD, and Ahmedin Jemal, DVM, PhD, as well as previous ACS researchers Liora Sahar, PhD, GISP, Jiemin Ma, PhD, and Jeffrey Drope, PhD.

Why Does it Matter? 

Information on cancer deaths attributable to cigarette smoking by city and region can inform and help evaluate local tobacco control policies such as city- or county-level tobacco taxes and smoke-free air laws, which have been shown to reduce the number of people who smoke.