Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
How many people smoke in the United States and Mexico?
Dr. DePinho –There are more than 94 million former and current smokers in the United States, and more than 21 million in Mexico, according to the 2009 Global Adult Tobacco Survey (GATS) Fact Sheet.
This specific initiative is importantly focused on comprehensive tobacco control in youth, involving prevention and cessation, wherever necessary. What might actually speak more powerfully to your question is that in the United States 3,800 children start smoking every day. That’s a dire statistic.
In Texas, 27,000 children will become daily smokers each year. We have about 17% of high school students smoking and another 9% using smokeless tobacco products. Quite strikingly, in Mexico, about 27% of high school youth (between the ages 13 and 15) smoke. Unfortunately, many of them become lifelong customers.
How do the smoking rates compare to other countries in the world?
Dr. DePinho – In the U.S., we’ve made good inroads and progress because we’ve had a comprehensive campaign against smoking for some years now.
But in other countries, particularly in Asia and certain Latin American countries, the magnitude of the problem has continued unabated. We and others have worked very hard to try to help those countries curb the use of tobacco, but in China, for example, this is a particularly alarming problem.
Why is it important to run anti-smoking campaigns?
Dr. DePinho – Both smoking prevention and cessation are important. When you think about prevention, the focus is on helping people avoid smoking in the first place. Indeed, if you achieve that, it is one of the most effective ways of curbing the societal trends in smoking itself. That is an important aspect because tobacco products are so addictive that once you start it is hard to stop.
Cessation has been effective with a variety of strategies but the important thing is that this is an effort that is comprehensive in nature, involving both prevention and cessation.
It is important to run these campaigns because tobacco is such a major cause of cancer, and of many other significant diseases – particularly lung and heart disease. So it extracts a very significant social, emotional and economic toll on families around the world. Indeed, recent estimates suggest that a good half of cancer can be prevented through a variety of strategies.
Smoking and obesity are major causes of cancer. And so, people not smoking would have a profound impact on lung cancer incidence and the development of a variety of other cancers and chronic diseases.
Dr Mohar – It is important to note that tobacco doesn’t only cause cancer but it also causes other types of pathology associated with chronic disease.
Tell us about the anti-smoking campaign which is going to be launched by the University of Texas, the National Institute of Cancer of the United Mexican States, and the Commission of National Institutes and High Specialty Hospitals?
Dr. DePinho – The mission of MD Anderson is to eradicate cancer in Texas, the nation and the world. Reflected in that effort is a major global academic program that we’ve had for many years now that has enabled us to form collaborative relationships with 26 sister institutions around the world. So this is part of our effort to reach out and collaborate with other governmental agencies and cancer institutions to try to prevent, detect and treat cancer to solve a major humanitarian crisis.
As you might know, MD Anderson is the largest cancer center in the United States; it has more than 19,000 employees and 7,000 trainees. It has a singular focus on cancer and a significant reach within the United States and internationally in terms of patient treatment. MD Anderson also has major efforts in prevention and cancer control all the way through to survivorship.
This is part of our general plan to help curb the impact of cancer across the globe. MD Anderson is the number one cancer center in the U.S. according to the U.S. News & World Report Best Hospitals survey and it has the largest research program focused on cancer supported by the U.S. National Cancer Institute.
Specifically, this effort relates to a major initiative that MD Anderson has launched called the Moon Shots Program. This program is designed to accelerate the decline in cancer mortality across major cancer types including lung cancer amongst other cancers. What we’ve articulated over the past year is a very action-orientated, milestone-driven effort to try to reduce cancer mortality in this decade using prevention, early detection, treatment, and survivorship efforts.
So in the context of prevention we’ve put an enormous emphasis on what we call cancer control. In other words this is not simply an academic exercise in which we’re trying to discover more prevention strategies, etc. We know an awful lot about the instigators of cancer and how they can be thwarted. This effort is about converting that knowledge and those discoveries into actions and deliverables.
The actions are evidence-based strategies to curb the use of tobacco in children and this effort uses many different strategies to achieve the deliverable of helping inspire children to not smoke in the first place. We feel that this is a very important flagship project of the Moon Shots Program at MD Anderson where our strategy is to engage many stakeholders, government, educators, media, and legislators to assist us in developing policies, educational activities, and services that are evidence-based and proven to curb the use of tobacco.
Dr Mohar – I just want to emphasize that I think this specific collaboration is a great opportunity. For the first time we really have a joint effort in smoking control with MD Anderson and not only with the Mexican NCI but with the Mexican NIH, particularly with the Lung Institute, the public Health Institute, the Heart Institute and naturally the Cancer Institute.
Why have these institutions decided to collaborate on an anti-smoking campaign?
Dr. DePinho – Well this builds on the wonderful relationship that we already have with Mexico and its cancer institutions, so we are very proud of this collaboration. We have collaborated on other fronts before, but one of the things that is very inspiring about the Mexican government and its Ministry of Health is its strong passion for prevention.
This is the lowest of the low hanging fruit with respect to curbing the humanitarian crisis of cancer. We are building on a collaborative relationship from our global academic program that already exists to enable us to move forward and make a huge impact on this particular aspect of our cancer campaign.
Dr Mohar - I think this collaboration will strengthen the efforts of the Mexican NIH to have a better control of smoking cessation.
It is a huge vow here in Mexico, but I think that the Mexican NIH together with the leadership and authority on Cancer that MD Anderson has worldwide, will be able to provide a better campaign.
How will this collaborative campaign differ from previous smoking and tobacco-cessation campaigns?
Dr. DePinho – This is a comprehensive, action-orientated effort that involves trying to inspire legislative policies and leverage the power of mass media, and industries such as Hollywood. It is about developing innovative platforms that reach children such as video games.
It is about developing educational materials that will inspire children at different ages and different backgrounds – cultural, ethnic, and otherwise - to really understand what tobacco use does to a person. They need to really understand and gain sufficient motivation and practical tools to help them avoid tobacco experimentation and potential downstream addiction.
At least in Texas, what has been lacking has been a comprehensive, culturally- and linguistically-tailored effort to inspire children from not smoking in the first place.
What we’ve learned is that no single strategy is effective in isolation, and that we’ll need a variety of coordinated strategies involving policy, education, mass media, and others that really get into children’s minds and help them understand the good choices that they can make throughout their lives from a health standpoint. So this is very action oriented.
What is this collaborative campaign hoping to achieve?
Dr. DePinho - One of the things we want to do with this, again it really speaks to the specificity of our effort and the effectiveness, is to really understand how it is that we can inspire Hispanic children specifically to not start smoking. So this specific initiative is designed to develop platforms and strategies for Hispanic children in Texas – as we have a very large Hispanic population – and in Mexico.
With the platforms that we develop, we will then scale those proven efforts into other Hispanic communities in the United States and other Hispanic cultures, Latin countries, etc. throughout the world. So this is the first step in a comprehensive global effort to work with a variety of collaborators to curb the use of tobacco in Hispanic cultures.
Dr Mohar – Although this is a long-term battle, we really hope to see improvements in the short-term.
Are there any plans to collaborate with more institutions to create an even larger campaign?
Dr. DePinho - Absolutely. We’re very interested in collaboratively developing and implementing tailor-made initiatives for Asian countries and a variety of other countries, so that we can really connect.
It is very important that people recognize that you really need tailor-made efforts that enable us to speak to that child of a particular age in a particular cultural context. The kind of sports figures, pop stars, etc. that one would engage in Mexico to assist in communicating such a message would be different from a similar effort in Japan, for example.
What do you think the future holds for smoking prevention and cessation campaigns?
Dr. DePinho - I think we have made terrific progress over the last decade where we have seen strong collaborative campaigns such as in the World Health Organization’s Framework Convention on Tobacco Control or in some regions of the U.S.
We hope to establish similar trends across the globe with the ultimate goal of eradicating the use of tobacco which is a major cause of morbidity, mortality and human misery.
Would you like to make any further comments?
Dr. DePinho - I think for the first time in the history of the field of cancer we have a very strong understanding of the major instigators of the disease and for those with established cancer, how to control them using game-changing technologies based on our strong understanding of its genetic basis.
So we are at a very special turning point in the history of the field and we are in a position now to decisively reduce the incidence of death due to cancer. The next decade will be one in which we start to turn the tide against this dreaded disease. And in particular, for us to really impact substantively in the near term, prevention and early detection will be major components of our war on this disease.
Where can readers find more information?
Dr. DePinho - They can visit our website: http://www.mdanderson.org/
They can also find more information on our Moon Shots Program here: http://cancermoonshots.org/
About Dr DePinho and Dr Mohar
Ronald A. DePinho, M.D., is President of The University of Texas MD Anderson Cancer Center. His research program has focused on the molecular underpinnings of cancer, aging and degenerative disorders and the translation of such knowledge into clinical advances.
Dr. DePinho’s independent scientific career began at the Albert Einstein College of Medicine, where he was the Feinberg Senior Scholar in Cancer Research. He then joined the Department of Medical Oncology at the Dana-Farber Cancer Institute and Department of Medicine and Genetics at the Harvard Medical School. At Harvard, he was the founding Director of the Belfer Institute for Applied Cancer Science at the Dana-Farber Cancer Institute and a Professor of Medicine and Genetics at Harvard Medical School.
Dr. DePinho is a former member of the Board of Directors of the American Association for Cancer Research, and has served on numerous advisory boards in the public and private sectors including co-chair of advisory boards for the NCI Mouse Models of Human Cancer Consortium and for the Human Cancer Genome Altas Project.
Dr. DePinho studied biology at Fordham University, where he graduated class salutatorian, and received his M.D. degree with distinction in microbiology and immunology from the Albert Einstein College of Medicine.
For his fundamental contributions to cancer and aging, he has received numerous honors and awards including the March of Dimes Basil O’Connor Award, James S. McDonnell Scholar Award, the Cancer Research Institute Scholar Award, the Melini Award for Biomedical Excellence, the Irma T. Hirschl Award, the Kirsch Foundation Investigator Award, and the Richard and Claire Morse Scholar Award.
He is the 2002 recipient of the American Society for Clinical Investigation Award, the 2003 AACR Clowes Award, the 2007 Helsinki Medal, the 2007 Harvey Lectureship and the 2009 Albert Szent-Gyorgyi Prize. He is a member of the Institute of Medicine of the National Academy of Sciences.
In 2010, Dr. DePinho was elected to membership in the American Academy of Arts and Sciences. In 2012, he was elected as a member of the National Academy of Sciences. He is a founder of Aveo Pharmaceuticals and a number of biopharmaceutical companies focused on cancer therapy and diagnostics.
Dr Alejandro Mohar is the Director of the National Cancer Institute of Mexico. He has held this position since 2003. Prior to this he was the Director of Research there. In 2010 he received an award for 25 years’ service in the National Cancer Institute.
He received his MD from the Medicine Faculty, UNAM. From 1982 he held a Fellowship in Pathological Anatomy at the National Institute of Nutrition. He received his M.Sc, and D.Sc, in Science in Epidemiology from Harvard University, School of Public Health.
Dr Mohar has received multiple prizes and distinctions and has numerous publications both nationally and internationally.