Governor Andrew Cuomo has just signed a law raising the legal smoking age in New York—the fourth most populated state in the U.S.—from 18 to 21.
This could be big news for lung cancer. According to the American Cancer Society, 95 percent of all smokers begin the habit before age 21. And with an estimated 142,670 U.S. lung cancer deaths this year—80 percent of which are smoking-related—the law has the potential to save thousands of lives.Read More
“This is a big deal,” Dr. Brendon Stiles, a thoracic surgeon at Weill Cornell Medicine and NewYork-Presbyterian said about the new law. “Although some people may complain that lawmakers are taking away individuals’ rights, this is a timely and important intervention.”
Lung cancer is the leading cause of cancer deaths in the country; more men and women die of lung cancer than of colon, breast, and prostate cancers combined.
Smoking plays a major role in these deadly numbers; when someone repeatedly inhales smoke—a known carcinogen—the smoke causes immediate damage to the cells in the lung tissue. And while the human body is excellent at healing damaged cells, with every cell the body heals, there’s a risk that the DNA inside the cell will be healed wrong—that is, with cancerous mutations.
“There’s no gray zone. Smoking causes lung cancer. That’s it,” Dr. Joseph Friedberg, head of the Division of Thoracic Surgery at the University of Maryland School of Medicine, previously told SurvivorNet. “If you’re smoking, stop.”
Smoking Doesn’t Just Cause Lung Cancer—It Makes it More Difficult to Treat, Too
Dr. Ronald Natale, Medical Director of the Clinical Lung Cancer Program at Cedars-Sinai Medical Center, told us that, because smokers with lung cancer can have thousands of DNA mutations, they may be less likely to reap the benefits of promising new cancer drugs that work by targeting one specific “driver” cancer mutation.
Many patients who are smokers, Dr. Natale said, “don’t have a driver mutation that we can treat with a [targeted drug] pill.” For these patients, chemotherapy is usually the primary treatment.
Dr. Friedberg also told us that smoking can make lung cancer surgery riskier, because the smoke damages the cells along the windpipe that clear out mucus, and when mucus gets trapped in the lungs after surgery, people can develop deadly pneumonia.
For all of these reasons—and the known fact that smoking is highly addictive—the best way to avoid lung cancer is to avoid smoking in the first place.
The new law, which Governor Cuomo officially signed on Tuesday, will make it illegal to sell tobacco products, electronic cigarettes, and vaporizers to anyone under 21 in the state of New York. The changes will go into effect later this year.
New York joins 14 states—and hundreds of local communities, including New York City—that have these laws already (including the first and second most populated states in the country, California and Texas).
While raising the tobacco age from 18 to 21 may only slash three years from someone’s legal ability to smoke, the American Lung Association’s stance is that taking up smoking during this three-year window usually determines whether someone will continue smoking throughout their adult years.
“Virtually all adult smokers had their first cigarette before turning 21, and most before 18,” the American Lung Association’s “Tobacco 21” statement reads. “Adolescents and young adults are uniquely vulnerable to the effects of nicotine and nicotine addiction.”
According to a report from the National Academy of Medicine, raising the minimum smoking age to 21 across all of the U.S. could decrease smoking rates by 12 percent, and nationwide, it could prevent 223,000 deaths among people born between 2000 and 2019.
A Possible Step Toward Curbing The E-Cigarette Problem
The new law will apply to e-cigarettes and vaporizers, too—which have become a national health concern as products like JUUL have rapidly gained popularity among teens.
According to the U.S. Centers for Disease Control and Prevention (CDC), e-cigarettes have become the most commonly used tobacco product among middle school and high school students, and the most recent data show that 3.6 million middle and high school students across the country reported using e-cigarettes in the last 30 days. While those who were under age 18 were already too young to legally buy the products before the law, many of them have relied on people in the 18-to-21 age range to buy the products for them. Accordingly, the law could cut off their illegal suppliers.
Many e-cigarette companies—including JUUL Labs—market their products as safer alternatives to smoking combustible tobacco cigarettes. The reality, though, is that it’s too soon to say for sure that they’re not also a huge contributor to lung cancer risk.
JUULs have only been around since 2017, and the types of studies needed to identify their potential harm could take decades to complete (in part because the mutations that lead to lung cancer develop slowly over time—sometimes taking as long as 40-50 years to cause cancer).
“Vaping is still in its infancy,” Dr. Raja Flores, Chairman of the Department of Thoracic Surgery at Mount Sinai Health System, told SurvivorNet in a previous conversation about e-cigarettes. “In order to prove something causes cancer, you need a large number of people and a longer period of time.”
Even if e-cigarettes are less harmful than traditional cigarettes, the nicotine they contain is just as addictive, and when teens get hooked on nicotine from e-cigarettes, their likelihood of taking up tobacco cigarettes jumps. In February, the CDC put out a report showing that traditional tobacco use had ticked up slightly among high school students since 2017, reversing course on a previous downward trend.
“Teen e-cigarette use is rising precipitously and is potentially a gateway to regular tobacco use,” Dr. Brendon Stiles, of Weill Cornell Medicine and NewYork-Presbyterian said. “We have to do what we can to slow it down now before we see a new peak in tobacco-related illnesses, including lung cancer.”
JUUL Labs—the company that makes and markets the most popular e-cigarette—has been under intense scrutiny from the U.S. Food and Drug Administration (FDA) for targeting minors with its teen-friendly flavors and marketing strategy.
JUUL has consistently responded by assuring the FDA that the company’s only intent is to market the product to adults who are already smokers. Greg Steinsiek, a spokesperson for JUUL, issued a statement in response to the new legislation in New York affirming this stance.
“We cannot fulfill our goal to provide the world’s one billion adult smokers with a true alternative to combustible cigarettes, the number one cause of preventable death in this country, if youth-use continues unabated,” Steinsiek wrote. “Tobacco 21 laws fight one of the largest contributors to this problem—sharing by legal-age peers—and they have been shown to dramatically reduce youth-use rates. That is why we are committed to working with lawmakers to enact these effective policies and hope more jurisdictions follow in New York’s example.”
New York’s new law will take effect in 120 days — and underage smoking rates, the hope is, will accordingly fall.
With all this being said, some argue that teens will continue to get their hands on e-cigarettes and tobacco products even if they can’t legally buy them. And when SurvivorNet asked lung cancer experts about New York’s new law, some voiced doubts about how much of an effect raising the smoking age will really have.
“This is just Big Tobacco trying to show they can compromise [on e-cigarette laws]” Dr. Flores told us. “Real legislation with the best interest of the people in mind should ban e-cigarettes period. E-cigarettes should only be given with a prescription for smokers trying to quit.”