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It is over forty years since the public health community came to the consensus that smoking tobacco, particularly cigarettes, caused lung cancer. Despite widespread dissemination of the likely health consequences, cigarette smoking is still a prevalent behaviour in all developed countries and is a rapidly increasing behaviour in developing countries. There is an extensive literature on quitting studies indicating that, for many smokers, successful quitting is one of the hardest lifestyle changes to achieve. Given this, many argue that the majority of the emphasis should be on preventing the initiation of smoking in the first place. This chapter focuses on influences encouraging young people to become smokers.

Tobacco control policy has evolved over time and will continue to do so. To every action by the tobacco industry there has been a reaction by public health authorities and vice versa. As a result there has been a continuing struggle between those committed to market expansion (the industry) and those committed to market shrinkage (public health authorities). This chapter considers the following issues: prevention of smoking initiation; management of addiction; regulation of the cigarette, the way it is sold, its nicotine content and its emissions; protection of non-smokers from second-hand smoke; public education and control of labelling and trademarks; disincentives to purchase (tax) and restrictions on sales to minors. The chapter will summarize what is, in effect, modern comprehensive policy.

One of the major goals in cancer research is to elucidate the molecular and cellular events driving the progression of cells from a normal to a cancerous state. This transformation relies on the accumulation of mutations in various proto-oncogenes, tumor-suppressor genes, and DNA repair (caretaker) genes. Under normal circumstances, these genes participate in regulating cell and tissue behavior. However, progressive accumulation of mutations in these genes causes cells to transform to a malignant state. These mutations collaborate to overcome the numerous barriers and obstacles cells erect to prevent uncontrolled growth, including cell cycle control, absence of appropriate growth stimuli, programmed cell death, limited replicative potential, and immune-mediated eradication. In addition, these mutations ultimately result in altered interactions with the extracellular environment, facilitating tumor initiation and progression.