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Many of us know someone whose life was cut short by tobacco, and their stories are heartbreaking. What makes them even more so is that, in many cases, it didn’t have to happen. As the leading cause of preventable death, smoking causes 1 in 5 of all deaths in the United States, totaling more than 480,000 annually. Tobacco is also linked to about one-third of all cancers in the United States, including cancers of the pancreas, bladder, kidney, mouth, and throat, as well as the lung. Even with all of the recent advancements in cancer research and care, these remain some of the most lethal and difficult cancers to treat.

As a physician-scientist and president of Dana-Farber Cancer Institute, an academic medical center singularly focused on reducing the burden of cancer, I see the tragedy of tobacco in the patients who walk through our doors every day. Many yearned for the strength to quit smoking, but tobacco addiction is too powerful.

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While we are doing everything we can through science, medicine, and compassionate care to provide our patients with hope and healing, the fact remains that the single most effective thing we can do to prevent cancer and save lives is to reduce smoking and tobacco use.

Today, we have renewed momentum. Spurred by advocacy, some retailers are taking action by raising the age to purchase tobacco products from 18 to 21. Twelve states have passed legislation to do the same, along with hundreds of cities and towns. These state and local efforts can and should be a model for the nation, and new legislative proposals are gaining rare bipartisan support in Congress to make 21 the national legal age to purchase tobacco-related products.

Without question, this is the right thing to do and we must seize this opportunity. But we must get it right. New federal legislation must cover all tobacco products, including electronic cigarettes. It should include education and training for retailers, along with strong enforcement measures to hold retailers accountable. Importantly, it should not prevent more states and local governments from passing even tighter tobacco-control measures. And it must not include any loopholes that allow the continued marketing of flavors designed to lure young customers.

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The US Food and Drug Administration reports that electronic tobacco use among young people is reaching “epidemic proportions.” Last year alone, its use increased by nearly 40 percent among high school students and by nearly 30 percent among middle school students, according to the Centers for Disease Control and Prevention. And while we’re still learning the full scope of the health risks of vaping, we do know that electronic cigarettes contain a range of cancer-causing chemicals combined with nicotine, whose addictive properties are enhanced during adolescence. For many teens, nicotine addiction formed through vaping leads to smoking cigarettes. In fact, 90 percent of adult smokers begin as teenagers or earlier. Two-thirds become daily smokers before turning 19, according to the Campaign for Tobacco-Free Kids, which is fighting hard to stop teen vaping, along with local organizations like Tobacco Free Mass. The stakes of these efforts couldn’t be higher, because roughly one-third of teens who take up smoking will eventually die from their tobacco use.

Raising the legal age to purchase tobacco products to 21 is the clear and sensible action to help reduce teen smoking. But it is just one step in a long journey to reduce cancer rates in the United States. We need to invest more in prevention and cessation efforts, pass more local and statewide smoke-free laws, encourage more retailers to ban tobacco sales altogether, tax electronic cigarettes like traditional cigarettes, ban flavored tobacco, and use the authority of the FDA to help keep tobacco products, especially electronic cigarettes, out of the hands of young people.

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We’ve known the dangers of nicotine and tobacco for decades. But tobacco use, like cancer, finds ways to continue to grow and creep into hidden places. For as hard as it is today to imagine a time when smoking was allowed on airplanes, in restaurants, or even hospitals, it’s just as hard to imagine vaping in classrooms. But it’s happening today across the country in schools and other places where young people are supposed to be safe, healthy, and free to flourish.

We have a responsibility to use this knowledge to continue the progress we’ve made to reduce tobacco use. Let’s take this sensible step today to raise the legal age to buy tobacco to 21 nationally. But we cannot be deterred and stop there. Let’s persist and continue on the path to safeguard future generations from a life of addiction and disease, and save lives.


Laurie H. Glimcher, MD, is president and CEO of Dana-Farber Cancer Institute.