Cigarette smoking and tobacco use are the major impediments to effective cancer control in the US and many other countries. While a wide range of approaches to smoking prevention and cessation has been identified, evidence suggests that physicians can help smokers stop and thus make significant contributions to reducing the incidence of cancers and other smoking-related disease. Yet, physicians who wish routinely to treat their nicotine-addicted patients are faced with a dilemma–very few feel they are successful in helping patients stop smoking. While success rates for smoking cessation are indeed low-a sustained 10% cessation rate due to brief physician treatment should be considered ‘successful’—there are a number of strong reasons that argue in favor of expanding, rather than decreasing, physician efforts to help their smoking patients stop. Among the reasons discussed in this paper are the following: public health impact; cost effectiveness; breaking the dependence cycle; opportunity for continuity of care; and development of treatment expertise. These arguments should be persuasive even if success rates remain at current levels. They become even more salient as success rates rise and physicians continue to contribute to reductions in smoking-related morbidity and mortality both through their treatment of patients and leadership in a variety of other efforts to reduce tobacco use.