Tobacco use was well established among the inhabitants of the Americas when Columbus made his epic voyage. They smoked it in pipes and as cigars and also used it as snuff; it played an important role in social and religious practices. By 1550 pipe smoking was well established in Europe, to be largely supplanted by snuff in the 18th century and by cigarettes in the latter part of the 19th century. It was only proven in the 1950s that smoking was the major cause of lung cancer, which in turn, was responsible for an increasing proportion of deaths. Efforts to reduce smoking have had a limited success so far, but the overall incidence of lung cancer in the UK is now falling. Patterns across Europe are generally similar.