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The Challenge of Eliminating Tobacco-induced Cancers in the Developing World
Table 1: Diseases Caused by Smoking and Second-hand Smoke
Disease Caused by Smoking Disease Caused by Second-hand Smoke
Cancers Chronic Diseases Children Adults
Larynx Stroke Brain tumours Stroke
Oropharynx Blindness Middle ear disease Nasal irritation
Cataracts Nasal sinus cancer
Oesophagus Periodontitis Lymphoma Breast cancer
Trachea, bronchus or lung Aortic aneurysm Respiratory symptoms Coronary heart disease
Impaired lung function
Acute myeloid leukaemia Coronary heart disease Asthma Lung cancer
Stomach Pneumonia Sudden infant death syndrome (SIDS) Atherosclerosis
Pancreas Atherosclerotic peripheral vascular disease Leukaemia Chronic obstructive pulmonary disease (COPD)
Chronic respiratory symptoms
Asthma
Impaired lung function
Kidney and ureter Chronic obstructive pulmonary disease (COPD) Lower respiratory illness Reproductive effects in women:
Asthma Low birthweight
Other respiratory effects Pre-term delivery
Colon Hip fractures
Cervix Reproductive effects in women
(including reduced fertility)
Bladder
Evidence of causation suggestive; evidence of causation sufficient.
For smoking-attributable cancers, the risk generally increases with the
Figure 1: Incidence and Mortality from the Most Common
number of cigarettes smoked and the number of years of smoking,
Cancers in Less Developed Countries
and generally decreases after quitting completely. Risk of lung cancer
Male Female
is particularly dependent on duration of smoking; therefore, the earlier
Lung
the age at initiation of smoking, the greater the individual risk.
Stomach
Furthermore, the longer the time period during which a major
Liver
Breast
proportion of adults in a population have smoked, the greater the Oesophagus
incidence and mortality from the disease in that population. Risk of
Cervix uteri
Colon and rectum
lung cancer is also proportional to the number of cigarettes smoked,
Prostate
increasing with increasing cigarette usage. In populations with a long
Oral cavity
duration and heavy intensity of cigarette usage, the proportion of lung
Leukaemia
Non-Hodgkin’s lymphoma
cancer attributable to smoking is of the order of 90%.
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This Bladder
attributable proportion applies to men in most Western populations. In
Brain, nervous system
Larynx
populations in which women are increasingly using cigarettes, the
Pancreas
attributable proportion in women is also approaching this level. In the
Ovary, etc.
US, the risk of dying from lung cancer is more than 22 times higher
Other pharynx
Incidence
Thyroid
among men who smoke cigarettes and about 12 times higher among
Mortality
Nasopharynx
women who smoke cigarettes compared with those who have never
30 25 20 15 10 5 0 5 10 15 20 25 30
smoked.
12
Recently, the spread of tobacco use to developing countries
Age-standardised incidence per 100,000 population
has led to papers describing similar patterns there. In a study of one
million deaths in China, lung cancer risk was two to four times higher Mediterranean region, is linked to lung disease, cardiovascular disease
among men who smoked compared with men who did not smoke. and cancer.
15
This association was generally consistent over both rural and urban
areas.
7
A newly published study in South Africa showed that the odds Tobacco-related Cancer Burden in Developing Countries
ratio for lung cancer among current smokers was 16.3 (95% Tobacco use is responsible for up to 1.5 million cancer deaths per year,
confidence interval [CI] 9.6–27.6) for men and 6.4 (95% CI 4.0–10.4) 60% of these deaths occurring in low- and middle-income countries.
1
for women compared with those who have never smoked.
13
A shifting tobacco epidemic in developing countries, together with the
rapid ageing of populations and other factors, is likely to lead to a new
All forms of tobacco are lethal. Bidis are small hand-rolled cigarettes epidemic of tobacco-induced cancers in developing countries. In low-
typically smoked in India and other South-East Asian countries. Bidi and middle-income countries, tobacco-attributable deaths have been
smokers have a three-fold higher risk of oral cancer compared with projected to double between 2002 and 2030.
1
Lung cancer is the most
non-smokers and are also at increased risk of lung, stomach and frequent type of cancer in developing countries (see Figure 1).
16
It is
oesophageal cancer.
14
Kreteks, clove and tobacco cigarettes, most projected that the number of lung cancer deaths will nearly double by
commonly smoked in Indonesia, place smokers at increased risk of 2030 (from 1.3 million in 2005 to 2.2 million in 2030). The burden of
acute lung injury and lung cancer as well.
15
Shisha, tobacco cured with this increase will be felt most dramatically in low- and middle-income
flavourings and smoked from hookahs primarily in the eastern countries in Africa and Asia. The first estimates of the health impacts
ASIA-PACIFIC ONCOLOGY & HAEMATOLOGY 11
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