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Current Issues
The Challenge of Eliminating Tobacco-induced Cancers in the Developing World
a report by
Douglas W Bettcher
1
and Dongbo Fu
2
1. Director; 2. Technical Officer, Tobacco Free Initiative, World Health Organization (WHO)
Cancer is a leading cause of death worldwide. The World Health and the potential for increased tobacco use are highest and where
Organization (WHO) estimates that 7.6 million people died of cancer healthcare services are least available.
in 2005.
1
More than 70% of all cancer deaths occur in low- and
middle-income countries.
1
Deaths from cancer in the world are Association Between Tobacco and Cancer
projected to continue rising, with an estimated nine million people No part of the human body escapes damage from tobacco use.
dying from cancer in 2015 and 11.4 million dying in 2030.
2
This forms Tobacco use is the single most important risk factor for cancer and
part of a larger epidemiological transition in which the burden of causes a large variety of cancer types, such as lung, larynx,
chronic, non-communicable disease is now increasing in less oesophagus, stomach, bladder, oral cavity and others (see Table 1).
developed countries. Tobacco use is the single largest preventable The parts of the body with direct contact with smoke (lungs, oral
cause of cancer in the world today. In addition to the accumulating cavity and oesophagus) are at the greatest risk of developing cancer.
risks associated with diet, alcohol and industrial exposure, the increase Environmental tobacco smoke (passive smoking) causes lung
in tobacco use in developing countries will result in large increases in cancer. The proportion of lung cancers in ex-smokers and those who
tobacco-induced cancers and death. This article summarises the have never smoked that are attributable to environmental tobacco
current status of the tobacco epidemic and tobacco-induced cancer smoke was estimated as between 16 and 24%, mainly the result of the
burden and the challenges in curbing the tobacco epidemic in contribution of work-related exposure.
9
the developing world. It also explores potential policy responses to the
growing tobacco epidemic in developing countries. Such responses Lung cancer is recognised to be the most important cause of
may include mobilising the political will of governments to implement death from cancer in the world (1.3 million deaths/year).
2
The
the WHO Framework Convention on Tobacco Control (WHO FCTC) to major cause of the disease is tobacco smoking, primarily of
fulfil their commitment to fight the tobacco epidemic and protect their cigarettes. Tobacco’s role in increasing the chance of lung cancer
population from tobacco-related death. Another response is the is one of the most widely known of tobacco’s harmful effects on
integration of tobacco control interventions into the overall framework human health. Sir Richard Doll’s 1950 paper demonstrating the
of chronic disease prevention and control, together with encouraging association between smoking and lung cancer has become a
more engagement in tobacco control from oncologists as part of their public health classic. After half a century, the report of the
routine practice. Surgeon General in 2004 stated that cancer “was among the first
diseases causally linked to smoking”.
10
A Growing Tobacco Epidemic in Developing Countries
Tobacco use is the single largest preventable cause of cancer in the
world today. Tobacco kills one person every six seconds.
3
It kills up to Douglas W Bettcher is Director of the Tobacco Free
one in every two users of those who use it as intended.
3,4
In the 20th
Initiative at the World Health Organization (WHO) in
Geneva. He is the principal focal point for the scaling up
century, it is estimated that the tobacco epidemic has killed 100
of WHO’s country-level tobacco control work as one of
million people worldwide. Unless urgent action is taken there could be
the five partners in the 125 million US$ Bloomberg
Initiative. Dr Bettcher was also WHO’s principal focal
up to one billion deaths during the 21st century.
5
Tobacco use is
point (1998–2007) for providing Secretariat support for
growing fastest in low-income countries as a result of low prices and the negotiation of WHO’s first treaty, the WHO
steady population growth coupled with tobacco industry targeting,
Framework Convention on Tobacco Control (WHO FCTC),
for managing the Interim Secretariat support to Parties and for providing technical support
ensuring that millions of people become fatally addicted each year.
to assist in the implementation of the treaty.Dr Bettcher has also worked in the areas of
More than 80% of the world’s tobacco-related deaths by 2030 will be clinical medicine, public health and international health policy in a number of countries,
in low- and middle-income countries.
6
notably in developing countries.
More than 40% of the world’s smokers live in two major developing Dongbo Fu is a Technical Officer for Tobacco Cessation in the National Capacity Building
countries: China and India. As many as 100 million Chinese men
Unit of the Tobacco Free Initiative at the World Health Organization (WHO). He is also an
Associate Professor at the School of Public Health at Fudan University in Shanghai. His
currently under 30 years of age will die from tobacco use.
7
In India,
current work focuses on promoting tobacco cessation services in developing countries
about one-quarter of deaths among middle-aged men are caused by
through the integration of tobacco cessation into primary healthcare systems. Dr Fu
smoking.
8
As the number of smokers in this group increases with
received his MPH and PhD from the School of Public Health, Fudan University and his MD
from Jiangxi Medical College.
population growth, so will the number of deaths. The shift of the
E: fud@who.int
tobacco epidemic to the developing world will lead to unprecedented
levels of disease and early death in countries where population growth
© TOUCH BRIEFINGS 2008 19
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