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Cancer is a leading cause of death worldwide. The World Health Organization (WHO) estimates that 7.6 million people died of cancer 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 projected to continue rising, with an estimated nine million people dying from cancer in 2015 and 11.4 million dying in 2030.2
This forms part of a larger epidemiological transition in which the burden of chronic, non-communicable disease is now increasing in less developed countries. Tobacco use is the single largest preventable cause of cancer in the world today. In addition to the accumulating risks associated with diet, alcohol and industrial exposure, the increase in tobacco use in developing countries will result in large increases in tobacco-induced cancers and death. This article summarises the current status of the tobacco epidemic and tobacco-induced cancer burden and the challenges in curbing the tobacco epidemic in the developing world. It also explores potential policy responses to the growing tobacco epidemic in developing countries. Such responses may include mobilising the political will of governments to implement the WHO Framework Convention on Tobacco Control (WHO FCTC) to fulfil their commitment to fight the tobacco epidemic and protect their population from tobacco-related death. Another response is the integration of tobacco control interventions into the overall framework of chronic disease prevention and control, together with encouraging more engagement in tobacco control from oncologists as part of their routine practice.
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 one in every two users of those who use it as intended.3,4 In the 20th century, it is estimated that the tobacco epidemic has killed 100 million people worldwide. Unless urgent action is taken there could be up to one billion deaths during the 21st century.5 Tobacco use is growing fastest in low-income countries as a result of low prices and steady population growth coupled with tobacco industry targeting, ensuring that millions of people become fatally addicted each year. More than 80% of the world’s tobacco-related deaths by 2030 will be in low- and middle-income countries.6
More than 40% of the world’s smokers live in two major developing countries: China and India. As many as 100 million Chinese men currently under 30 years of age will die from tobacco use.7 In India, about one-quarter of deaths among middle-aged men are caused by smoking.8 As the number of smokers in this group increases with population growth, so will the number of deaths. The shift of the tobacco epidemic to the developing world will lead to unprecedented levels of disease and early death in countries where population growth and the potential for increased tobacco use are highest and where healthcare services are least available.
Association Between Tobacco and Cancer
No part of the human body escapes damage from tobacco use. Tobacco use is the single most important risk factor for cancer and causes a large variety of cancer types, such as lung, larynx, oesophagus, stomach, bladder, oral cavity and others (see Table 1). The parts of the body with direct contact with smoke (lungs, oral cavity and oesophagus) are at the greatest risk of developing cancer. Environmental tobacco smoke (passive smoking) causes lung cancer. The proportion of lung cancers in ex-smokers and those who have never smoked that are attributable to environmental tobacco smoke was estimated as between 16 and 24%, mainly the result of the contribution of work-related exposure.9