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Global Tobacco Use and Cancer: Findings and Solutions from The RISK FACTORS GLO BA L TOBACCO USE AND CANCER: F INDINGS AND SOLUTIO NS FROM THE TOBACCO ATLAS MICHAEL P ERIKSEN (LEFT) , AMY L NYMAN (CENTRE) AND CARRIE F WHITNEY (RIGHT) , GEORGIA STATE UNIVERSITY, SCHOOL O F P UBLIC HEALTH Tobacco use harms nearly every organ of the body and results in 6 million deaths annually. One in five cancer deaths is caused by smoking and the death and harm from smoking is preventable. While the relationship between tobacco and cancer is clear, it is further explained using statistics and findings from The Tobacco Atlas , a tobacco control tool and global reference for monitoring tobacco use prevalence, trends and statistics. he harm caused by tobacco has been established Figure 1: Projected global tobacco-caused deaths for decades, yet still one in five adults in the world Tcurrently smokes cigarettes. Globally, tobacco use Proje ct ed Gl obal kills nearly 6 million people a year, including Tobacco-Caused De aths approximately 600,000 deaths resulting from By c aus e, 201 5 b aseli ne sc enari o Tota ls mig ht no t sum due to r oundi ng. secondhand smoke exposure. 1 If current trends continue, it is estimated that tobacco will cause approximately 8 33% million deaths per year by 2030, and 1 billion total deaths Malig nant Neoplas ms 2,12 0,00 0 in the twenty-first cen tury , th e majo rity of which will occur in low- and mid dle -i nc ome co untries. 2 While tobacco use results in numerous adverse health 29% Res pir at or y outcomes, it is estimated that one in five cancer deaths Diseas es 1, 870,000 worldwide is caused by smoking. 3 By 2015, it is projected that 33% of all tobacco-related deaths worldwide will be 29% from cancer (Figure 1). Tobacco use is the only risk factor Cardi ovas cula r Diseas es shared by the four major non-communicable diseases 1, 860,000 1% (Figure 2), and tobacco use must be addressed globally in Tubercul osi s 2% 90,000 Diab et es 3% order to curb cancer deaths. 2% Melli tus Dige stive Lower 130,000 Diseas es Respir atory 200,000 Abo ut Infe ctions The Tobacco Atlas 150,00 0 The Fourth Edition of The Tobacco Atlas was published in 2012 by the American Cancer Society and the World Lung Source: Tobacco Atlas 4th edition; tobaccoatlas.org Foundation, and released at the 15th World Conference on MPOWER, the United Nations (UN) 2011 High Level Tobacco or Health in Singapore. The first edition of The Meeting on Non-communicable Diseases, and considerable Tobacco Atlas was published in 2002 by the World Health global funding for tobacco control. The Tobacco Atlas monitors Organization. The original Atlas preceded the WHO changes in global tobacco control and illustrates the global Framework Convention on Tobacco Control (WHO FCTC), progress in tobacco control over the past decade, which has CANCER CONTROL 2014 43 RISK FACTORS arguably been the most productive period in Figure 2: Risk factors tobacco control history. The Atlas provides statistics on the history of tobacco use, Risk Factors international prevalence and trends data, Tobacc o is t he o nly risk fa ct or s hared by all of statistics on deaths and harm from smoking, the f our leading noncommunica ble disease s. Tobacco Un healthy Lack of Harmful personal and societal costs of tobacco use, and Use Di et s Physical Use of Activi ty Alcoh ol discusses tobacco industry behaviour and CARDIOVASCULAR current and proposed solutions for global DIABETES tobacco control. , and the The Tobacco Atlas CANCER accompanying interactive web site fou nd at CHRONIC RESPIR ATORY www.tobaccoatlas.org, is a comprehe n siv e an d user-friendly tool for investi g ating and monitoring global tobacco issue s . T he follo wing sections (935,000 a year) are caused by smoking. 4 The dangers of highlight key findings from The Atlas , their implications for cigarette smoke extend to non-smokers who are exposed to cancer control worldwide and global tobacco control secondhand cigarette smoke, also called forced smoking. In interventions and practices. countries with a high male to female smoker ratio, women are often victims of secondhand smoke exposure, illness, and Tobacco and cancer findings from The Tobacco Atlas death. In fact, three-quarters of secondhand smoke deaths Harm and cancer resulting from tobacco use occur among women and children (Figure 3). Tobacco use harms nearly every part of the body, inducing cancers in many different organs. While much research has Cigarette consumption and prevalence focused on the impact of cigarette smoking on health Cigarette smoking is a twentieth century phenomenon outcomes, links have also been established between (Figure 4) that has followed a pattern of smoking initiation smokeless tobacco and oral cancers, and between other and the broad adoption of the habit, trailed by an increase in P adverse outcomes and the use of cigars, pipes, water pipes, smoking-related illness and death and eventually a decline in 5 kreteks and bidis . Cigarette smoking, or the inhalation of smoking prevalence. This pattern has been observed in many burned tobacco leaves, is the single largest contributor to high-income countries, resulting in a devastating tobacco cancer deaths in the world. Worldwide, roughly 80% of male epidemic of significant economic and health proportions. lung cancer deaths and 50% of female lung cancer deaths are Thi s sam e pattern is now emerging in low- and middle- caused by smoking. The International Agency for Research income countries. Comparing areas in wh ich c ig arette on Cancer (IARC) has estimated that annually there are 1.1 co nsum ption is roughly equivalent, there is a dis t urb ing tre nd million lung cancer deaths globally and of these, 83% towards an increase in cigarette prevalence and consumption c —Mauriti us in low- and middle-income countries, even as Figure 3: Number of global deaths caused by secondhand smoke in non-smokers consumption decreases in high-income countries. For Number of example, consumption in Western Europe dropped by 26% between 1990 and 2009 while simultaneously Global Deaths increasing in the Middle East and Africa by 57%. The Cau sed by Secondha nd S moke in Nonsmokers 2004 pattern is such that, as the population in low-income MEN WOME N CHILDR EN countries increases, the net result will be a global . g n i d increase in cigarette consumption. In high-income n u o 26% 47% 28% r o countries, where cigarette smoking has been t e u 156,00 0 281,00 0 166,00 0 d widespread for the better part of a century, at least 30% m u s t o n of all cancer deaths are caused by tobacco use, t h g i m particularly deaths from lung and upper aerodigestive s l a t o 6 T system cancer. This mortality pattern, which has occurred over decades, is now decreasing as a result of fewer smokers in the developed world. The same 75% of seco ndh and smoke deaths oc cur a mong women a nd chi ldren mortality pattern is beginning to emerge in low- and middle-income countries, where extensive tobacco use 44 CANCER CONTROL 2014 P E RISK FACTORS P is a more recent phenomenon and the Figure 4: Cigarette smoking as a twentieth century phenomenon pattern has the potential to continue in 4 8 countries where tobacco use is only 1 8 1 8 Eno ugh ci gar ettes 5 7 beginning. In 2011 alone, nearly 80% of 2 were co nsumed in 2009 Gl obal Ci gar ette 5 3 5000b the 6 million tobacco-related deaths Co nsum ption in 5 for each man, woman, 3 and chi ld in t he wor ld occurred in low- and middle-income 5 One Century 4 !to h ave s moked an 4000b countries. In some parts of Asia and Increased O ver 4 average of 865 ci gar ettes or 43 pack s. 100 Times 2 Eastern Europe, tobacco is responsible 6 3000b Counted i n 2 for between one-quarter and one-third billi ons of cigar ettes 3 0 of all male deaths (Figure 5). 2000b 5 6 1 2 The fact that these cancer deaths are 8 6 0 1 entirely preventable is paradoxically 1000b 0 0 0 0 0 1 frustrating and encouraging. Despite 0 0 0 0 0 0 6 5 1 2 3 the near universal knowledge of the 1 1880 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2009 2000 harm caused by tobacco use, smoking continues to be widespread, with over 1 billion tobacco users approximately 4:1, though this is likely to change as female in the world today, and approximately half of all lifetime smokers in low- and middle-income countries begin to smoke smokers will eventually die of a related cause. At the same at higher rates, often the result of economic and social time, evidence-based interventions are well established and changes in the country, coupled with tobacco industry millions of lives could be saved if countries put into practice marketing and exposure. While smoking prevalence among what is known to be effective. men is higher than among women, on average, there is generally much less difference between the smoking Gender differences in tobacco use prevalence of teenage boys and girls. The implication is that Globally, male smokers outnumber female smokers by smoking rates among women are likely to rise even more as Figure 5: Male deaths Mal e D e a th s Male d eaths 2 8% and gr eater, 200 4 31% Pola nd 28% Netherlan ds 28% Ru ssian Federation 28% 31% Belar us Belgium 35% Kazakhstan 30% Hun gary Tobacco use is the number- 28% 33% Croatia 38% Ar menia one killer in China and is Turkey 30% responsi ble for 1.2 million Bosnia & de aths annually.
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