As an oncologist with over 30 years of experience, it is disturbing that most cancers are linked to tobacco use and therefore preventable.1. These figures have remained largely unchanged over the years. Of the cases of lung cancer, 80-85% are attributed to tobacco smoke2. Tobacco use is responsible for 11% of all new cases and 18% of all cancer deaths worldwide.3. Although there have been significant efforts worldwide to reduce tobacco use, much more needs to be done. The theme for this year’s World No Tobacco Day, ‘Commit to Quitting’, draws attention to the need to help and support those addicted to quit the habit, a largely neglected yet very important measure to use to reduce.
Tobacco causes 8 million deaths a year, of which 3 million are from cancer. Secondhand smoke kills more than 1 million people a year, including 65,000 children. There are 1.3 billion smokers worldwide, with 80% living in LMICs. In addition, many in the Southeast Asian region use smokeless tobacco, the main cause of the high incidence of head and neck cancer in the region4. Tobacco not only affects the health of people, but also costs countries money in terms of healthcare costs and lost productivity. It has been shown that the impact of health expenditure on national economies due to tobacco-related diseases is much higher than the income from the sale of tobacco products. In addition, smoking among cancer survivors remains a problem with one longitudinal study showing that nearly 10% of cancer survivors smoke for 9 years after their diagnosis5, which illustrates the importance of developing comprehensive cessation / support programs for cancer patients who smoke.
World No Tobacco Day: ‘Commit to Quitting’
Today is World No Tobacco Day, an opportunity to remind the public and the international health community that tobacco remains one of the major risk factors for cancer and non-communicable diseases (NCDs).
This year, the WHO launched a full year campaign6 focus on smoking cessation. Strike programs are cost-effective and have long-term health benefits. The campaign aims to reduce the number of tobacco users worldwide by empowering them to quit, using various tools such as ‘Florence’, WHO’s digital health worker, powered by artificial intelligence7. Strike programs include psychological support8, and approved nicotine replacement therapies (NRT)9 which can help smokers to be successful in their efforts to quit. New products are strongly marketed10 as alternatives to smoking such as tobacco pouches, e-cigarettes and HTPs. However, we still do not know if these products are effective in helping adults quit conventional cigarettes nor their long-term health consequences.11.
From a public health perspective, various measures can be taken to help people quit tobacco. For example, tobacco taxes and price increases have been shown to reduce the incidence of smoking, making cigarettes less affordable.12. Furthermore, the development of smoke-free places increases the chances of successfully quitting smoking, reduces exposure to second-hand smoke and has the added benefit of preventing the ‘normalization’ of tobacco use in public, which is especially important for teenagers and children.13. It is important that there is strong legislation with the application of laws prohibiting tobacco advertising, promotion and sponsorship, as studies have shown that direct or indirect marketing approaches increase the likelihood that people will continue to use tobacco and promote public perceptions of smoking as socially acceptable.14.
A multi-stakeholder approach
As a global cancer control organization, tobacco control is a priority area for the Union for International Cancer Control (UICC). To make real and sustained progress in reducing tobacco use, we need to work across the health sector and with other sectors that are critical to tobacco control efforts, including the labor, business and environmental sectors. The social cost of tobacco is severe and affects several areas. We know that people deprive themselves of food to buy tobacco and that tobacco use is linked to poverty with low-income people who are more likely to smoke. Tobacco has a detrimental impact on the environment due to intensive farming and its impact on the water supply and because the cultivation of tobacco contributes to deforestation and soil degradation.
We have the tools to accelerate progress in tobacco control. It is very encouraging that countries are increasingly implementing measures that support the WHO Framework Convention on Tobacco Control (FTCT), where about 65% of the world population is covered by at least one MPOWER measure in 2019, compared to only 15% in 200715. We have seen a decline in smoking prevalence worldwide over the past decade15.16 and millions of lives were saved from tobacco-related diseases and death. However, we still have a lot of work to do to further reduce the tobacco epidemic by investing in tobacco control measures and fighting the influence of the industry. By joining forces with the tobacco control community, the cancer and NCD community, along with organizations from other sectors, can lobby governments to put in place strong tobacco control measures. We have recently seen the result of these combined efforts where Philip Morris was removed from sponsorship and strong participation in a major conference in Asia after strong support from NGOs. We owe it to future generations to act now to protect their health. Tobacco control must be at the heart of these efforts.