The tobacco burden in the light of World Lung Cancer Day


Lung cancer is the second most common cancer and the leading cause of cancer deaths among men and women. With a major and direct impact on the population, World Lung Cancer Day is commemorated every year on the 1ˢᵗ of August. This period is dedicated to educating people in correctly understanding lung cancer risks as well as different treatments available. It is also the perfect time to emphasize the importance of effective ways of prevention through early screenings and tobacco cessation (as the main risk factor).

Lung cancer: the leading cause of death and most diagnosed cancer worldwide

  • In 2020, there is an estimated 2.21 million new cases of lung cancer and 1.8 million deaths due to lung cancer worldwide [1].
  • In 2020, over 320,000 individuals in EU nations were newly diagnosed with lung cancer, (approximately 1 new case every minute) with over 257,000 deaths from Lung cancer [2].
  • Lung cancer is expected to remain the leading cause of cancer mortality in the EU which accounts for 25% of deaths in Europe [3] and one of the most diagnosed cancers accounting for 12.2% of all new cancer diagnoses in the EU in 2020 [4].
  • Incidence rates for lung cancer in Europe are still increasing, with incidence rates being highest in East Europe among males, and in West Europe among females [5].
  • Compared with other leading causes of cancer, lung cancer continues to be associated with relatively low survival after diagnosis. For patients diagnosed with lung cancer, the cumulative probability of surviving their cancer for at least five years was 13% (11.2% in males, 13.9% in females) on average across EU countries. Ranging from ≤10% in Croatia, Lithuania, and Bulgaria to ≤20% in Austria, Sweden, Iceland, and Switzerland [6].

Tobacco smoking: the main cause of lung cancer in Europe

  • Tobacco use is the main cause of lung cancer and the single greatest avoidable risk for cancer overall.
  • Tobacco use causes about 63% (6 out of 10) of all lung cancer deaths in men and women globally [7].
  • Tobacco use contributes to greater than 85% (almost nine out of ten) of the occurrence of lung cancer in Europe [8] with an additional fraction caused by secondhand smoke exposure in non-smokers.
  • In the EU, the lung cancer mortality rate attributable to tobacco smoking varies across regions and countries for nearly two-folds, ranging from the highest in Central Europe  (25.64/100,000), followed by Western Europe  (19.17/100,000) and Eastern Europe  (15.45/100,000) [7]. This highlights that tobacco prevention needs to be strengthened, especially in EU regions with high smoking prevalence and countries where the mortality rate of smoking smoking-induced lung cancer is high.
  • Secondhand smoke, as well as environmental factors, particularly air pollution, are as well key risk factors for lung cancer.
  • Lung cancer caused by secondhand tobacco smoke, it is estimated that 526,000 disability-adjusted life years (DALYs) and 24,000 deaths were attributable to secondhand tobacco exposure in non-smokers in the EU nations [9].
  • South-Eastern EU countries showed the highest burden of secondhand smoke, whereas northern EU countries showed the lowest burden [9].
  • Other risk factors for lung cancer include indoor air pollution caused by unventilated combustion of coal in the household for heating and cooking; outdoor air pollution; exposure to hazardous chemicals in some occupations [10]. Tobacco production and consumption-related waste also contribute largely to air and environmental pollution [11] related to the development of lung cancer.

Effective tobacco control measures to reduce tobacco use and lung cancer incidence

  • As the majority of lung cancer cases are attributable to tobacco smoking, the main priority is to reduce smoking prevalence through effective tobacco control policies and regulations.
  • The WHO MPOWER measures should be reinforced to raise awareness about the risks of tobacco products, support people who wish to quit smoking, prevent others from starting and reduce the incidence of smoking and the diseases that tobacco causes, such as lung cancer.
M: Monitoring is key to understanding the nature and extent of tobacco use and ensuring that the most appropriate and targeted policies to reduce it are developed and implemented to prevent cancer and tobacco-induced diseases.

P: Protect from secondhand smoke. Exposure to second-hand smoke at home or at work increases the risk for non-smokers of developing lung cancer by 20-30% [12]. Smoke-free public areas and banning smoking indoors and at workplaces can also act as an incentive for smokers to quit [13] and discourage never-smokers, particularly youth, from starting. Study showed that having a comprehensive smoke-free workplace reduced smoking prevalence by 10% [14].

O: Offer support services to help people quit smoking. Currently, only 26 countries offer comprehensive cessation programs (only 8 countries in the EU), including cost coverage to help people stop, accounting for only one person in three (32%) globally [13]. Moreover, quitting smoking before the age of 40 lowers tobacco-related death risks by tenfold compared to not quitting [15].

W: Health warning labels on tobacco packages have a demonstrated effectiveness in quitting and reduction of use. The number of individuals who benefited from large health warning labels (covering at least 50% of the front and back of the package) covered 101 countries consisting of 60% of the world's population (WHO). In the EU, there are currently 29 countries implemented large health warning labels, and 8 countries adopted plain packaging [13].

E: Enforce bans on tobacco advertising, promotion, and sponsorship (TAPS). Comprehensive bans on tobacco advertising and promotion, including social media and sponsorships or promotional activities, can be very effective in countering the tobacco industry's marketing tactics and reduce consumption by an estimated 7.4% in smoking and 5.4% in overall tobacco consumption [16].

R: Raise taxes. Increasing taxes on tobacco products has proven to be one of the more effective means to lower smoking incidence. Research in the EU showed a significant correlation between the increases in tobacco prices due to taxation and lung cancer death rates, with lung cancer deaths dropping rapidly by 50% within a decade of prices rising sharply [17].
  • Implementation of tobacco control policies at the highest level could prevent 21.2%, an estimated 1.65 million lung cancer cases in Europe, accounting for a reduction of 19.8% of lung cancer cases in men and 23.2% of lung cancer cases in women over the next two decades across European countries [18].
  • At the EU level, comprehensive regulatory tobacco control measures should be strengthened in line with the Tobacco Products Directive and the Tobacco Taxation Directive. With the emergence of novel tobacco products, extending taxation to novel tobacco products, tackling TAPS on the internet and social media, and a full ban on flavours should be deemed as priorities.

Ending the tobacco epidemic is a critical step for beating cancer in the European Union

  • The most effective approach to reducing lung cancer incidence and mortality is to strengthen prevention, notably through tobacco control policies and policies to reduce air pollution.
  • Europe as a region remains to have the highest prevalence of tobacco smoking among adults (≥ 15 years) in the world with an estimated 36% of men and 20% of women smoking tobacco in 2020 [13].
  • Lung cancer risks cannot be reduced by switching to less harmful products but can be dramatically reduced by tobacco cessation. 
  • By eliminating tobacco use, nine out of every ten cases of lung cancer could be avoided [8].

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424. doi: 10.3322/caac.21492.
  2. Bettio M, Carvalho RN, Dimitrova N, et al. Measuring the cancer burden in Europe: The European Cancer Information System (ECIS). Ann Oncol. 2019;30:v675.
  3. Kalubula, M.; Shen, H.; Liu, L. Ambient Air Pollution and Cigarette Smoking: Co-Drivers of Increased Burden of Lung Cancer in Europe. doi: 10.20944/preprints202001.0091.v1.
  4. JRC (2020), ECIS – European Cancer Information System, https://ecis.jrc.ec.europa.eu.
  5. van Meerbeeck JP, Franck C. Lung cancer screening in Europe: where are we in 2021? Translational Lung Cancer Research. 2021;10(5):2407-2417. 
  6. OECD (2020), Addressing Challenges in Access to Oncology Medicines, OECD, Paris, https://www.oecd.org/health/health-systems/addressing-challenges-in-access-to-oncology-medicines.htm.
  7. Yang X, Man J, Chen H, Zhang T, Yin X, He Q, Lu M. Temporal trends of the lung cancer mortality attributable to smoking from 1990 to 2017: A global, regional and national analysis. Lung Cancer. 2021 Feb;152:49-57. doi: 10.1016/j.lungcan.2020.12.007.
  8. Kulhánová I, Forman D, Vignat J, et al. Tobacco-related cancers in Europe: The scale of the epidemic in 2018. Eur J Cancer. 2020;139:27-36.
  9. Carreras G, Lachi A, Cortini B, et al. Burden of disease from second-hand tobacco smoke exposure at home among adults from European Union countries in 2017: an analysis using a review of recent meta-analyses. Prev Med. 2021;145:106412.
  10. Loomis D, Grosse Y, Lauby-Secretan B, et al. The carcinogenicity of outdoor air pollution. Lancet Oncol 2013;14:1262-3.
  11. Chen DT-H. Tobacco control measures in COVID-19 recovery: an opportune time to restore equity and planetary health. Environ Health Prev Med. 2022;27:15-15.
  12. United States Environmental Protection Agency.  Secondhand Smoke and Smoke-free Homes. United States Environmental Protection Agency; 2022.
  13. World Health Organisation. WHO report on the global tobacco epidemic, 2021: Addressing new and emerging products. Geneva: World Health Organization; 2021.
  14. Farrelly MC, Evans WN, Sfekas AE. The impact of workplace smoking bans: results from a national survey. Tob Control. 1999 Autumn;8(3):272-7. doi: 10.1136/tc.8.3.272.
  15. Pirie K, Peto R, Reeves GK, Green J, Beral V; Million Women Study Collaborators. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet. 2013 Jan 12;381(9861):133-41. doi: 10.1016/S0140-6736(12)61720-6.
  16. Saffer, H. (2000). Tobacco advertising and promotion. Tobacco control in developing countries, 1, 215-236.
  17. Hill C. Cancer prevention and screening (Prévention et dépistage des cancers). Bulletin du Cancer. 2013;100: 6
  18. Gredner T, Mons U, Niedermaier T, Brenner H, Soerjomataram I. Impact of tobacco control policies implementation on future lung cancer incidence in Europe: An international, population-based modeling study. The Lancet Regional Health – Europe. 2021;4.

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