NEWS

Tobacco Use a Leading Global Cancer Risk, Report Says

Renee Twombly

The same cancer-causing lifestyles of people in wealthy nations are also threatening the health of people in the developing world, according to a new report from the World Health Organization (WHO).

Half of the top 10 preventable global disease risks identified in the publication, World Health Report 2002, reflect overconsumption of food and drink and lack of exercise, which are collectively responsible for an estimated 59% of 56.6 million deaths annually, according to the report. These risks, some of which are known risk factors for cancer, are obesity, high blood pressure, high cholesterol, and alcohol and tobacco use.

Health hazards around the world now "concern consumption—either too little, in the case of the poor, or too much, in the case of the better off," said Gro Harlem Brundtland, M.D., the Director General of WHO. "The world is living dangerously, either because it has little choice or because it is making the wrong choices about consumption and activity."



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Dr. Gro Harlem Brundtland

 
But to cancer experts, the data on tobacco use sound the loudest alarm. Tobacco use, the primary risk factor for the leading cancer killer in developed nations, ranked as the fourth most preventable health risk in the 70 nations studied, behind malnutrition, unsafe sex, and high blood pressure, respectively.

"The scale of tobacco use is astounding," said Kirk Smith, Ph.D., chair of environmental health sciences at the University of California at Berkeley, who contributed data to the report. A penchant for smoking cigarettes, as well as cigars and pipes and chewing tobacco, is spreading across the globe, he said. WHO reports that almost one billion men and 250 million women in the world today are daily smokers, and that of everyone alive today, 500 million will eventually be killed by tobacco.

"The trends are terrible, and soon tobacco may exceed malnutrition as the most important risk factor in the world," said Smith.

Between 1990 and 2000, deaths caused by tobacco use (mostly cancer related) increased by more than one million, and most of that increase occurred in developing countries, said Majid Ezzati, Ph.D., a fellow at Resources for the Future in Washington, D.C., and an author of the report. There have been large increases in smoking in developing countries, especially among males, in the past few decades. About 35% of men in developed countries smoke, but the figure is almost 50% in developing nations. The first estimates of the health impacts of smoking in China and India have also shown substantially increased risk of mortality and disease among smokers. Almost two-thirds of Chinese men smoke, for example, producing more than a half a million deaths a year in that country alone, according to Smith.

Smoking rates remain relatively high in most former socialist countries, according to the findings. And although prevalence of tobacco use has declined in some high income countries, it is increasing in some low- and middle-income countries, especially among young people and women.

Among industrialized countries, where smoking has been common, smoking is estimated to cause more than 90% of lung cancer in men and about 70% of lung cancer among women. Considering all the health impacts of smoking, tobacco is responsible for 24% of adult deaths in North America, said Smith. Worldwide in 2000, tobacco use is estimated to have caused 12% of vascular disease, 66% of trachea, bronchus, and lung cancers, and 38% of all chronic respiratory disease, although the pattern varies by subregion.

For the first time, lung cancer risk assessments were made for indoor smoke exposure from solid fuel use and occupational exposure. According to the report, 13% of lung cancer in middle-income countries is caused by exposure to carcinogens in the work place. Indoor air pollution, ranked in the report as one of the top 10 preventable health risks, is responsible for another 7% of lung cancer in middle income countries, especially China. It mostly affects women and is largely the result of unvented cooking and heating with solid fuels like coal.

Still, smoking is the major risk, and unless tobacco use is curtailed, deaths from tobacco will exceed 9 million by 2020, the report warned.

"The tobacco epidemic is clearly rolling along at a fast pace," said Alan Lopez, Ph.D., a WHO senior science adviser. "A decade ago, we underestimated the number of deaths we are now experiencing from tobacco use, and I suspect we have underestimated its future toll."

WHO’s Framework Convention on Tobacco Control, which seeks to control tobacco use through a globally accepted public health treaty, is an important first step to keeping tobacco use from growing in vulnerable areas, like Africa, said Ezzati. "If we put a stop to the indiscriminate spread of tobacco and reduce current use, we can prevent a lot of disease."

"The report is not perfect, but goes a long way to addressing disease burden of the major health risks," Lopez added. "If we can address the use of tobacco, we will have a major impact on cancer worldwide."



             
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