world cancer report - iarc

Europe and North America, but the burden
is already high in China and recent studies
suggest that there the disease and death
toll will be heavy (Fig. 4.5). While in the
United Kingdom and the USA, tobacco is
responsible for about a third of all deaths
at ages 35 to 69 years [6], for China the
current estimate for men is about 12% to
20% but is predicted to increase to 33% by
2030 [7,8] with, for the time being, about
equal proportions of lung cancers, other
cancers and other diseases.
The numbers of lives lost to tobaccoinduced
disease and the extent to which
lives are shortened may be regarded as
indicative, at least in theory, of what could
be saved by cessation of smoking. The
effectiveness of preventive activity may
often be assessed in terms of the number
of lives able to be saved and these data
taken into account when determining the
allocation of resources. Clearly, total and
immediate cessation of smoking is
unachievable and can be set aside as a
realistic goal. Even reducing current
smoking rates by 50% would avoid 20-30
million premature deaths in the first quarter
of the current century and about 150
million in the second quarter. The affected
numbers of individuals in virtually all communities
are so great that any incremental
decrease in smoking rates will affect large
numbers of individuals and have direct
repercussions, for example, on health
budgets .Accordingly, the efforts directed
toward smoking cessation should not be
balanced solely against an assessment of
the numbers of lives saved, but must
involve consideration of total community
health care resources and the avenues
through which such finite resources are
most usefully expended.
Nature of intervention
Beyond being a primary concern for individual
users, smoking or tobacco use has
ramifications for the whole community.
Therefore all sectors of society have to be
mobilized against it. As a means of influencing
an individual's decision to smoke,
or to continue to smoke, responsibility has
traditionally been accorded to doctors and
public health specialists. However, a critical
influence may be exercised by teachers
and all professionals in schools. In
terms of action at a community level, a
critical role may fall to legislators, who are
responsible for design of legislation controlling
tobacco use, and politicians, who
enact relevant legislation.
Tobacco usage has massive economic
ramifications for governments who derive
benefits from taxes on tobacco trade, but
these may be considered to be offset by
the costs of diagnosing and treating diseases
linked to tobacco, as well as other
less direct costs. The broad economic
impact of tobacco use involves traders
dealing on world or national scales. The
economic ramifications of tobacco control
may involve agronomy insofar as alternative
crops must be considered. Finally, the
wider community may be influenced by
the manner in which relevant issues are
presented through the media [9].
Legislation is a crucial aspect of tobacco
control and WHO has proposed a framework
convention on this topic [10]. Key
Region Deaths due to % of total deaths Years of life lost due to % of total years of
tobacco use (1,000s) (all causes) tobacco use (1,000s) life lost (all causes)
Established market economies 1,063 14.9 11,607 11.7
Former socialist economies of Europe 515 13.6 7,803 12.5
India 129 1.4 1,719 0.6
China 820 9.2 8,078 3.9
Other Asian countries and islands 223 4.0 2,638 1.5
Sub-Saharan Africa 78 0.9 1,217 0.4
Latin America and the Caribbean 99 3.3 1,340 1.4
Middle East 111 2.4 1,779 1.2
World 3,038 6.0 36,182 2.6
Developed regions 1,578 14.5 19,410 12.1
Developing regions 1,460 3.7 16,772 1.4
Table 4.1 The estimated burden of mortality attributable to tobacco use in 1990. Numbers of deaths and years of life lost due to tobacco use are shown. These
figures are also expressed as a percentage of the total numbers of deaths and years of life lost from all causes.
Tobacco control 129