Tobacco and Public Health - TCSC Indonesia

486
SMOKING AND LUNG CANCER
women (Gilliland and Samet 1994). The smoking of tobacco is the principal cause of
lung cancer. The IARC Monograph on Tobacco Smoking (IARC 1986) estimated the
proportion of lung cancer deaths attributable to tobacco smoking in five developed
countries (Canada, England and Wales, Japan, Sweden, and the United States) to range
between 83 and 92 per cent for men and 57 and 80 per cent for women. Historically,
the incidence of lung cancer has waxed and waned to a greater or lesser degree in different
populations related to the timing, prevalence, and intensity of the smoking epidemic
and the different local dose of carcinogens delivered per cigarette. In some
countries, especially those in which the epidemic struck early and was supplied with
high tar cigarettes, age-standardized annual incidence and mortality rates exceeded
100 per 100 000 men and subsequently declined with the falling prevalence of men
smoking. In the same populations the uptake of smoking in women was delayed by
one or two decades. This delay, and a contemporaneous marketing of the filter tipped
and lower dose cigarettes, resulted in a slower rise in rates. Consistent with the historical
rise and fall in the prevalence of smoking in men, in several populations lung cancer
rates in men have now peaked or are falling. The prevalence of smoking in women
has either continued to grow or has declined only slowly. There is evidence from some
countries that lung cancer rates in women may be stabilizing but the scenario in most
countries is one of continuing increases in incidence and mortality. In 2000 it was estimated
globally that 1.2 million people were diagnosed with lung cancer (Parkin 2001).
This number is expected to grow. Many countries of Europe, Asia, Africa, and South
America have only recently achieved a high prevalence of smoking, especially in
women. In terms of lung cancer alone, these populations will generate millions of
additional deaths over the next few decades.
In men in all European countries, except Portugal, lung cancer is now the leading
cause of cancer death. In the United States (and in all except a few Scandinavian countries)
it is the commonest tumour in terms of incidence as well (although the recent inflation
of prostate cancer incidence figures with very early cases is taking prostate cancer
above lung cancer in terms of the incidence of the disease). The range of geographical
variation in lung cancer mortality in Europe is three-fold in both sexes, the highest
rates being observed in the United Kingdom, Belgium, the Netherlands, and
Czechoslovakia, and lowest rates reported in southern Europe and also in Norway
and Sweden (Levi et al. 1989). This overall pattern of age-standardized lung cancer
mortality rates does not reveal the important and diverging cohort effects occurring in
various countries: for instance, some of the countries in which there are now low rates
such as those in southern Europe and parts of eastern Europe, experienced a later
uptake and spread of tobacco use, and now appear among the most elevated rates in
the younger age groups. This suggests that these same countries, including Italy,
Greece, France, Spain, and several countries in eastern Europe, will have the highest
lung cancer rates in men at the beginning of the next century in the absence of rapid
intervention.