Tobacco and Public Health - TCSC Indonesia

cancer and others where there is still a gap. In the SEER (Surveillance Epidemiology
and End Results) Programme of the US NCI, the incidence of lung cancer in both
black and white women increased by over 90 per cent between 1973–1977 and
1988–1992: the increase in the incidence of breast cancer was around 25 per cent in
both racial groups (comparison made between incidence rates age-adjusted using 1970
US population). Of great worry is that there does not appear to be any end in sight to
this increase in lung cancer risk internationally: it is programmed to continue for several
decades to come.
Part of the complacency over the effect on women was also due to the strong tendency
for women to smoke brands of cigarettes which were lower in tar and nicotine content
than men: it was assumed that this would have less of a risk on lung cancer than the
higher tar cigarettes which men generally smoked. Now marked changes in the rates of
the major histological cell types of lung cancer can be seen with particular increases
in the risk of adenocarcinoma (Zheng et al. 1994; Levi et al. 1997). The changes seen
are compatible with increased risk of adenocarcinoma due to increasing levels of
smoking of light cigarettes (‘low tar, low nicotine’). It appears that abandoning,
high-tar cigarettes (15–45 mg tar) may have had some impact on reducing squam
ous-cell carcinoma risk, there is now a ‘balancing’ by light cigarettes increasing risk of
adenocarcinoma.
Cigarette smoking kills half of all those who adopt the habit with 50 per cent of these
deaths occurring in middle age and each losing an average of 20 years of non-smokers
life expectancy (Doll et al. 1994). It kills in over 24 different ways with lung cancer
being the commonest cancer-site (Doll et al. 1994). Lung cancer rates have been declining
in men and increasing in women: cigarette smoking in men has been declining
while it has been increasing in women. These two are closely related. The move to
‘light’ cigarettes, which is increasingly common, now appears to be linked to increases
in adenocarcinoma of the lung and shows no sign of being linked to a reduced risk
overall. Clearly cigarettes are different but still seriously harmful after decades of selfregulation.
There is no such thing as a safe cigarette. Smokers should be urged and
helped to stop smoking, children and young adults should be convinced not to smoke.
Tobacco can become an addictive drug: it should be left alone (Boyle et al. 1995).
Acknowledgements
It is a pleasure to acknowledge the support provided by the Cancer Council Victoria
and the Italian Association of Cancer Research (Associazione Italiana per la Ricerca
sul Cancro).
References
GRAHAM G. GILES AND PETER BOYLE 497
Adler, I. (1912). Primary malignant growths of the lungs and bronchi: A pathological and clinical study.
London: Longmans, Green and Co.,
Anon, (1942). Cancer of the lung (editorial). Br Med J, 1, 672–3.