UICC World Cancer Congress 2006

1. The World Health Organization (WHO) declared cancer prevention and control as one of the most important scientific and public health challenges of our days.(WHO 2002) The WHO estimates that there are over 20 million people living with cancer, the majority of whom live in the developing world, and 10 million new cases a year worldwide.

2. Currently over 1.3 billion people use tobacco worldwide. Approximately half of current smokers will die of a tobacco-related disease, and half of those deaths will occur between the ages of 35 and 69 years.

3. The WHO estimates that 5 million people a year die of a tobacco-related cause and this number will rise to 10 million people a year by 2020, and 70% of these deaths will occur in developing countries. Smoking is responsible for 24% of all male deaths and 7% of all female deaths (as high as 40% for men in some central and eastern European countries and 17% for women in the United States).

4. Tobacco use prevalence is declining in several developed countries, but is still climbing in developing countries, mainly among women. In the 35 most developed countries in the world, the per capita consumption of tobacco declined in 17% in the last decade; during the same period, tobacco consumption in developing countries increased 15% and continues in an upward trend in most of these countries.

5. The WHO stated that tobacco use is a contributor to poverty at the individual, community and national levels. Tobacco control is intrinsically linked with achieving the Millennium Development Goals.

6. Given the lag time between smoking and the development of cancer, it is estimated that the cancer toll in developing countries will increase in the next few decades. Worldwide, tobacco is responsible for 30% of all cancer deaths in developed countries and the number is rising rapidly in the developing countries. Several countries' report on their progress towards achieving the Millennium Development Goals cite the increase in tobacco use and cancer as major contributors to ill health and mortality (for example, Hungary, Indonesia, Jordan and Lithuania).

7. Tobacco is consumed in many forms (e.g. pipe, cigar, chew), all of which harmful, cigarette smoking, however, is the most common form of tobacco use. Cigarettes contain over 60 substances known to be carcinogens. Tobacco smoke produces gene mutations and chromosomal abnormalities in humans and is a known human carcinogen. In 2002 the International Agency for Research on Cancer (IARC) released the results of it updated tobacco and cancer monograph reaffirming that tobacco is a carcinogen and, more importantly, confirming that exposure to secondhand tobacco smoke is also a human carcinogen. The IARC determined that the excess risk for lung cancer is 20% for women and 30% for men with exposure to secondhand smoke, increasing with increased exposure. More recently, the California Environmental Protection Agency declared exposure to second-hand smoke to be a toxic air contaminant.

8. Cigarette smoking causes cancers of the lung, oral cavity, nasal cavities and nasal sinuses, pharynx, larynx, esophagus (squamous-cell carcinoma and adenocarcinoma), pancreas, stomach, liver, urinary bladder, renal pelvis, kidney (renal cell carcinoma), uterine cervix and myeloid leukemia. There is a several-fold increase in the risks for these cancers in the presence of smoking that ranges from 20 to 30 times increased risk for lung cancer to a three to six times increased risk overall. In addition, there is a synergistic effect between smoking and other risk factors for cancer, such as exposure to arsenic, asbestos, radon, alcohol consumption, Human papillomavirus infection.

9. Worldwide, lung cancer is the most common cause of cancer death. The IARC estimates that there are 1.2 million cases a year and the number is increasing. Smoking cessation at any age is beneficial; smoking cessation is also beneficial after a cancer diagnosis.

10. The WHO compares tobacco use to a communicable disease whose vector is the tobacco industry. For decades the tobacco industry has known about the carcinogenic effects of cigarettes smoking but had not disclosed the data or publicly admitted that tobacco causes cancer. The industry continues to deny the harmful effects of secondhand smoke and the addictive properties of nicotine.

11. The tobacco industry has waged massive public and political campaigns to influence the development of tobacco control policies, including attempts to influence the work of WHO and IARC. In addition, the tobacco industry has manipulated the media to confuse the public understanding of the health effects of tobacco. Worldwide, governmental spending on tobacco control is outweighed by the tobacco industry's spending in marketing and political strategies. However, tobacco control is a cost-effective measure that alleviates the burden of tobacco-related diseases.

12. Health professionals' involvement in the political process can greatly assist in increasing the power of tobacco control and preventing the growth of tobacco-related cancers for future generations. Tobacco control should be an integral part of the oncology practice. At a minimum, tobacco use, cessation and relapse should be standard in the data collection at entry and follow up of all oncology-related trials and other research, as suggested by Gritz et al.

13. Unfortunately, health professionals have not given tobacco control its due priority. This is related to a lack of knowledge about the harmful health effects and the addictive nature of tobacco use, lack of skills to help with cessation efforts, and lack of political involvement. The tobacco industry, on the other hand, is a powerful influence in the political process and a significant barrier to tobacco control.

14. The essential elements of a comprehensive tobacco control program are: taxation, regulation of products, restrictions on advertisement and sponsorships, protection of nonsmokers, support for cessation, youth access restriction and firm action against cigarette smuggling. Countries and U.S. states that have implemented comprehensive tobacco control strategies have seen a decline in tobacco consumption. Such decline is seen both in developing countries, such as Thailand, Brazil and South Africa and in developed countries, such as Canada, Australia, and in the US, the states of California and Massachusetts.

15. Recognizing the worldwide spread of the tobacco-related epidemic, and the multinational reach of the tobacco industry, the WHO took the lead in sponsoring the first international public health treaty, the WHO Framework Convention on Tobacco Control (WHO FCTC). The treaty entered into force in February of 2005 and as of March 20, 2006 had 124 countries which are parties. The treaty is a legally binding document for countries that ratified and ratification means agreeing to implement national legislation that conforms to the treaty's policy recommendations. The treaty addresses comprehensive population-based policies that have been proven to be effective in promoting a decline in tobacco use in the population. Demand side policy measures include price and taxation of tobacco products, product regulation, marketing ban or restrictions, marketing regulations, protection against exposure to second-hand smoke and increased access to tobacco cessation treatment, among others. Supply side measures address control and elimination of contraband and economically viable crop replacement.

16. The treaty is based on best practices of countries that have implemented several of the policies and include experience from high, middle and low income countries – the expected positive impact of the treaty's implementation in reducing tobacco use worldwide will be carefully monitored by governments and civil society.

17. As countries embrace the WHO FCTC, new opportunities for collaborative research arise to investigate the process and the outcomes of the treaty's implementation and enforcement.

Suggested Reading:

Boyle P. Cancer, cigarette smoking and premature death in Europe: a review including the Recommendations of European Cancer Experts Consensus Meeting, Helsinki, October 1996. Lung Cancer 1997 May;17(1):1-60

Committee of Experts on Tobacco Industry Documents. Tobacco Company Strategies to Undermine Tobacco Control Activities at the World Health Organization. Geneva: WHO; July 2000. URL: http://filestore.who.int/~who/home/tobacco/tobacco.pdf

Drope J, Chapman S. Tobacco industry efforts at discrediting scientific knowledge of environmental tobacco smoke: A review of internal industry documents. Journal of Epidemiology and Community Health. 2001;55:588-594

Glantz SA, Slade J, Bero LA et al. The Cigarette Papers. Berkeley: University of California Press; 1996. http://ark.cdlib.org/ark:/13030/ft8489p25j/

Gritz ER, Dresler C, Sarna L. Smoking, the missing drug interaction in clinical trials: ignoring the obvious. Cancer Epidemiol Biomarkers Prev. 2005 Oct;14(10):2287-93

Hirschhorn N. Shameful Science: Four decades of the German tobacco industry's hidden research on smoking and health. Tobacco Control. 2000;9:242-247

Hirschhorn N, Bialous S. Second hand smoke and risk assessment: what was in it for the tobacco industry? Tobacco Control. 2001;10(4):375-382

International Agency for Research on Cancer (IARC). Tobacco Smoke and Involuntary Smoking. Summary of Data Reported and Evaluation. Last updated 24 July 2002 VOL.: 83 (2002) http://monographs.iarc.fr/htdocs/monographs/vol83/01-smoking.html http://monographs.iarc.fr/htdocs/monographs/vol83/02-involuntary.html http://monographs.iarc.fr/htdocs/indexes/vol83index.html

Jha P, Chaloupka F, eds. Curbing the Epidemic: Governments and the Economics of Tobacco Control: The World Bank; 1999. URL: http://www1.worldbank.org/tobacco/reports.asp

Muggli M, Forster J, Hurt R, et al. The smoke you don't see: Uncovering tobacco industry scientific strategies aimed against control of environmental tobacco smoke. AJPH. 2001;91(9):1419-1423

Murray CJL, Lopez AD. Assessing the burden of disease that can be attributed to specific risk factors. In Ad Hoc Committee on Health Research Relating to Future Intervention Options. Investing in Health Research and Development. World Health Organization, Geneva, 1996. URL: http://www5.who.int/tobacco/page.cfm?sid=47

Ong E, Glantz S. Tobacco industry efforts subverting International Agency for Research on Cancer's second-hand smoke study. Lancet. 2000;355:1253-1255

Ong E, Glantz S. Constructing “Sound Science” and “Good Epidemiology”: Tobacco, Lawyers, and Public Relations Firms. AJPH. 2001;91(11):1749-1757

Poswillo DC. Report of the Scientific Committee on Tobacco and Health. London, UK: The Stationery Office; 1998. ISBN 011322124x. URL: http://www.doh.gov.uk/public/scoth.htm

Samet J, Yoon S. Women and the Tobacco Epidemic: Challenges for the 21st Century: The World Health Organization/Institute for Global Tobacco Control, Johns Hopkins School of Public Health; 2001. URL: http://tobacco.who.int/repository/tpc49/WomenMonograph.pdf Samet J, Burke T. Turning Science Into Junk: The Tobacco Industry and Passive Smoking. AJPH. 2001;91(11):1742-1744

State of California AIR RESOURCES BOARD. Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. As Approved by the Scientific Review Panel on June 24, 2005. California Environmental Protection Agency. Air Resources Board. Office of Environmental Health Hazard Assessment. Sacramento, CA: December 2005 http://www.arb.ca.gov/regact/ets2006/ets2006.htm

US Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: USDHHS Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 2000.

US Department of Health and Human Services. 9th Report on Carcinogens. Research Triangle Park, NC: USDHHS, Public Health Service, National Toxicology Program; 2000

USDHHS National Cancer Institute. Monograph 13: Risks Associated with Smoking Cigarettes with Low Tar Machine-Measured Yields of Tar and Nicotine 2001. URL: http://cancercontrol.cancer.gov/tcrb/monographs/13/index.html U.S. Department of Health and Human Services. (2004). The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

World Health Organization. National cancer control programmes: policies and managerial guidelines. 2nd ed. Geneva: World health Organization; 2002. http://www5.who.int/cancer/main.cfm?p=0000000029

WHO Informal Meeting on Health Professionals and Tobacco Control. (2004). Code of practice on tobacco control for health professional organizations. http://www.who.int/tobacco/communications/events/codeofpractice/en/index.html

World Health Organization. (2006). Framework Convention on Tobacco Control. Geneva: WHO. http://www5.who.int/tobacco/page.cfm?sid=96

World Health Organization. (2006). Why is tobacco a public health priority. http://www.who.int/tobacco/about/en