Lung cancer is the most common malignancy worldwide, accounting for 13% of all new cancer cases. According to the Global Burden of Disease Study 2015, lung cancer is also the leading cause of cancer mortality-over 1.7 to 1.8 million deaths every year and the highest age-standardized death rate (26.6 deaths per 100,000 population) among cancers. In Brazil, the Instituto Nacional de Câncer (INCA, Brazilian National Cancer Institute) estimated a total of 596,000 new cancer cases in 2016, 28,220 (4.7%) of which were primary lung malignancies. Lung cancer is the second most incident cancer among men and the fourth most incident cancer among women in the country.
Brazilian National Cancer Institute estimate for new cancer cases in 2016 by gender. Adapted from Instituto Nacional de Câncer José Alencar Gomes da Silva.
Burden of Disease:
Internationally, lung cancer continues to be the leading cause of cancer-related deaths in men and women. A breakdown by level of economic development shows no differences in cancer deaths in men but a higher rate of lung cancer deaths in women in industrialized countries as compared with developing nations. Among females in developing countries, lung cancer deaths lag behind those due to breast cancer. Lung cancer incidence and mortality are tightly linked to cigarette smoking patterns. As smoking rates peak – generally first in men, followed by women – lung cancer incidence and mortality rise in subsequent decades before declining following the initiation of comprehensive tobacco control programs. These trends have occurred earlier in industrialized countries as compared with the developing world. In the United States (US) and the United Kingdom (UK), lung cancer incidence and mortality rates have in fact been falling since the 1990s. In contrast, emerging nations – including Brazil, Russia, India, China, and South Africa (BRICS) – continue to have high rates of cigarette smoking in both men and women. They exhibit a lower incidence of cancer but a higher mortality burden compared with developed countries. Reasons for these patterns include unequal access to healthcare leading to delayed diagnosis and treatment, environmental contamination, and sociocultural barriers.
Global lung cancer incidence and mortality. Global age-standardized incidence and mortality rates for lung cancer, 20 countries with the highest rates internationally.
Tobacco smoking is the primary cause for lung cancer, responsible for over two thirds of lung cancer deaths globally. Second-hand smoke exposure at home or in the workplace also increases risk of lung cancer. Quitting smoking can reduce the risk of lung cancer: after 10 years of quitting smoking, risk of lung cancer falls to about half that of a smoker.
The World Health Organization highlights the damage tobacco causes to lung health: over 40% of all tobacco-related deaths are from lung diseases like cancer, chronic respiratory diseases and tuberculosis.
In 2017, tobacco killed 3.3 million users and people exposed to second-hand smoke from lung-related conditions, including:
1.5 million people dying from chronic respiratory diseases
1.2 million deaths from cancer (tracheal, bronchus and lung)
600 000 deaths from respiratory infections and tuberculosis
(https://www.who.int/news/item/29-05-2019-who-highlights-huge-scale-of-tobacco-related-lung-disease-deaths)
Tobacco Key facts:
Tobacco kills up to half of its users.
Tobacco kills more than 8 million people each year. More than 7 million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke.
Over 80% of the world's 1.3 billion tobacco users live in low- and middle-income countries.
In 2020, 22.3% of the global population used tobacco, 36.7% of all men and 7.8% of the world’s women.
To address the tobacco epidemic, WHO Member States adopted the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2003. Currently 182 countries have ratified this treaty.
The WHO MPOWER measures are in line with the WHO FCTC and have been shown to save lives and reduce costs from averted healthcare expenditure.
What can be done?
WHO is urging countries to fight the tobacco epidemic through full implementation of the WHO Framework Convention on Tobacco Control (WHO FCTC) and enforcing effective tobacco control actions, including WHO’s recommended “MPOWER” policy measures, for example by reducing demand for tobacco through taxation, creating smoke-free places and cessation support.
The Organization also encourages parents and community leaders to take steps to safeguard the health of their families and communities by informing them of and protecting them from the harms caused by tobacco. (https://www.who.int/news/item/29-05-2019-who-highlights-huge-scale-of-tobacco-related-lung-disease-deaths)
The 6 MPOWER measures are:
Monitor tobacco use and prevention policies
Protect people from tobacco use
Offer help to quit tobacco use
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion and sponsorship
Raise taxes on tobacco.
References:
Lung cancer in Brazil. Luiz Henrique Araujo, Clarissa Baldotto, Gilberto de Castro Jr, Artur Katz, Carlos Gil Ferreira, Clarissa Mathias, Eldsamira Mascarenhas, Gilberto de Lima Lopes, Heloisa Carvalho, Jaques Tabacof, Jeovany Martínez-Mesa, Luciano de Souza Viana, Marcelo de Souza Cruz, Mauro Zukin, Pedro De Marchi, Ricardo Mingarini Terra, Ronaldo Albuquerque Ribeiro, Vladmir Cláudio Cordeiro de Lima, Gustavo Werutsky, Carlos Henrique Barrios. Grupo Brasileiro de Oncologia Torácica (https://doi.org/10.1590/S1806-37562017000000135). (https://www.scielo.br/j/jbpneu/a/NnmgVRdvjbjhR4MysDgWfSD/?lang=en# ). Accessed: 8 jul 2022.
Barta JA, Powell CA, Wisnivesky JP. Global Epidemiology of Lung Cancer. Ann Glob Health. 2019 Jan 22;85(1):8. doi: 10.5334/aogh.2419. PMID: 30741509; PMCID: PMC6724220.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6724220/). Accessed: 8 jul 2022.
WHO highlights huge scale of tobacco-related lung disease deaths. (https://www.who.int/news/item/29-05-2019-who-highlights-huge-scale-of-tobacco-related-lung-disease-deaths) . Accessed: 8 jul 2022.
Tobacco. (https://www.who.int/news-room/fact-sheets/detail/tobacco). Accessed: 8 jul 2022.
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