RISK FACTORS
44 CANCER CONTROL 2014
arguably been the most productive period in
tobacco control history. The Atlas provides
statistics on the history of tobacco use,
international prevalence and trends data,
statistics on deaths and harm from smoking,
personal and societal costs of tobacco use, and
discusses tobacco industry behaviour and
current and proposed solutions for global
tobacco control. The Tobacco Atlas, and the
accompanying interactive website found at
www.tobaccoatlas.org, is a comprehensive and
user-friendly tool for investigating and
monitoring global tobacco issues. The following sections
highlight key findings from The Atlas, their implications for
cancer control worldwide and global tobacco control
interventions and practices.
Tobacco and cancer findings from The Tobacco Atlas
Harm and cancer resulting from tobacco use
Tobacco use harms nearly every part of the body, inducing
cancers in many different organs. While much research has
focused on the impact of cigarette smoking on health
outcomes, links have also been established between
smokeless tobacco and oral cancers, and between other
adverse outcomes and the use of cigars, pipes, water pipes,
kreteks and bidis. Cigarette smoking, or the inhalation of
burned tobacco leaves, is the single largest contributor to
cancer deaths in the world. Worldwide, roughly 80% of male
lung cancer deaths and 50% of female lung cancer deaths are
caused by smoking. The International Agency for Research
on Cancer (IARC) has estimated that annually there are 1.1
million lung cancer deaths globally and of these, 83%
(935,000 a year) are caused by smoking.4 The dangers of
cigarette smoke extend to non-smokers who are exposed to
secondhand cigarette smoke, also called forced smoking. In
countries with a high male to female smoker ratio, women are
often victims of secondhand smoke exposure, illness, and
death. In fact, three-quarters of secondhand smoke deaths
occur among women and children (Figure 3).
Cigarette consumption and prevalence
Cigarette smoking is a twentieth century phenomenon
(Figure 4) that has followed a pattern of smoking initiation
and the broad adoption of the habit, trailed by an increase in
smoking-related illness and death and eventually a decline in
smoking prevalence.5 This pattern has been observed in many
high-income countries, resulting in a devastating tobacco
epidemic of significant economic and health proportions.
This same pattern is now emerging in low- and middleincome countries. Comparing areas in which cigarette
consumption is roughly equivalent, there is a disturbing trend
towards an increase in cigarette prevalence and consumption
in low- and middle-income countries, even as
consumption decreases in high-income countries. For
example, consumption in Western Europe dropped by
26% between 1990 and 2009 while simultaneously
increasing in the Middle East and Africa by 57%. The
pattern is such that, as the population in low-income
countries increases, the net result will be a global
increase in cigarette consumption. In high-income
countries, where cigarette smoking has been
widespread for the better part of a century, at least 30%
of all cancer deaths are caused by tobacco use,
particularly deaths from lung and upper aerodigestive
system cancer.6 This mortality pattern, which has
occurred over decades, is now decreasing as a result of
fewer smokers in the developed world. The same
mortality pattern is beginning to emerge in low- and
middle-income countries, where extensive tobacco use
Risk Factors
Tobacco is the only risk factor shared by all of
the four leading noncommunicable diseases.
Tobacco
Use
Unhealthy
Diets
Lack of
Physical
Activity
Harmful
Use of
Alcohol
� � � �
� � � �
� � � �
�
CARDIOVASCULAR
DIABETES
CANCER
CHRONIC RESPIRATORY
Figure 2: Risk factors
Number of
Global Deaths
Caused by Secondhand Smoke in Nonsmokers 2004
75% of secondhand smoke deaths
occur among women and children
28%
166,000
47%
281,000
26%
156,000
CHILDREN
WOMEN
MEN
Totals might not sum due to rounding.
-Mauritius
Figure 3: Number of global deaths caused by secondhand smoke in non-smokers