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Do not smoke; if you smoke, stop doing so. If you fail to
stop, do not smoke in the presence of non-smokers
It
is estimated that between 25 and 30% of all cancers in developed
countries are tobacco-related. From the results of studies
conducted in Europe, Japan and North America, between 87 and
91% of lung cancers in men, and between 57 and 86% of lung
cancers in women, are attributable to cigarette smoking. For
both sexes combined the proportion of cancers arising in the
oesophagus, larynx and oral cavity attributable to the effect
of tobacco, either acting singly or jointly with the consumption
of alcohol are between 43 and 60%. A large proportion of cancers
of the bladder and pancreas and a small proportion of cancers
of the kidney, stomach, cervix and nose and myeloid leukaemia
are also causally related to tobacco consumption. Because
of the length of the latency period, tobacco-related cancers
observed today are related to the cigarette smoking patterns
over several previous decades. On stopping smoking, the increase
in risk of cancer induced by smoking rapidly ceases. Benefit
is evident within 5 years and is progressively more marked
with the passage of time.
 Smoking
also causes many other diseases, most notably chronic obstruction
pulmonary disease (commonly called chronic bronchitis) and
an increased risk of both heart disease and stroke. The death
rate of long-term cigarette smokers in middle age (from 35
to 69 years of age) is three times that of life-long non-smokers
and approximately half of regular cigarette smokers, who started
smoking early in life, eventually die because of their habit.
Half the deaths take place in middle age when the smokers
lose approximately 20 -25 year of life expectancy compared
to non-smokers; the rest occur later in life when the loss
of expectation of life is 7-8 years. There is, however, now
clear evidence that stopping smoking before cancer or some
other serious disease develops avoids most of the later risk
of death from tobacco, even if cessation of smoking occurs
in middle age Table 6.
While the rate at which young people start to smoke will be
a major determinant of ill-health and mortality in the second
half of this century, it is the extent to which current smokers
give up the habit that will determine the mortality in the
next few decades and which requires the urgent attention of
public health authorities throughout Europe.
Tobacco
smoke released to the environment by smokers, commonly referred
to as environmental tobacco smoke (ETS) and which may be said
to give rise to enforced 'passive smoking', has several deleterious
effects on people who inhale it. It causes a small increase
in the risk of lung cancer and also some increase in the risk
of heart disease and respiratory disease and is particularly
harmful to small children. Smoking during pregnancy increases
the risk of stillbirth, diminishes the infant's birth weight,
and impairs the child's subsequent mental and physical development
while smoking by either parent after the child's birth, increases
the child's risk of respiratory tract infection, severe asthma,
and sudden death.
Although
the greatest hazard is caused by cigarette smoking, cigars
can cause similar hazards if their smoke in inhaled and both
cigar and pipe smoker cause comparable hazards of cancers
of the oral cavity, pharynx, extrinsic larynx, and oesophagus.
Worldwide,
it is estimated that smoking killed four million people each
year: in the 1990s and that altogether some 60 million deaths
were caused by tobacco in the second half of the Twentieth
century. In most countries, the worst consequences of the
"Tobacco Epidemic" are yet to emerge, particularly
among women in developed countries and in the populations
of developing countries, as, by the time the young smokers
of today reach middle or old age, there will be approximately
ten million deaths each year from tobacco (three million in
the developed, seven million in the developing countries).
If the current prevalence of smoking persists, approximately
500 million of the world's population today can expect to
be killed by tobacco, 250 million in middle age.
The
situation in Europe is particularly worrying. The European
Union is the second largest producer of cigarettes (749 billion
in 1997/98) after China (1675 billion in 1998) and the major
exporter of cigarettes (400 billion). In Central and Eastern
Europe, there has been a major increase in the smoking habit.
Of the six World Health Organisation (WHO) regions, Europe
has the highest per capita consumption of manufactured cigarettes
and faces an immediate and major challenge in meeting the
WHO target for a minimum of 80% of the population to be non-smoking.
In 1990-1994 34% of men and 24% of women in the European Union
were regular smokers. In women the rates were reduced by the
low rates in southern Europe, but the rates there are rising
and seem set to continue to rise over the next decade. In
the age range 25-39 years the rates are higher (55% in men
and 40% in women) and this can be expected to have a profound
influence on the future incidence of the disease. It is particularly
disturbing that in many parts of Europe, the prevalence of
smoking remains high among General Practitioners, who should
set an exemplary lifestyle in terms of health. This should
be a target for immediate action.
It
has been shown that changes in cigarette consumption are affected
mainly at a sociological level rather than by actions targeted
at individuals (for example, individual smoking cessation
programmes). Actions such as advertising bans and increases
in the price of cigarettes influence cigarette sales particularly
among the young. A "Tobacco Policy" is, consequently
essential to reduce the health effects of tobacco, and experience
shows that this should be aimed at both stopping young people
from starting to smoke and helping smokers to stop. To be
efficient and successful, a tobacco policy has to be comprehensive
and maintained over a long time period. Increased taxes on
tobacco, total bans on direct and indirect advertising, smoke-free
enclosed public areas, prominent health warning labels on
tobacco products, a policy of low maximum tar levels in cigarettes,
education about the effects of smoking, encouragement of smoking
cessation, and health interventions at the individual level,
all need to be implemented. It must be recognized that nicotine
is an addictive drug and that some smokers who are heavily
addicted need medical help to overcome the addiction.
The
importance of adequate intervention is shown by the low lung
cancer rates in those Nordic countries which, since the early
1970's, have adopted integrated central and local policies
and programmes against smoking. In the UK, tobacco consumption
has declined by 46% since 1970 and lung cancer mortality among
men has been decreasing since 1980, although the rate still
remains high. In France, between 1993 and 1998, there has
been a 11% reduction in tobacco consumption due to the implementation
of anti-tobacco measures introduced by the Loi Evin.
The
first point of the European Code Against Cancer should consequently
be:
DO
NOT SMOKE. Smoking is the largest single cause of premature
death.
SMOKERS:
STOP AS QUICKLY AS POSSIBLE. In terms of health improvement,
stopping smoking before having cancer or some other serious
disease avoids most of the later excess risk of death from
tobacco even if smoking is stopped in middle age.
DO
NOT SMOKE IN THE PRESENCE OF NON-SMOKERS. The health consequences
of your smoking may affect the health of those around you.
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