The tobacco burden in the light of World Lung Cancer Day

Lung cancer is the second most common cancer and the leading cause of cancer deaths among men and women. With a major and direct impact on the population, World Lung Cancer Day is commemorated every year on the 1ˢᵗ of August. This period is dedicated to educating people in correctly understanding lung cancer risks as well as different treatments available. It is also the perfect time to emphasize the importance of effective ways of prevention through early screenings and tobacco cessation (as the main risk factor).

In 2020, there is an estimated 2.21 million new cases of lung cancer and 1.8 million deaths due to lung cancer worldwide [1]. In 2020, over 320,000 individuals in EU nations were newly diagnosed with lung cancer, (approximately 1 new case every minute) with over 257,000 deaths from Lung cancer [2]. Lung cancer is expected to remain the leading cause of cancer mortality in the EU which accounts for 25% of deaths in Europe [3] and one of the most diagnosed cancers accounting for 12.2% of all new cancer diagnoses in the EU in 2020 [4]. Incidence rates for lung cancer in Europe are still increasing, with incidence rates being highest in East Europe among males, and in West Europe among females [5]. Compared with other leading causes of cancer, lung cancer continues to be associated with relatively low survival after diagnosis. For patients diagnosed with lung cancer, the cumulative probability of surviving their cancer for at least five years was 13% (11.2% in males, 13.9% in females) on average across EU countries. Ranging from ≤10% in Croatia, Lithuania, and Bulgaria to ≤20% in Austria, Sweden, Iceland, and Switzerland [6].

Tobacco use is the main cause of lung cancer and the single greatest avoidable risk for cancer overall. Tobacco use causes about 63% (6 out of 10) of all lung cancer deaths in men and women globally [7]. Tobacco use contributes to greater than 85% (almost nine out of ten) of the occurrence of lung cancer in Europe [8] with an additional fraction caused by secondhand smoke exposure in non-smokers. In the EU, the lung cancer mortality rate attributable to tobacco smoking varies across regions and countries for nearly two-folds, ranging from the highest in Central Europe  (25.64/100,000), followed by Western Europe  (19.17/100,000) and Eastern Europe  (15.45/100,000) [7]. This highlights that tobacco prevention needs to be strengthened, especially in EU regions with high smoking prevalence and countries where the mortality rate of smoking smoking-induced lung cancer is high. Secondhand smoke, as well as environmental factors, particularly air pollution, are as well key risk factors for lung cancer. Lung cancer caused by secondhand tobacco smoke, it is estimated that 526,000 disability-adjusted life years (DALYs) and 24,000 deaths were attributable to secondhand tobacco exposure in non-smokers in the EU nations [9]. South-Eastern EU countries showed the highest burden of secondhand smoke, whereas northern EU countries showed the lowest burden [9]. Other risk factors for lung cancer include indoor air pollution caused by unventilated combustion of coal in the household for heating and cooking; outdoor air pollution; exposure to hazardous chemicals in some occupations [10]. Tobacco production and consumption-related waste also contribute largely to air and environmental pollution [11] related to the development of lung cancer.