More stringent tobacco control policies in Europe could result in 1.65 million fewer lung cancer cases over 20 years, according to an international population-based modelling study reported in an upcoming edition of The Lancet Regional Health – Europe.
The assessment of the impact of increasing implementation of tobacco control policies in European countries on the future burden of lung cancer was produced by scientists from the International Agency for Research on Cancer (IARC) based in France and the German Cancer Research Centre, the University of Heidelberg and the University of Cologne.
Lung cancer is still the most frequently diagnosed cancer and the leading cause of cancer deaths worldwide. Tobacco smoking is the largest preventable cause of lung cancer and contributes to greater than 80% to the occurrence of this disease.
“Given the impact of population aging, the burden of lung cancer related to tobacco smoking is likely to increase in the coming decades,” says The Lancet report.
Despite recent declines in smoking prevalence, Europe continues to have the highest prevalence of tobacco smoking in the world among adults above 15 years, with an estimated 36% of men and 20% of women smoking tobacco in 2020.
The study calculates that one in four cases of lung cancer in Europe could be prevented with “improved and expanded implementation of evidence-based tobacco control policies at the most comprehensive level”, considerably reducing the cancer burden in the region.
Study details
Impact of tobacco control policies implementation on future lung cancer incidence in Europe: An international, population-based modeling study
Thomas Gredner, Ute Mons, Tobias Niedermaier, Hermann Brenner and Isabella Soerjomataram.
Affiliations: German Cancer Research Center (DKFZ) and National Center for Tumor Diseases in Heidelberg, Germany; University of Heidelberg; University of Cologne; and Section of Cancer Surveillance, International Agency for Research on Cancer in Lyon, France.
Published in The Lancet Regional Health – Europe, Volume 4, May 2021
Summary
Background
Despite recent trends in declining smoking rates, tobacco smoking remains the most preventable cause of cancer in Europe. We aimed to estimate numbers and proportions of future lung cancer cases that could be potentially prevented over a 20-year period if countries in Europe were to achieve a comprehensive implementation of tobacco control policies.
Methods
Historical data from population-based cancer incidence (or mortality) was used to predict sex-specific lung cancer incidence for 30 European countries up to 2037.
Hypothetical country-specific smoking prevalence that would be expected if countries would have achieved the highest-level implementation of tobacco control policies (defined by the maximum total score of the Tobacco Control Scale, TCS) was estimated by combining national prevalence data on current smoking and data on the status of implementation of key tobacco control policies.
Resulting numbers and proportions of potentially preventable lung cancer cases were estimated taking into account latency periods between changes in smoking prevalence and excess cancer risks.
Findings
In Europe, an estimated 1.65 million lung cancer cases (21·2%, 19·8% in men and 23·2% in women) could be prevented over a 20-year period with the highest-level implementation of tobacco control policies.
Large variation was seen in European regions and countries reflecting the current level of tobacco control, with the largest potential for prevention in Western Europe (24·5%), Southern Europe (23·1%) and Eastern Europe (22·5%), and the lowest but still substantial potential for further prevention in Northern Europe (12·5%).
In women, among whom lung cancer incidence is expected to increase, we estimated somewhat larger proportions of preventable lung cancer cases ranging from 9·9 to 33·9% as compared to men (8·6 to 28·5%). In the final year of study period (2037), these proportions even exceed 50% in women for some countries.
Interpretation
Improved and expanded implementation of evidence-based tobacco control policies at the most comprehensive level could reduce future lung cancer incidence considerably across Europe.
Funding
The study was funded by German Cancer Aid.
Research in context
Evidence before this study
Tobacco smoking is a major preventable contributor to cancer morbidity and premature mortality. Tobacco control policies have shown significant impact in reducing the prevalence of smoking, in particular those embedded in the World Health Organization Framework Convention on Tobacco Control.
Given the extended latency time to cancer occurrence, reductions in the number of cases are difficult to assign to specific prevention measures and tobacco control achievements therefore often remain unrecognised.
To identify studies on predicted impact of uptake of comprehensive tobacco control policies on lung cancer in Europe, we searched PubMed for English articles between 1 January 2010 and 30 September 2020 using the search terms (“Tobacco smoking policy” OR “Tobacco smoking control” OR “Tobacco control policy”) AND “Cancer”.
Previous studies from different countries have modelled the benefits of implementing specific tobacco control policies on the national future cancer burden and suggest that up to 25% of future lung cancer cases could be avoided with a set of country-specific tobacco control policies.
However, to our knowledge, no study has assessed the impact of a comprehensive tobacco control policies implementation on future lung cancer incidence across nations and regions in Europe.
Added value of this study
In this study, we estimated the impact of broadening the implementation of tobacco control polices on the future burden of lung cancer in Europe. We used long-term historical data from countries in Europe to provide a robust estimate of future cancer incidence if the current tobacco control practice and trends were to continue and compared this to a scenario where countries were to achieve the highest score of tobacco implementation.
Our modelling study provides an assessment of tobacco control on the burden of lung cancer in Europe taking into account the time needed for cancer risk to decline after stopping smoking.
Our findings provide a long-term view of the benefit of comprehensive implementation of tobacco control polices in Europe that could potentially prevent an estimated 1•65 million lung cancer cases over a 20-year period.
Despite recent declines in smoking prevalence and expected future declines in lung cancer rates, our findings suggest that strengthening tobacco control could reduce 9.9 to 33.9% of lung cancer cases in women and 8.6 to 28.5% in men across European countries.
Implications of all the available evidence
Our estimates provide an assessment of future tobacco policy impact based on the relation of current implementation and tobacco smoking prevalence in countries and illustrate the great potential of comprehensive implementation of tobacco control policies for 30 European countries separately and combined.
This information should be motivation for national and European-level policy makers to implement comprehensive tobacco control interventions including taxes, smoke-free legislation, public information campaigns, advertising bans, health warnings/standardised packaging and access to treatment.
Our model could be extended to other cancer types and regions to highlight the wide-ranging benefits of tobacco control policies implementation.
With none of the European countries currently being covered by a comprehensive tobacco control, more rigorous efforts in increasing the uptake of tobacco control policies are needed in the face of substantial challenges that can be expected given the still high prevalence of smoking and the effects of population aging.
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