29 July 2022
Special Edition - World Lung Cancer Day

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).

Lung cancer: the leading cause of death and most diagnosed cancer worldwide

  • 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 smoking: the main cause of lung cancer in Europe

  • 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.

Effective tobacco control measures to reduce tobacco use and lung cancer incidence

  • As the majority of lung cancer cases are attributable to tobacco smoking, the main priority is to reduce smoking prevalence through effective tobacco control policies and regulations.
  • The WHO FCTC MPOWER measures should be reinforced to raise awareness about the risks of tobacco products, support people who wish to quit smoking, prevent others from starting and reduce the incidence of smoking and the diseases that tobacco causes, such as lung cancer.
M: Monitoring is key to understanding the nature and extent of tobacco use and ensuring that the most appropriate and targeted policies to reduce it are developed and implemented to prevent cancer and tobacco-induced diseases.
P: Protect from secondhand smoke. Exposure to second-hand smoke at home or at work increases the risk for non-smokers of developing lung cancer by 20-30% [12]. Smoke-free public areas and banning smoking indoors and at workplaces can also act as an incentive for smokers to quit [13] and discourage never-smokers, particularly youth, from starting. Study showed that having a comprehensive smoke-free workplace reduced smoking prevalence by 10% [14].
O: Offer support services to help people quit smoking. Currently, only 26 countries offer comprehensive cessation programs (only 8 countries in the EU), including cost coverage to help people stop, accounting for only one person in three (32%) globally [13]. Moreover, quitting smoking before the age of 40 lowers tobacco-related death risks by tenfold compared to not quitting [15].
W: Health warning labels on tobacco packages have a demonstrated effectiveness in quitting and reduction of use. The number of individuals who benefited from large health warning labels (covering at least 50% of the front and back of the package) covered 101 countries consisting of 60% of the world's population (WHO). In the EU, there are currently 29 countries implemented large health warning labels, and 8 countries adopted plain packaging [13].
E: Enforce bans on tobacco advertising, promotion, and sponsorship (TAPS). Comprehensive bans on tobacco advertising and promotion, including social media and sponsorships or promotional activities, can be very effective in countering the tobacco industry's marketing tactics and reduce consumption by an estimated 7.4% in smoking and 5.4% in overall tobacco consumption [16].
R: Raise taxes. Increasing taxes on tobacco products has proven to be one of the more effective means to lower smoking incidence. Research in the EU showed a significant correlation between the increases in tobacco prices due to taxation and lung cancer death rates, with lung cancer deaths dropping rapidly by 50% within a decade of prices rising sharply [17].
  • Implementation of tobacco control policies at the highest level could prevent 21.2%, an estimated 1.65 million lung cancer cases in Europe, accounting for a reduction of 19.8% of lung cancer cases in men and 23.2% of lung cancer cases in women over the next two decades across European countries [18].
  • At the EU level, comprehensive regulatory tobacco control measures should be strengthened in line with the Tobacco Products Directive and the Tobacco Taxation Directive. With the emergence of novel tobacco products, extending taxation to novel tobacco products, tackling TAPS on the internet and social media, and a full ban on flavours should be deemed as priorities.

Ending the tobacco epidemic is a critical step for beating cancer in the European Union

  • The most effective approach to reducing lung cancer incidence and mortality is to strengthen prevention, notably through tobacco control policies and policies to reduce air pollution.
  • Europe as a region remains to have the highest prevalence of tobacco smoking among adults (≥ 15 years) in the world with an estimated 36% of men and 20% of women smoking tobacco in 2020 [13].
  • Lung cancer risks cannot be reduced by switching to less harmful products but can be dramatically reduced by tobacco cessation.
  • By eliminating tobacco use, nine out of every ten cases of lung cancer could be avoided [8].
All references for the above material are available in the full article on ensp.network.

Extension of the EU Council Recommendation on cancer screening to Lung Cancer

The European Commission is drawing attention to the issue of lung cancer including prevention, early diagnosis and treatment with a major focus on lung cancer screening. The European Health Commissioner recognises the importance of this step which will be tackled via the new European approach to cancer screening, a major initiative that will come from the Commission later this year. 
On the basis of the scientific advice looking into improving cancer screening across the EU, the European Commission came forward with a proposal to update the 2003 Council Recommendation on cancer screening by extending the current screening programmes to both lung and prostate cancer in 2022. 
“...But we must not forget the highest mortality in women and men is lung cancer. We will take this into account when we present our new European approach cancer screening â€“ a major initiative that will come from the Commission just after the summer. On the basis of the scientific advice we received, we consider that current screening programmes need to be extended to both lung and prostate cancer. â€ť
Commissioner Kyriakides at the Expert Meeting on Oncology - Modern Cancer Control: Saving Lives through Smart Solutions, 13 July 2022 ​

ENSP 2021 Brochure

"Ending tobacco epidemic, an essential step for beating cancer"

Tobacco rests a great risk factor for cancer, often still unknown and underestimated. Thus, every month in 2021, ENSP dedicated a section of "The Network" to a certain type of cancer and its link to tobacco. As we also commemorate World Cancer Awareness Day in November, ENSP dedicated a section on its platforms to share the latest data gathered related to lung cancer and tobacco use in the brochure "Ending tobacco epidemic, an essential step for beating cancer".

New ENSP Project

BREATHE - Breaking tobacco addiction for improved lung cancer

The project starts in 2022 and will address knowledge disparities in clinicians treating lung cancer patients who smoke across 6 European countries in appropriate evidence-based methods to address tobacco dependence, support patients to quit smoking during the care continuum, and become champions of integrated lung cancer care.
The project will utilize the extensive network of the European Network for Smoking and Tobacco Prevention (ENSP) and the previous investments and materials developed to further extend and promote the CME accredited - ENSP e-Learning platform.
Within this project, ENSP aims to develop an additional module on “Tobacco dependence treatment for Lung Cancer patients” and then adapt, translate, and deliver a user-friendly, accredited module to be added to the ENSP e-Learning training programme in advanced tobacco treatment in 6 countries throughout the World Health Organization (WHO) European Region (Spain, France, Denmark, Poland, Romania, Georgia).

This primary objective will be addressed through the below ten activities:


Activity 1: Develop an additional module on “Tobacco dependence treatment for Lung Cancer patients” for the existing training program on tobacco treatment we have curated as part of previous EPACTT Projects.

Activity 2:  Adapt and translate the module in 6 languages for the target countries.

Activity 3: Submit the new module for formal accreditation by the official European Accreditation Council for Continuing Medical Education (EACCME).

Activity 4: Recruit 20 HCPs working with lung cancer patients and their caregivers in each of the participating countries

Activity 5: Recruit and survey 20 patients/caregivers per HCP in each country before the intervention

Activity 6: Deliver the online tobacco treatment training through an interactive, user-friendly e-learning platform in the above languages.

Activity 7: Organize and conduct a booster online training session in each of the participating countries.

Activity 8: Recruit and survey 20 patients/caregivers per HCP in each country after the intervention.

Activity 9: Perform program evaluation to evaluate if target outcomes were reached.

Activity 10: Ongoing advocacy for evidence-based tobacco treatment services to be included in the lung cancer patient care continuum.

The Project is funded by the Charities Aid Foundation (CAF) and the Lung Ambition Alliance. More information will follow soon.

Other news and publications

Call for abstracts

International Conference on E-Cigarette: patterns of use and health impacts

The French National Cancer Institute (INCa), a public agency and a key player in the development of research in the fight against tobacco, is organising an " International scientific conference on E-Cigarette: patterns of uses and health impacts" on 5 and 6 December 2022 in Paris.
A call for abstracts is launched to give all researchers the opportunity to present and promote their research through a poster, an oral communication, or a symposium. The deadline for submission is 31 July 2022.
Innovative research is expected and encouraged, particularly in response to European issues and contexts, from a variety of disciplines: human and social sciences, epidemiology, public health, clinical and fundamental sciences. Ongoing research is also accepted.
This conference offers a very special time for sharing and disseminating knowledge on the latest and ongoing research data on E-Cigarette. Its objective is to contribute to the development of a network of international researchers. These exchanges will make it possible to identify the gaps and needs in E-cigarette research, particularly at the European level.

Now also indexed in PubMed Central. Learn more...

The latest publications in the TPC Journal:
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