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Lung Cancer Prevention Through Tobacco Control: Are We Having Any Impact?!

Geoffrey T. Fong!University of Waterloo!

Ontario Institute for Cancer Research!

Canadian Cancer Research Conference Community Forum !

Toronto—November 27, 2011

Lung Cancer in Canada

  Second highest incidence rate in Canada. In 2011: – 25,400 new cases of lung cancer

(14% of all cancer cases)

  It's a very deadly type of cancer. In 2011: – 20,600 people will die of lung cancer

(27% of all cancer deaths)

Smoking and Lung Cancer

  Smoking accounts for about 80-85% of lung cancer cases in Canada

  Smoking increases lung cancer rates by about 15 times

  About 16% of smokers will get lung cancer

Lung Cancer Trends and Smoking Trends

Delay between cause and effect: cigarettes, then lung cancer deaths

Cigarettes per adult per day

10

5

0 1900 1920 1940 1960 1980 2000 USA:

lung cancer

lung cancer

cigarette consumption +

Lung cancer deaths per million per year

0

500

1,000

0

500

1,000

10

5

0

lung cancer

lung cancer

cigarette consumption +

0

500

1,000

Clear Strategy for Reducing Lung Cancer

1. Primary prevention: prevent the cancer in the first place

2. Reduce smoking

Some Statistics on Global Tobacco Use

  1.1–1.3 billion people smoke –  82% live in low-and middle-income countries –  500 million will die of tobacco-related causes

  20th Century: 100 million tobacco-related deaths

  21st Century: 1 billion tobacco-related deaths

  6 million will die this year (5.3M users + 600K SHS)

  By 2025: 8 million will die/year

  WHO: Tobacco use is the leading preventable cause of death and disability in the world

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“Tobacco is the most effective agent of death ever developed and deployed on a worldwide scale.”

– John Seffrin, Past President, American Cancer Society and the

International Union Against Cancer

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“Tobacco use is unlike other threats to global health. Infectious diseases do not employ multinational public relations firms. There are no front groups to promote the spread of cholera. Mosquitoes have no lobbyists.”

– WHO Zeltner Report (2000)

Framework Convention on Tobacco Control (FCTC)

  First-ever health treaty

  Unanimously adopted in 2003

  174 nations have become Parties to the FCTC: one of the most rapidly progressing treaties in recent times.

  Conferences of the Parties: COP-1: Feb 2006 in Geneva COP-2: July 2007 in Bangkok COP-3: Nov 2008 in S. Africa COP-4: Nov 2010 in Uruguay COP-5: Nov 2012 in Seoul

Policies of the FCTC

Demand-side strategies   More prominent warning labels

  Elimination of “light/mild” and other deceptions

  Bans/restrictions on marketing (advertising, sponsorship)

  Smoke-free laws

  Higher taxes

  Support for cessation

  Education, communication, public awareness

Supply-side strategies   Reduce illicit trade

  Reduce youth access

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The International Tobacco Control Policy Evaluation Project (the ITC Project)

Canada United States Australia United Kingdom

Ireland Thailand Malaysia South Korea

China

France

New Zealand Mexico Uruguay

Netherlands Germany Bangladesh

India Bhutan Brazil Mauritius

The ITC Survey Research Team: Principal Investigators, Co-Investigators

Canada: Geoffrey Fong, Mary Thompson, David Hammond, Changbao Wu, Mark Zanna, Christian Boudreau, Steve Brown, Sharon Campbell, Paul McDonald, Emmanuel Guindon

United States: Michael Cummings, Andrew Hyland, Richard O’Connor, Gary Giovino, Frank Chaloupka, Jim Thrasher, Ernesto Sébrie, Mohammad Siahpush, Hana Ross, Maansi Travers, Fritz Laux

Australia: Ron Borland, Hua Yong, Lin Li, Melanie Wakefield, David Young United Kingdom: Ann McNeill, Gerard Hastings, Abraham Brown, Louise Hassan, Fiona Harris Ireland: Shane Allwright, Luke Clancy, Fenton Howell, Maurice Mulcahy Thailand: Buppha Sirirassamee, Warangkana Polprasert, Philip Guest, Steve Hamann,

Prakit Vateesatogkit, Aree Jampaklay, Aree Prohmmo, Chanya Sethaput Malaysia: Maizurah Omar, Rahmat Awang, Foong Kin, Ahmad Shalihin Mohd Samin New Zealand: Nick Wilson, George Thomson, Richard Edwards, Judy Li South Korea: Hong-Gwan Seo, Yoo-Seock Cheong, Seung-Kwon Myung, Yeol Kim China: Jiang Yuan, Li Qiang, Yang Yan, Feng Guoze, Xiao Lin France: Romain Guignard, Pierre Arwidson, François Beck, Jean-Louis Wilquin, Sylviane Ratte Germany: Martina Pötschke-Langer, Ute Mons Netherlands: Marc Willemsen, Gera Nagelhout, Bas van den Putte, Hein de Vries Mexico: Jim Thrasher, Edna Arillo Santillán, Eduardo Lazcano Ponce, Rosaura Pérez Hernández,

Luz Myriam Reynales, Victor Villabos Uruguay: Marcelo Boardo, Eduardo Bianco Brazil: Cristina Perez, Valeska Figuerido, Tania Cavalcante, André Szklo, Paula Johns, Eliane Volchan Bangladesh: Nigar Nargis, SM Ashiquzzaman, Ummul Ruthbah, Hussain Ghulum, Iftekharul Huq,

Abu S.M. Abdullah Bhutan: Sonam Phuntsho, Ugyen Norbu Mauritius: Premduth Burhoo, Bimla Moussa, Deowan Mohee, Véronique Le Clézio India: Prakash Gupta, Mangesh Pednekar

Key Objectives of the ITC Project

  To create and sustain an international research platform, using best practices in research and evaluation, for promoting evidence-based policies and other interventions for reducing tobacco use throughout the world

  To provide government policymakers, researchers, and other health stakeholders with evidence on effectiveness of current tobacco control policies

  To evaluate the impact of new tobacco control policies when they are introduced

  To build capacity (especially within LMICs) for research on tobacco control

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ITC Surveys are being conducted in: Over 50% of the world’s population Over 60% of the world’s smokers Over 70% of the world’s tobacco users

China

On the back of every pack in China, the warnings appear in English!

< 10% of adult smokers understood both English

warnings

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Smoking Prevalence in Restaurants in the 6 ITC cities in China compared to Other Countries Before and After Smoke-Free Laws: Ireland (04), Scotland (06), France (08), Germany (07-08), Netherlands (08), Mexico City (08), Mauritius (09)

0

20

40

60

80

100

% o

f B

ars

in

wh

ich

th

ere

wa

s A

NY

sm

ok

ing

•

84 •

IE Mar 04

2

59

SC Mar 06

0

71

2

FR Jan 08

83

NL Jul 08

5

86

29

DE 07- 08

•

•

MXC Apr 08

9

78

62

16

MU Mar 09

•

China 87-96%

• • • • • • • • • • •

% o

f Res

taur

ants

in w

hich

ther

e w

as A

NY

smok

ing

The Netherlands

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Dutch Health Minister:– Eliminating all information campaigns because "well-informed" people can make their own choices.

ITC report (Mar 2011):Dutch smokers are the leastknowledgeable and least concerned of all ITC countries about the harms of SHS.

Geoffrey Fong gives a speech in Xi’an China in April 2011 to the leading national group of tobacco control experts in China: “Things are bad in China, but at least they aren’t as bad as they are in the Netherlands.”

BMJ article—Apr 9, 2011

Canada

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Dec 9, 2010: Hearing held by the House of Commons Health Committee on the Govt’s decision to shelve the revision.

ITC Canada Survey data show that every indicator of label impact has declined

dramatically over the past 7 years

Dec 30, 2010: Health Minister reverses decision—the revision of the warnings will continue. New warnings will be introduced in 2012.

Sep 28, 2010: Health Canada announces that the ongoing initiative to revise the 10-year-old tobacco warnings is being shelved

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  Federal Tobacco Control Strategy (FTCS): from 2001 to March 31, 2012

  Very successful in reducing smoking rates from 24% in 2000 to 17% in 2010 (youth 15-19: 25% to 12%)

  But much more needs to be done – Target of 12% by 2011 has not been met – Low income (<15K): 34%;

First Nations: 59%; Nunavut: 54%

  The tobacco industry never sleeps; product is highly addictive and marketing efforts are still rampant.

Federal Tobacco Control Strategy in Canada

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  Higher taxation: contrary to popular belief, real prices have NOT increased in Canada in the past decade.

  Plain packaging: eliminate the powerful marketing on the pack itself

  Greater efforts toward reducing tobacco use in First Nations (including ensuring that their policies are eventually consistent with existing laws in Canada)

  Banning use of flavours in other tobacco products such as waterpipe, smokeless tobacco

Possibilities for the Future of Tobacco Control in Canada

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  Because of tobacco control, we have had a huge impact on preventing lung cancer.

  Tobacco use is the leading preventable cause of death and disease in Canada and the world.

  There are still about 4 million smokers in Canada

  When tobacco control relaxes, smoking rates go up.

  Tobacco control is extremely cost effective as well as effective in saving lives.

  It is time for Canada to make a renewed commitment to tobacco control.

Conclusions

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For more information

www.itcproject.org

Tobacco use in Canada The ITC Project

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ITC Project Research Support!

Core support provided by the U.S. National Cancer Institute

(P01 CA138389)

Additional core funding provided by the

Canadian Institutes of Health Research

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ITC Project Research Organizations!

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