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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
8
“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
9
“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
12 12
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
16 16
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
20
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
22
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
24
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
25 25
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
26
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
27
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
28
For more information
www.itcproject.org
Tobacco use in Canada The ITC Project
29
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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