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Smoking risks need to be highlighted in Asia

Tobacco consumption is the world’s leading cause of cancer. In most developed countries, smoking is responsible for up to 30% of all cancer cases and up to 90% of lung cancer cases. Each year, a staggering 440 000 people die in the US from tobacco use. Nearly one of every five deaths is related to smoking. Cigarettes kill more Americans than alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs use combined. Based on the American Cancer Society’s data collected from 1995 to 1999, the US Centers for Disease Control estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking. The US Environmental Protection Agency (EAP) has published a major assessment of the respiratory health risks of passive smoking, saying that exposure to environmental tobacco smoke – commonly known as second-hand smoke – is also responsible for approximately 3000 lung cancer deaths each year in non-smoking adults and cause the respiratory tract infection such as bronchitis and pneumonia in about 150 000 to 300 000 cases in infants and young children. The situation in the developing world is even worse, where smoking is actually increasing with each passing day. Data from the WHO shows that in the year 2000, there were about 70 million people in the world who died from smoking, and if this trend persists, this figure will be 220 million in 2025 and 520 million in 2050, with half of them in productive middle age losing 20– 25 years of life. In China, a total of 2.1 million cancer cases were estimated in the year 2000 (1.3 million in men and 0.8 million in women), with the most common sites being lung, stomach and liver in men and breast, lung and stomach in women. The total number of new cases was expected to increase by 14.6% by the year 2005. The rising rates of lung cancer incidence is the highest in both sexes with 27% in men and 38% in women. Each year, 1.2 million people die from tobacco use in China. It was estimated that there were a total of 497 908 cases of lung cancer in 2005. It is now the top priority for cancer prevention, early detection and treatment in China. In Asia, many other countries face a similar situation which really needs to be highlighted by the medical societies. Nevertheless, smoking is an acquired (learned) behavior and is also the most preventable cause of cancer. In the last decade, the battle against tobacco has been growing throughout the world, and more and more people have become aware of the risk of smoking and have therefore quitting smoking. In well developed countries, the effort made fighting against smoking has seen fruitful results. In the US the death rate of lung and bronchus cancer for males fell from 9 million in 1990 to less than 8 million in 2004, showing that control of the smoking behavior can decrease occurrence of cancer. As the WHO documents showed, halving tobacco consumption would prevent 20–30 million people from dying before 2025 and 170–180 million people from dying before 2050 from all tobacco-related diseases, including cancer. As there is such a great reward for mankind, why don’t we do it?! Recent research has demonstrated that smoking is reversely closely related to the mutations of epidermal growth factor receptor (EGFR) gene in patients with lung adenocarcinoma. The likelihood of EGFR mutations in exons 19 and 21 decreases as the number of pack-years of smoking increases. Mutations were less common in people who smoked for more than 15 packyears or who stopped smoking cigarettes less than 25 years ago. The presence of EGFR mutations has also been associated with the favorable treatment results of tyrosine kinase inhibitors especially in east Asian countries. Therefore, quitting smoking has special significance to Asian population.