Sharma Rajesh, Rakshit Bijoy
Humanities and Social Sciences, National Institute of Technology Kurukshetra, Kurukshetra, India.
Economics and Business Environment, Indian Institute of Management Jammu, Jammu and Kashmir, India.
EPMA J. 2022 Dec 15;14(1):167-182. doi: 10.1007/s13167-022-00308-y. eCollection 2023 Mar.
Identifying risk factors for cancer initiation and progression is the cornerstone of the preventive approach to cancer management and control (EPMA J. 4(1):6, 2013). Tobacco smoking is a well-recognized risk factor for initiation and spread of several cancers. The predictive, preventive, and personalized medicine (PPPM) approach to cancer management and control focuses on smoking cessation as an essential cancer prevention strategy. Towards this end, this study examines the temporal patterns of cancer burden due to tobacco smoking in the last three decades at global, regional, and national levels.
The data pertaining to the burden of 16 cancers attributable to tobacco smoking at global, regional, and national levels were procured from the Global Burden of Disease 2019 Study. Two main indicators, deaths and disability-adjusted life years (DALYs), were used to describe the burden of cancers attributable to tobacco smoking. The socio-economic development of countries was measured using the socio-demographic index (SDI).
Globally, deaths due to neoplasms caused by tobacco smoking increased from 1.5 million in 1990 to 2.5 million in 2019, whereas the age-standardized mortality rate (ASMR) decreased from 39.8/100,000 to 30.6/100,000 and the age-standardized DALY rate (ASDALR) decreased from 948.9/100,000 to 677.3/100,000 between 1990 and 2019. Males accounted for approximately 80% of global deaths and DALYs in 2019. Populous regions of Asia and a few regions of Europe account for the largest absolute burden, whereas countries in Europe and America have the highest age-standardized rates of cancers due to tobacco smoking. In 8 out of 21 regions, there were more than 100,000 deaths due to cancers attributable to tobacco smoking led by East Asia, followed by Western Europe in 2019. The regions of Sub-Saharan Africa (except southern region) had one of the lowest absolute counts of deaths, DALYs, and age-standardized rates. In 2019, tracheal, bronchus, and lung (TBL), esophageal, stomach, colorectal, and pancreatic cancer were the top 5 neoplasms attributable to tobacco smoking, with different burdens in regions as per their development status. The ASMR and ASDALR of neoplasms due to tobacco smoking were positively correlated with SDI, with pairwise correlation coefficient of 0.55 and 0.52, respectively.
As a preventive tool, tobacco smoking cessation has the biggest potential among all risk factors for preventing millions of cancer deaths every year. Cancer burden due to tobacco smoking is found to be higher in males and is positively associated with socio-economic development of countries. As tobacco smoking begins mostly at younger ages and the epidemic is unfolding in several parts of the world, more accelerated efforts are required towards tobacco cessation and preventing youth from entering this addiction. The PPPM approach to medicine suggests that not only personalized and precision medicine must be provided to cancer patients afflicted by tobacco smoking but personalized and targeted preventive solutions must be provided to prevent initiation and progression of smoking.
The online version contains supplementary material available at 10.1007/s13167-022-00308-y.
识别癌症发生和进展的风险因素是癌症管理与控制预防方法的基石（《欧洲精准医学杂志》，2013年，第4卷第1期，第6页）。吸烟是几种癌症发生和扩散的公认风险因素。癌症管理与控制的预测、预防和个性化医疗（PPPM）方法将戒烟作为一项重要的癌症预防策略。为此，本研究在全球、区域和国家层面考察了过去三十年吸烟导致的癌症负担的时间模式。
从《2019年全球疾病负担研究》中获取了全球、区域和国家层面与16种吸烟所致癌症负担相关的数据。使用两个主要指标，即死亡人数和伤残调整生命年（DALYs）来描述吸烟所致癌症的负担。使用社会人口指数（SDI）衡量各国的社会经济发展情况。
在全球范围内，吸烟所致肿瘤死亡人数从1990年的150万增加到2019年的250万，而年龄标准化死亡率（ASMR）从1990年的39.8/10万降至2019年的30.6/10万，年龄标准化伤残调整生命年率（ASDALR）从948.9/10万降至677.3/10万。2019年，男性约占全球死亡人数和伤残调整生命年的80%。亚洲人口众多的地区和欧洲的一些地区负担的绝对数量最大，而欧洲和美洲国家吸烟所致癌症的年龄标准化率最高。在21个地区中的8个地区，2019年因吸烟所致癌症死亡人数超过10万，其中东亚居首，其次是西欧。撒哈拉以南非洲地区（南部地区除外）的死亡人数、伤残调整生命年和年龄标准化率的绝对数量是最低的之一。2019年，气管、支气管和肺癌（TBL）、食管癌、胃癌、结直肠癌和胰腺癌是吸烟所致的前5种肿瘤，根据各地区的发展状况，其负担情况有所不同。吸烟所致肿瘤的年龄标准化死亡率和年龄标准化伤残调整生命年率与社会人口指数呈正相关，成对相关系数分别为0.55和0.52。
作为一种预防手段，戒烟在所有风险因素中具有最大潜力，每年可预防数百万癌症死亡。吸烟所致癌症负担在男性中更高，且与各国的社会经济发展呈正相关。由于吸烟大多始于年轻时，且这种流行在世界多个地区仍在发展，因此需要加快努力戒烟，并防止年轻人染上这种瘾。PPPM医学方法表明，不仅要为受吸烟影响的癌症患者提供个性化和精准医疗，还必须提供个性化和有针对性的预防解决方案，以防止吸烟的发生和进展。
网络版包含可在10.1007/s13167-022-00308-y获取的补充材料。
