Steep rise in tobacco related cancer cases in Kerala’s capital: ICMR reports

Highlighting the need to step up tobacco control efforts, incidence of tobacco related cancer in Thiruvananthapuram district has shown an alarming increase of 220 per cent among males and 219 per cent among females over the six-year period from 2009-11 to 2012-14.

The number of cancer cases among men shot up sharply from 885 in 2009-11 to 2,835 in 2012-14, as per the latest publicly available Population Based Cancer Registries (PBCR) of the Indian Council of Medical Research.

An analysis of the registry reports reveals that the number of tobacco related cancers among females sharply went up from 272 cases in 2009-11 to 869 in 2012-14 in the district.

Significantly, tobacco related cancers among men are the third highest in a ranking of 27 population-based registries in the country covered by the 2012-14 report with 2835 cases. This is the highest after Delhi (4185 cases) and Ahmedabad Urban (3085 cases).

The PBCR Thiruvanathapuram was established in 2006 with the objectives of assessing the magnitude and pattern of cancer incidence and mortality rates as well as estimating relative survival of various cancers.

Lung cancers top the tobacco related cancers among males, according to the consolidated report of Hospital Based Cancer Registries maintained at Regional Cancer Centre (RCC) here.

Demonstrating an increasing trend over the years, the proportion of tobacco related lung cancers among males have risen from 28 per cent in 1999-2000 to 35.7 per cent in 2012-14. It was 29.5 per cent in 2001-03, 29.9 per cent in 2004-06; and 33.1 per cent in 2007-11.

Consistent with the knowledge that women in Kerala are more prone to using smokeless tobacco products, mouth cancer has the first place among tobacco related cancers in this gender.

Projections of the ‘PBCRs: 2012-2014’ on the number of cases and relative burden of cancer in the country show that tobacco related cancers would top the list of all cancers by 2020 with an estimated 523,471 cases accounting for 30 per cent of all cancers.

These reports are available at http://ncrpindia.org/Annual_Reports.aspx.

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One cigarette a day 'increases heart disease and stroke risk'

Smokers need to quit cigarettes rather than cut back on them to significantly lower their risk of heart disease and stroke, a large BMJ study suggests.

People who smoked even one cigarette a day were still about 50% more likely to develop heart disease and 30% more likely to have a stroke than people who had never smoked, researchers said.

They said it showed there was no safe level of smoking for such diseases.

But an expert said people who cut down were more likely to stop.

• Why young people are now less likely to smoke
• Quit smoking campaign backs e-cigs
• 'One smoke leads to daily habit for most'

'Stop completely'
Cardiovascular disease, not cancer, is the greatest mortality risk for smoking, causing about 48% of smoking-related premature deaths.

While the percentage of adults in the UK who smoked had been falling, the proportion of people who smoked one to five cigarettes a day had been rising steadily, researchers said.

Their analysis of 141 studies, published in the BMJ, indicates a 20-a-day habit would cause seven heart attacks or strokes in a group of 100 middle-aged people.

But if they drastically cut back to one a day it would still cause three heart attacks, the research suggests.

The researchers said men who smoked one cigarette a day had about a 48% higher risk of developing coronary heart disease and were 25% more likely to have a stroke than those who had never smoked.

For women, it was higher - 57% for heart disease and 31% for stroke.

Prof Allan Hackshaw at the UCL Cancer Institute at University College London, who led the study, told the BBC: "There's been a trend in quite a few countries for heavy smokers to cut down, thinking that's perfectly fine, which is the case for things like cancer.

"But for these two common disorders, which they're probably more likely to get than cancer, it's not the case. They've got to stop completely."

The researchers said it might be expected that smoking fewer cigarettes would reduce harm in a proportionate way as had been shown in some studies with lung cancer.

However, they found that men who smoked one cigarette per day had 46% of the excess risk of heart disease and 41% for stroke compared with those who smoked 20 cigarettes per day.

For women it was 31% of the excess risk of heart disease and 34% for stroke.

Prof Hackshaw said the increased risks of cardiovascular illness were over the course of a lifetime but damage could be done in just a few years of smoking.

But he said the good news was that those who quit smoking could also quickly reduce their risk of cardiovascular disease.

Cutting down not 'useless'
Paul Aveyard, professor of behavioural medicine at the University of Oxford, said the "well conducted" study confirmed what epidemiologists had suspected - that light smoking created a "substantial risk for heart disease and stroke".

But he said it was wrong to conclude cutting down smoking was useless.

"Those who try to cut down with the aid of nicotine, whether from nicotine replacement treatment or an e-cigarette, are more likely to stop eventually and thus really reduce their risks from smoking," he said.

Martin Dockrell, tobacco lead at Public Health England, said: "This study adds to the growing body of evidence which tells us that cutting down to just one cigarette a day still leaves a substantial risk of heart attack and stroke. The best and safest thing you can do is to quit completely for good."

Deborah Arnott, chief executive of health charity ASH, said: "It's addiction to nicotine that keeps people smoking but it's the tar in cigarette smoke that does the serious damage.

"Vaping is much less harmful, but only if you quit smoking altogether."

Simon Clark, director of the smokers' group Forest, said discouraging people from cutting down smoking could be "counter-productive".

Source: BBC

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Just 3 per cent of cigarette trade in India illicit: Study differs from industry claims

Industry estimates of the illegal cigarette trade in India could be vastly overrated, suggests a study published in BMJ Tobacco Control that found that less than 3% cigarettes sold in the market have travelled through illegal channels. Industry estimates, which come out routinely every time taxes on tobacco products are increased, put the figure at 20-25%.

The study collected 11,063 empty cigarette packs from 1,727 retailers across the country and found varying proportions of illicit products across the country. A cigarette pack was classified as illicit if it had a duty-free sign, no graphic health warnings, no textual health warnings or no mention of “price inclusive of all taxes” or similar text.

Empty packs generated by one day’s single-cigarette sales were collected directly from vendors in four large and four small cities covering the length and breadth of India. Ten areas were randomly selected in each city/town, and all shops selling cigarettes within 1 km of the central point were surveyed.

The study concluded: “Our estimate of the illicit cigarette market share of 2.73% casts serious doubt on the tobacco industry estimate of 20% and Euromonitor’s estimate of 21.3%.” The estimates varied substantially across locations, with the highest prevalence of illicit packs in the Mizoram capital of Aizawl (35.87%) near the Bangladesh and Myanmar borders. The share of illicit cigarettes was found to be much higher (13.77%) among the cheapest cigarette brands.

Conducted by researchers from the Centre for Public Policy Research, Kochi, and the School of Economics, University of Cape Town, the study is the first independent estimate of illicit cigarette trade in India. It is significant because raising tobacco taxes are a crucial public health intervention to reduce health effects of tobacco products and because every time this is done, the tobacco industry cries foul and presents its own estimates of illicit trade to highlight how much revenue the government is losing out on.

For example the Tobacco Institute of India, which describes itself as a “representative body of farmers, manufacturers, exporters and ancillaries of the cigarettes’ segment of the tobacco industry in India, whose members account for more than 98% of the country’s domestic sales of duty paid cigarettes”, puts the share of illicit cigarettes at a quarter of the market. “Illegal cigarette trade comprising international smuggled and locally manufactured tax-evaded cigarettes accounts for as much as 1/4th of the cigarette industry in India. Based on the current tax rates on cigarettes, it is estimated that the government loses Rs. 13,000 crore per annum on account of illegal cigarette trade,” states the TII handbook on illicit cigarette trade.

“Tobacco industry always makes tall claims about how huge the illicit tobacco problem in India is and they have been saying that it has been increasing over the years,” Dr Rijo John, senior fellow at the Centre for Public Policy Research, Kochi, and one of the authors of the study, told The Indian Express. “In several countries that claim has worked as a deterrent for the government in taxation. But in India there are no independent studies to validate those claims.”

The study also comes in the backdrop of a Karnataka High Court order that ruled that 40% and not 85% should be the size of the pack warnings. The Supreme Court, which later stayed the Karnataka High Court order, will hear the matter in the coming days.

Dr Pankaj Chaturvedi, oncologist at the Tata Memorial Hospital, Mumbai said: “This article published yesterday is a big blow to the falsehood being promoted by cigarette lobby regarding magnitude of illicit cigarette business in India. For decades they have misled policy makers with fabricated statistics to garner sympathy and derail efforts for higher taxation and pack warning. This proves that statistics forwarded by tobacco lobby should never be relied upon.”

Source: The Indian Express

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