Covid 19, smoking and cancer: dangerous connections

An article published on August 16 in The Lancet Respiratory Medicine highlights a worrying increase in the number of incidences and deaths due to cancers of the trachea, bronchus, lung and larynx. In an editorial published in the same medical journal, researchers stress the need to fight more intensely against global tobacco use[1].

The article reports the latest global data on the incidence and mortality of cancers of the trachea, larynx, bronchus and lung between 1990 and 2009. Globally, there were 2.26 million new cases, 2.04 million deaths and 45.9 million years of disability-adjusted life expectancy (DALY), i.e. the number of healthy years lost.[2].

Disadvantaged categories and women on the front line

These figures have increased particularly among lower socio-economic groups and women, following the trajectory of global tobacco consumption patterns and levels. Unsurprisingly, tobacco use is the world's leading burden of disease[3], causing 76.2% of deaths from tracheal, bronchus and lung cancer in men, and 38.9% in women. Women are also particularly exposed to this category of cancers, particularly due to household air pollution and ambient particulate pollution. These risk factors have been ranked as the leading cause of disease burden in parts of Africa and Asia. However, the figures presented predate Covid-19, while it is now established that the pandemic has had a negative impact on the early diagnosis and treatment of cancers, such as lung cancer. Furthermore, research shows that lower socio-economic groups have been disproportionately affected in terms of risk of lung disease and access to health facilities.

Covid-19, smoking and the tobacco industry

As coronavirus infection and lung cancer share a number of symptoms (persistent cough, shortness of breath, etc.), the diagnosis of these cancers may have been further delayed. As The Lancet points out, the Covid-19 pandemic could have been seized as an opportunity to reduce smoking prevalence worldwide, through concerted awareness campaigns, better support and the use of digital technology. However, according to figures from Action on Smoking and Health, while the first months of the pandemic resulted in a drop in consumption in the UK, it appears to have increased during 2021.

Among the explanations for this increase, researchers put forward in particular the effects of stress, a feeling of boredom and isolation associated with periods of confinement. In addition, the controversy over the supposedly protective role of nicotine has contributed to sowing some confusion and weakening tobacco control policies. Finally, tobacco companies quickly saw the pandemic as a commercial opportunity, lobbying for their products to be considered "essential" and providing several countries with a high prevalence of smoking with protective equipment, asserting corporate social responsibility. These strategies have also contributed to delaying the adoption of essential anti-smoking measures, postponed due to the context of the pandemic and communication operations to improve their public image.

Responding to a global health emergency

Several health organisations have proposed strategies to address the current situation. The European Respiratory Society and 27 other organisations have thus appealed to the European Parliament's Special Committee on the fight against cancer. The aim is to enable a 20% increase in early diagnosis of lung cancer, to set up awareness campaigns, to promote European programmes and to link expertise together through multidisciplinary centres of excellence.

The cancer health situation is particularly problematic in Europe, with one million cases of cancer undiagnosed, 100 million screening tests not carried out, one in two people with symptoms not being hospitalised in an emergency, and one in five people not receiving the necessary treatment. As The Lancet suggests, the figures in low- and middle-income countries are likely to be worse.

The COVID-19 pandemic, in addition to increasing the global burden of respiratory cancers, has highlighted the magnitude of global health inequalities, which continue to grow today. According to the authors, the explosion of digital technologies could have been better leveraged by seeking to reach high-risk individuals and serving as a tool to combat global tobacco use.

FT

[1] The Lancet Respiratory Medicine, COVID-19, smoking, and cancer: a dangerous liaison, 08/16/2021, (accessed 09/01/2021)

[2] The Lancet Respiratory Medicine, Global, regional, and national burden of respiratory tract cancers and associated risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019, 08/16/2021, (accessed 09/01/2021)

[3] Mobilized by the World Health Organization, the burden of disease is a concept aimed at assessing the impact of health problems by quantifying the loss of healthy life in a population.