Banning tobacco sales to youth could prevent 1.2 million lung cancer deaths

A simulation study published in The Lancet[1], which draws on historical data from 82 countries, suggests that banning the sale of tobacco products to people born between 2006 and 2010 could prevent nearly half of future lung cancer deaths in men and a third in women by 2095 worldwide.

For this population-based birth cohort simulation study, the authors proposed a scenario in which tobacco sales were banned for people born between January 1, 2006, and December 31, 2010, and in which this measure was perfectly enforced. The authors quantified the number of preventable lung cancer deaths in this birth cohort through 2095.

Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer death worldwide, accounting for approximately 1.8 million deaths per year. Smoking is the leading risk factor for lung cancer and, in 2019, was estimated to cause over 67% of lung cancer deaths worldwide.

More than a million lung cancer deaths prevented

The birth cohort comprised a total population of 650,525,800 individuals. Overall, the authors predicted that 2,951,400 lung cancer deaths could occur in the population born between 2006 and 2010 if lung cancer rates continue to follow the trends observed over the past 15 years. They estimated that 1,186,500 (40.2 %) of the 2,951,400 lung cancer deaths in individuals born between 2006 and 2010 could be prevented by 2095 if the tobacco sales ban to these individuals were implemented and properly enforced.

Among men, the greatest number of lung cancer deaths would be avoided in upper-middle-income countries (64.1%, or 541,100 out of 844,200 deaths). The effect of the measure on lung cancer mortality would be greatest in central and eastern Europe, where 74.3% of potential deaths (48,900 out of 65,800) could be avoided.

Among women, high-income countries would be particularly affected by the estimated reduction in the number of deaths (62%, or 212,300 deaths out of 342,400). Western Europe stands out in particular with 77.7 TP3T of deaths (56,200 out of 72,300) that could be avoided.

In France specifically, 45,200 potential deaths from lung cancer out of 58,400 (77%), in both sexes combined, could be avoided by 2095 if a ban on tobacco sales were fully implemented.

This new research accompanies another study published Wednesday, October 2 in The Lancet Public Health[2], which indicates that reducing the current global smoking prevalence to 5 % by 2050 would translate into an additional year of life expectancy for men and 0.2 years for women.

The authors caution, however, that the use of new tobacco and nicotine products was not considered in this study because the products have recently arrived on the market and their impact on lung cancer mortality is unclear. This could affect lung cancer incidence trends in their scenario.

A measure still too little considered throughout the world

One of the measures included in many tobacco control strategies is the Tobacco Free Generation, which would limit the sale and supply of tobacco to people born after a given year. New Zealand pioneered the Tobacco Free Generation strategy by proposing to ban the sale of tobacco to people born on or after 1 January 2009. The new New Zealand government, led by the tobacco industry-influenced Health Minister Casey Costello, reversed this strategy and repealed the measure. A similar situation in Malaysia, where the Health Minister had indicated in 2022 that he wanted to ban the sale of tobacco to young people born after 2007. The government, under pressure from tobacco companies, reversed the measure in 2023. The United Kingdom[3] on the other hand, is considering implementing such a sales ban for people born after 2009. The details of the new law should be published soon. At the local level, some cities have already implemented a sales ban, such as Balanga City (Philippines), and several cities (Brookline, Melrose, Wakefield, Stoneham, Malden, Reading and Winchester) in Massachusetts in the United States[4].

The authors, however, point out that implementing a tobacco-free generation policy can be considered in countries with strong tobacco control policies, where smoking prevalence is below 15%, or where prevalence has declined rapidly. This should be accompanied by other tobacco control measures, such as tax increases or reductions in the number of outlets, expansion of smoke-free areas, restrictions on advertising, effective aids for smokers, etc.

In low- and middle-income countries, where youth populations are growing rapidly, the effects of tobacco bans could be even greater. "Our modelling highlights the magnitude of the benefits for governments considering implementing ambitious plans to create a tobacco-free generation," said study author Julia Rey Brandariz of the University of Santiago de Compostela in Spain. "Not only would this save a huge number of lives, it could also significantly reduce the pressure on healthcare systems to treat and care for people with tobacco-related illness."

©Generation Without Tobacco

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[1] Estimated impact of a tobacco-elimination strategy on lung-cancer mortality in 185 countries: a population-based birth-cohort simulation study, Rey Brandariz, Julia et al. The Lancet Public Health, Volume 9, Issue 10, e745 - e754

[2] Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: a systematic analysis for the Global Burden of Disease Study 2021 Bryazka, Dana et al. The Lancet Public Health, Volume 9, Issue 10, e729 - e744

[3] Tobacco-free generation, UK: Labour reintroduces ban on tobacco sales to people born after 2009, published on July 27, 2024, consulted on October 3, 2024

[4] Tobacco-free generation, Two Massachusetts cities plan to ban tobacco and nicotine sales to people born after 2004, published September 24, 2024, accessed October 3, 2024