‘Endgame’ youth cigarette sales ban could prevent 10,000 lung cancer deaths in SA over 70 years, UP researcher says

A University of Pretoria (UP) professor is part of a global team whose new research estimates that 10,000 lives could be saved in South Africa alone if the government implemented the “ultimate strategy” of banning the sale of cigarettes to people born between 2006 and 2010. – even when they grow up and become adults.

Professor Lekan Ayo-Yusuf, head of the School of Health Systems and Public Health (SHSPH) of the UP and director of the National Council against Smoking (NCAS), together with researchers from Spain, France, New Zealand, the USA, China and Brazil, set out to estimate the impact of smoking cessation on lung cancer mortality in people born between 2006 and 2010 in 185 countries.

Their first global simulation study of 650 million people predicts nearly three million lung cancer deaths among this group by 2095 if current smoking trends continue. Of these, around 1.8 million deaths are expected in men and around 1.1 million in women. However, the study found that 40% of these deaths, of more than 1.1 million people, could be prevented if a tobacco-free generation were achieved.

The team’s research paper, “Estimated impact of a tobacco-elimination strategy on lung-cancer mortality in 185 countries: A population-based birth-cohort simulation study,” was published in the well-known journal. The Lancet in October

South African prediction

“This is the first publication of the number of lung cancer deaths that can be prevented with an ‘end’ strategy,” Professor Ayo-Yusuf said. “In particular, when you look at Africa, the results show that, in the sub-Saharan Africa region, South Africa would have the most people saved from dying of lung cancer when these same children reach the age of 85 (between 2091) and 2095).

The analysis shows that about 12,000 lives could be saved in southern Africa and 48,000 in northern Africa, but when standardized for age and population size, southern Africa would have more lives saved: 5.5 people per 100,000 inhabitants, compared to 4.3 per 100,000 inhabitants in the north. Africa

Of the 12,000 lives that could be saved in southern Africa between now and 2095, 10,900 would be in South Africa, which has the highest daily smoking prevalence rate in sub-Saharan Africa.

“It is therefore an important political advocacy agenda to advance an end-to-end strategy in southern Africa, and particularly in South Africa,” Professor Ayo-Yusuf said. “However, such a policy position would also require addressing all of the political, social, and cultural dynamics that promote tobacco use, including tighter regulation of the tobacco industry’s activities, such as the industry’s efforts to pressure governments, directing young people to the promotion of tobacco and nicotine products, and their participation in the illicit trade.

Other global findings

The research results also suggest that, across the 185 countries and the research group of 650 million people, more lung cancer deaths could be prevented among men (846,000) than among women (342,000). Central and Eastern Europe had the highest predicted preventable deaths for men, while Western Europe led for women. Middle Africa showed the lowest potential impact, with only 2% of preventable deaths in men and 1% in women.

“The disparities in our results by sex were particularly large in Southern Africa, North Africa, East Asia, Southeast Asia and West Asia, where it was estimated that the proportion of lung cancer deaths prevented in male individuals was 20 percentage points higher than in female individuals,” the researchers wrote in their findings.

The study also highlighted income disparities, with high-income countries being able to prevent 61% of lung cancer deaths, compared to just 13% in low-income countries. The researchers cautioned that data from low-income regions were limited and should be interpreted with caution.

Research methodology

For this study, the researchers imagined a scenario in which tobacco sales were banned for people born between 2006 and 2010, and this ban was fully enforced until 2095. To predict how many lung cancer deaths could be prevented, they looked at lung cancer death rates for men and women of different age groups in countries with at least 15 years of data from the World Health Organization (WHO) mortality database ). For countries without these data, they used lung cancer cases from Cancer Incidence in Five Continents (CI5), a comprehensive resource that provides detailed cancer incidence data from cancer registries around the world.

The study estimated how many lung cancer deaths in this group could be prevented if smoking were eliminated. They did this by comparing death rates in people who had never smoked with expected death rates from lung cancer and applied that difference to the population. They then calculated the percentage of lung cancer deaths that could be prevented: population impact fractions (PIFs).

The results were also broken down by income levels, based on World Bank rankings, to see how a tobacco-free generation might affect different countries.

Read the full open access research paper on The Lancet website.