Estimation of cancer incidence and mortality attributable to smoking in China

Tobacco smoking, as a cause of cancer, is common in China. Few studies have been conducted to assess the burden of tobacco-related cancer in the Chinese population. We calculated the proportion of cancers attributable to tobacco smoking to estimate the burden of tobacco-related cancer. Population attributable fraction was calculated based on the assumption of total avoidance of smoking. Data on smoking prevalence were from two large-scale national surveys of representative samples of the Chinese population. Data on relative risk were derived from the meta-analyses and large-scale studies. Cancer mortality and incidence were originated from the third national death cause survey and cancer registries in China. We estimated that a total of 405,112 deaths of cancer were attributable to smoking in China in 2005, including 372,264 among men (32.7% of all cancer deaths) and 32,848 among women (5.0%). A total of 495,221 cancer cases were attributable to smoking, including 454,785 among men (30.0% of all cancer cases) and 40,436 among women (3.9%). Involuntary smoking was responsible for 11,507 lung cancer deaths (11.1%) among non-smoking women. Tobacco smoking is responsible for one-third of the total cancer deaths among men. Involuntary smoking is an important individual risk factor for lung cancer among non-smoking women. There is a need to continue and strengthen tobacco-control programs and initiatives to reduce smoking-related cancer burden in China.