Tobacco smoking is the largest single avoidable cause of premature death and the most important known carcinogen. Based on propor tions of cancers of lung, larynx, oral cavity and pharynx, oesophagus, pancreas, kidney, and bladder due to smoking, 15% (1.1 million new cases per year) of all cancer cases worldwide are attributed to smoking (25% of cases worldwide in men, 4% in women).

Recent cohort studies show that smoking for 30 years or more increases the risk of colon cancer, with about 25% of cases being attributable to smoking. In addition, passive smoking may account for a small proportion of the cancer burden. In men from developed countries, the tobacco burden has been estimated as 32% of all annual incident cases, whereas in those from developing countries, it has been estimated as 19%. In regions where men have smoked for several decades, 30-40% of all cancers are attributable to tobacco. In women from developed countries, 6% of all annual incident cases are accounted for by tobacco, in contrast with 2% in those from developing countries.

As a consequence of the massive rise in cigarette consumption over the last few decades in women and in developing countries, a substantial increase in the cancer burden is to be expected unless measures to control consumption are strengthened. Smoking cessation reduces the risk of cancer, but there has only been limited success in programmes promoting cessation.

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