National and Regional Fraction of Cancer Incidence and Death Attributable to Current Tobacco and Water-Pipe Smoking in the Eastern Mediterranean Countries in 2020

Abstract

INTRODUCTION We aimed to calculate the Population Attributable Fraction (PAF) of cancers due to tobacco use in the Eastern Mediterranean Region (EMRO), where water-pipe smoking is prevalent but its effect was not considered in previous studies. METHODS We applied Levin's formula to estimate PAFs of cancers due to tobacco use (defined as all type tobacco including both cigarette and water-pipe). We also calculated PAF of water-pipe smoking separately. Exposure prevalence data was retrieved from representative national and subnational surveys. Data on cancers incidence and death were also and cancer cases were obtained GLOBOCAN 2020. We also obtained associated relative risks from published meta-analyses. RESULTS Of the total 715,658 incident adult cancer cases that were reported in 2020 in EMRO, 14.6% (n = 104,800) was attributable to tobacco smoking [26.9% (n = 92,753) in men vs. 3.3% (n = 12,048) in women. Further, 1.0% of incident adult cancers were attributable to current water-pipe use (n = 6,825) (1.7% (n = 5,568) in men vs. 0.4% (n = 1,257 in women). CONCLUSION PAFs of cancers due to tobacco smoking in EMRO was higher in our study than previous reports. This could be due to the neglected role of water-pipe in previous studies that is a common tobacco smoking method in EMRO. The proportion of cancers attributable to water-pipe smoking in EMRO might be underestimated due to lack of research on the risk of cancers associated with water-pipe smoking and also less developed cancer registries in EMRO. IMPLICATION In this study, we found higher population attributable fractions (PAFs) for cancers due to tobacco smoking in the Eastern Mediterranean (EMR) region than previous reports. This difference could be due to ignoring the role of water-pipe smoking in previous studies. In 2020, 1% of incident cancers and 1.3% of cancer-related deaths in EMRO were attributable to water-pipe smoking. We also found a big difference in PAFs of cancers due to tobacco and water-pipe smoking across EMRO countries, with Tunisia, Lebanon, and Jordan having the highest, and Djibouti, Sudan and Somalia having the lowest proportions of cancers attributable to tobacco and water-pipe smoking.

Incident cancers attributable to using opium and smoking cigarettes in the Golestan cohort study

“…Using population-level data, we previously found that smoking tobacco contributes to 14% of incident cancers in the eastern Mediterranean region (26% in males, 3% in females). 29 In the current analysis, 8% of incident cancers were attributable to smoking cigarettes (12% in males, 2% in females). While the lower prevalence of smoking tobacco (particularly among females) in this region may explain the lower tobacco related PAFs in our study, using individual-level data that allowed obtaining PAFs that are adjusted for other confounders and risk factors may have also contributed to having lower estimates than other studies that used population-level data.…”

Waterpipe Use and Its Cardiovascular Effects: A Systematic Review and Meta-Analysis of Case-Control, Cross-Sectional, and Non-Randomized Studies

“…It is possible the CV effects resolve in most of the patients with cessation of WPS. Considering the other long-term complications, such as an increase in the incidence of cancer and death attributable to WPS, highlights the pressing need to encourage smoking cessation [56].…”

Population attributable proportion and number of cancer cases attributed to potentially modifiable risk factors in Iran in 2020

“…Further analyses at the sub‐national level to verify PAFs of opium use and waterpipe smoking in the high prevalence regions may highlight the importance of these risk factors in cancer prevention in Iran. A recent study investigated the attributable fraction of waterpipe use at the national and regional levels in the EMR 56 . As waterpipe and opium use prevalence is growing worldwide, such studies are recommended globally for both waterpipe and opium use.…”

“…A recent study investigated the attributable fraction of waterpipe use at the national and regional levels in the EMR. 56 As waterpipe and opium use prevalence is growing worldwide, such studies are recommended globally for both waterpipe and opium use.…”