Know it, to control it

Tobacco and lung cancer and India’s signature to the WHO tobacco control treaty

Cigarette smoking has reached epidemic proportions globally, and is the number one risk factor for lung cancer, associated with up to 90% of lung cancers. The smoke from tobacco and other tobacco products contain more than 7000 chemicals of which 70 are known carcinogens. As a person’s consumption of tobacco increases, the risk for cancer increases. This risk is also among people who breathe second-hand smoke that is smoke exhaled from a smoker. Studies have indicated that not only lung cancer, but also 30% of cancers in other parts of the body, including head and neck cancers, are as a result of the harmful effects of smoking. But tobacco use is one of the largest preventable causes of cancer.

Nicotine is a product of tobacco that promotes tumor formation and is associated with the upregulation of several genes that activate proteins that cause changes leading to cancer. Some authors suggest that the ischemia caused by the effects of smoking leads to angiogenesis facilitating tumor growth. These factors play a role in lung cancer and its spread. In addition, the effects of nicotine on human cells are so deleterious that it can adversely affect the benefits of radiotherapy and the chemotherapeutic agents used in the treatment of lung cancer.

Based on these alarming statistics and scientific research, the World Health Organization (WHO) put in place a control framework, the WHO Framework Convention on Tobacco Control (WHO FCTC). This encompasses a legally binding obligation “for reducing both demand and supply of tobacco products and providing a comprehensive direction for tobacco control policy at all levels” among all participating countries. These include monitoring of research, provision of smoke-free environments, smoking cessation initiatives, warning labels on tobacco products, media help for creating public awareness, ban on advertisements of tobacco products, and increasing prices and taxes on tobacco products.

Subsequently, WHO introduced MPOWER that provides assistance at country-level implementation of the above articles of the WHO FCTC

India joined this campaign and has taken legal recourse addressing the articles laid by the WHO FCTC. A recently published study on the implementation of tobacco control policies in India found that although MPOWER programs are accepted in India, there remains considerable room for improvement. The data analyzed from the WHO report on the Global Tobacco Epidemic Program, India for the years 2009, 2011, and 2013 using MPOWER concluded that the best results were achieved in 2013; as a result possibly due to the health warning issued on cigarette packages. However, as far as the cessation programs and taxation were concerned, a decline in the progress was observed.

In conclusion, it is evidenced that nicotine has tumor-promoting activities in lung cancer for its mutagenic properties. The potent mixture of nicotine and its metabolites can promote tumor progression through modulation of oncogenic signals in both cancerous and non-cancerous tissues. Cessation of cigarette smoke can provide prevention of lung cancer in smokers, and possibly on cancer prevention generally.