Q&A: Christopher Wild on Global Tobacco Use

With lung cancer on the rise, IARC helps nations implement tobacco-control efforts

Based on current smoking patterns, says Christopher Wild, PhD, director of the Lyon, France–based International Agency for Research on Cancer (IARC), an arm of the World Health Organization (WHO), it is estimated that around one in five adults worldwide smokes cigarettes, about half of whom will die prematurely from cancer and other tobacco-related diseases.

In recognition of the substantial harm caused by tobacco use globally—currently 6 million deaths and a half trillion dollars in economic losses annually—the WHO Framework Convention on Tobacco Control (FCTC) went into effect in 2005. Parties to this treaty agreed to adopt and implement measures to control tobacco use, and 177 parties have signed on, covering over 85% of the world's population, Wild says. He recently spoke with Cancer Discovery about the FCTC, IARC, and their efforts to combat the deadly tobacco epidemic.

Given all that we know about the dangers of tobacco, why are smoking rates increasing globally?

That's a complex question. In some countries, such as Turkey, there's a tradition of smoking, typically amongst men. In addition, the uptake is really high in countries where cigarettes have been readily available, where the price is relatively low, and where the marketing has been strong. The tobacco industry is looking for new markets, so they have been promoting smoking in regions where rates are currently low, and promoting it among women.

How have countries responded to the growing problem?

Many countries made the decision to ratify and then implement the FCTC, the first international public health treaty negotiated through the WHO. To help them, the WHO introduced six practical, affordable, and achievable measures, called MPOWER, in 2008. MPOWER emphasizes educating people about the dangers of tobacco use and supporting people who want to quit. It also makes two other key points for success: setting bounds on tobacco advertising and raising taxes on tobacco. I think the strongest recommendation is continuing to increase tobacco taxes and overall pricing, because that makes tobacco products less affordable and increases national revenues, and some of this money can be put toward cessation programs.

Is there a country that has been particularly successful in launching a tobacco-control program?

Turkey took a multipronged approach supported by the Prime Minister, and it's now a model that other countries might follow. They emphasized the risks of smoking, worked to protect children and nonsmokers from secondhand smoke, and implemented cessation programs for smokers. They banned smoking in public places. They mandated that television companies had to have 90 minutes of programming per month, some during peak viewing hours, about stopping smoking. They also established a tobacco-control board, with broad membership, in every province. By 2012, smoking was down 13.4% compared to 2006.

Will an effort in one country work in another?

What works has been remarkably consistent: higher taxes, bans on advertising to promote the habit, and bans on tobacco use in public places and places of work. How those things are promoted within each country, the communications tools they use, may well differ, but those principles seem to be quite universally applicable. Each country doesn't have to reinvent the wheel.

Have the programs improved health?

Where cigarette consumption has fallen, as in North America and Europe, a dramatic reduction in lung cancer deaths has followed. It is a powerful message that implementing the FCTC not only affects tobacco consumption, but also reduces mortality rates.

What other initiatives is IARC working on?

We monitor the global cancer burden. We recently published GLOBOCAN 2012, which provides the best estimates available of cancer incidence, prevalence, and mortality for 28 cancers in 184 nations.

We're currently working to establish the International Lung Cancer Cohort Consortium, which includes 21 cohorts of patients and about 12,000 lung cancer cases. We're trying to see how lifestyle, genetics, and other factors modulate the lung cancer risk associated with smoking. For example, we're particularly interested in the role of B vitamins, which seem to be associated with a decreased risk of lung cancer among smokers.

We're also working in the International Lung Cancer Consortium, which is different from the Cohort Consortium. One of the tasks is pooling large genome-wide association studies, which have helped us identify new genetic susceptibility markers for different histologic types of lung cancer. We are also helping to coordinate the lung cancer component of the “GAME-ON” initiative from the National Cancer Institute, which will help identify individuals at high risk for lung cancer and aid in detection of the disease at a treatable stage.

It sounds like the emphasis is really on early detection and prevention.

I've worked in cancer research for three decades, and it's always been a struggle to promote the prevention agenda. But as we're learning how complex cancer is at the molecular level, and how difficult it is to treat even with targeted therapies, we're recognizing that treatment has to be complemented by prevention and early detection, particularly in resource-limited settings. Tobacco control has to be right at the top of that prevention agenda.

This article is part of the AACR's commemoration of the 50th anniversary of the Surgeon General's report Smoking and Health. Please visit http://www.aacr.org for information on additional AACR publications and activities related to the recognition of this milestone.