‘Endgame’ youth cigarette sale ban could prevent 10,000 lung cancer deaths in SA over 70 years – UP researcher

A University of Pretoria (UP) professor is part of a global team whose new research estimates that 10,000 lives could be saved in South Africa alone if the government were to implement the ‘endgame strategy’ of banning cigarette sales to people born between 2006 and 2010 – even when they get older and become adults.

Professor Lekan Ayo-Yusuf, head of UP’s School of Health Systems and Public Health (SHSPH) and director of the National Council Against Smoking (NCAS), along with researchers from Spain, France, New Zealand, the USA, China and Brazil, set out to estimate the impact of eliminating tobacco smoking on lung-cancer mortality in people born between 2006 and 2010 across 185 countries.

Their first-of-its-kind global simulation study of 650 million people predicts nearly three million lung cancer deaths among this group by 2095 if current smoking trends continue. Of these, around 1.8 million deaths are expected in men, and about 1.1 million in women. However, the study found that 40% of these deaths – of more than 1.1 million people – could be prevented if a tobacco-free generation were achieved.

The team’s research paper, ‘Estimated impact of a tobacco-elimination strategy on lung-cancer mortality in 185 countries: A population-based birth-cohort simulation study’, was published in the renowned journal The Lancet in October.

South African prediction

“This is the first ever publication of the number of lung cancer deaths that can be prevented from an 'endgame' strategy,” Prof Ayo-Yusuf said. “Notably, when zooming in on Africa, the results show that, in the sub-Saharan African region, South Africa would have the most people saved from dying of lung cancer by the time these same children reach the age of 85 years [between 2091 and 2095].”

The analysis shows that about 12,000 lives could be saved across southern Africa, and 48,000 in northern Africa, but when standardised for age and population size, southern Africa would have more lives saved – 5.5 people per 100,000 population, compared to 4.3 per 100,000 in northern Africa.

Of the 12,000 lives that could be saved in southern Africa between now and 2095, 10,900 would be in South Africa, which has the highest daily smoking prevalence rate in sub-Saharan Africa.

“It is thus an important policy advocacy agenda to advance an endgame strategy in southern Africa, and especially in South Africa,” Prof Ayo-Yusuf said. “However, such a policy position would require also dealing with all the political, social and cultural dynamics that promote tobacco use, including stricter regulation of the activities of the tobacco industry – such as industry efforts to lobby governments, target youths for promotion of tobacco and nicotine products, and their involvement in illicit trading.”

Other global findings

The research findings also suggest that, across the 185 countries and 650 million people research pool, more lung cancer deaths could be prevented among men (846,000) than women (342,000). Central and eastern Europe had the highest predicted preventable deaths in men, while western Europe led for women. Middle Africa showed the lowest potential impact, with only 2% of deaths preventable in men and 1% in women.

“The disparities in our results by sex were particularly important in southern Africa, northern Africa, eastern Asia, southeast Asia, and western Asia, where the proportion of prevented lung cancer deaths in male individuals was estimated to be 20 percentage points higher than in female individuals,” the researchers wrote in their findings.

The study also highlighted income disparities, with high-income countries potentially preventing 61% of lung cancer deaths, compared to just 13% in low-income countries. The researchers cautioned that data from low-income regions was limited and should be interpreted carefully.

Research methodology

For this study, the researchers imagined a scenario where tobacco sales were banned for people born between 2006 and 2010, and this ban was fully enforced until 2095. To predict how many lung cancer deaths could be prevented, they looked at lung cancer death rates for men and women across various age groups in countries with at least 15 years of data from the World Health Organisation (WHO) Mortality Database. For countries without this data, they used lung cancer cases from the Cancer Incidence in Five Continents (CI5), a comprehensive resource which provides detailed data on cancer incidence from cancer registries around the world.

The study estimated how many lung cancer deaths in this group could be avoided if smoking was eliminated. They did this by comparing death rates in people who never smoked with the expected lung cancer death rates, and applied this difference to the population. They then calculated the percentage of lung cancer deaths that could be prevented – the Population Impact Fractions (PIFs).

The results were also broken down by income levels, based on World Bank classifications, to see how a tobacco-free generation might impact different countries.

Read the full open-access research paper on The Lancet’s website.