Tobacco and cancer risk statistics

Smoking is the single greatest avoidable risk factor for cancer; in the UK, it is the cause of more than a quarter (28%) of all deaths from cancer and has killed an estimated 6.5 million people over the last 50 years.2 A study published in December 2011 estimated that smoking causes nearly a fifth of all cancer cases in the UK.35

Worldwide, tobacco consumption caused an estimated 100 million deaths in the last century and if current trends continue it will kill 1,000 million in the 21st century.36 Around half of all regular smokers will die from the habit, half of these in middle age.1

• One in five British adults currently smokes
• Smoking causes around 87% of lung cancer deaths in men and around 83% of lung cancer deaths in women in the UK
• Smoking prevalence (any tobacco product) in British men was 30% in 2002 compared with 82% in 1948

Table 1.1 shows the strength of evidence for an increased risk of cancer due to tobacco consumption.

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section reviewed 01/06/05
section updated 01/05/12

Smoking causes around 87% of male and around 83% of female deaths from lung cancer in the UK.2 The estimate of lung cancer cases due to smoking in the UK is almost identical (87% of cases in men and 84% in women). This figure includes around 1,000 lung cancer cases due to exposure to environmental tobacco smoke in lifelong non-smokers.35 The link between lung cancer and cigarette smoking was first established in 1950, with a study showing a 26-fold increased risk of lung cancer among smokers of 15-24 cigarettes a day, compared with non-smokers.3 Recently, a 50-year follow-up study of smoking and lung cancer in British doctors showed a similar 25-fold increase in lung cancer risk in men smoking 25 cigarettes a day or more, compared to lifelong non-smokers.27

Lung cancer risk increases with both duration and intensity of smoking.4 (Figure 1.15)

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The effect of stopping smoking at any age on the excess risk of lung cancer is striking. Figure 1.2 shows the cumulative risk of lung cancer among men in the UK at age 75 according to age at which they stopped smoking.6

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The interaction between smoking and other harmful exposures can result in a much greater risk in people exposed to both. The risks of smoking and exposure to radon interact multiplicatively, and reanalysis of data from European case-control studies shows that most of the additional cases of lung cancer in people exposed to radon in the home are in smokers.7

Studies have shown that exposure to asbestos increases the risk of lung cancer by around ten-fold in non-smokers, while in smokers exposed to asbestos, there is a 100-fold increase in risk.8

Exposure to environmental tobacco smoke also causes lung cancer. The most recent meta-analyses show that exposure to ETS at work or in the home increases the risk of lung cancer among non-smokers by about a quarter, while heavy exposure at work doubles the risk.9,11 Exposure to ETS may also increase the risk of pharyngeal and laryngeal cancer.14 It has been estimated that exposure to ETS in the home causes around 11,000 deaths in the UK each year from lung cancer, stroke and heart disease combined.10

Male lung cancer incidence rates peaked in the early 1970s, reflecting the peak in smoking prevalence 20-30 years earlier. Rates in women have stabilised, after increasing throughout the 1970s and 1980s. Forecasting suggests that female lung cancer mortality rates will reach current male levels within the next ten years and then fall, while deaths will continue to fall in men.12

section reviewed 01/06/05
section updated 01/06/05

Most UK evidence on tobacco and cancer risk is based on smokers of manufactured filtered cigarettes. Risk is generally higher among smokers of filter-less cigarettes, high tar cigarettes, and black tobacco. Hand-rolled cigarettes have a stronger effect than manufactured cigarettes on risk of cancer of the oral cavity and pharynx.17,18 The proportion of male British smokers consuming self-rolled cigarettes increased to 37% in 2009 from 25% in 1998, and among women it increased from 8% to 21% over the same period.19

Pipe and cigar smokers have an increased risk of lung and upper aerodigestive tract cancer compared with non-smokers.4 A cohort study reported a seven-fold increase in risk of liver cancer in current cigar smokers and another study reported a three-fold increase in risk for current cigar or pipe smokers.20,21 Heavy pipe or cigar smoking also increases risk of bladder, bowel, stomach and pancreas cancers.4 The proportion of all men in Britain smoking cigars in 2009 was 2%, compared with 16% in 1978. Less than 1% of men in Britain smoke a pipe.19 

Long-term users of smokeless (chewing) tobacco have an increased risk for oral, pancreatic and oesophageal cancer. Much of the evidence for such an association comes from South East Asia, where betel quid is widely used. A recent review summarising the evidence about cancer and smokeless tobacco to date gave risk ratios for oral cancer in smokeless tobacco users in India and other Asian countries of about five, and in Sudan of about seven. The risk ratio for oral cancer in smokeless tobacco users in the USA and Canada was 2.6. Risk estimates of 1.6 and 1.8 were given for oesophageal and pancreatic cancer in Northern European smokeless tobacco users.22 In India, the risk of oral cancer is greatest in chewers of mixtures containing tobacco, but the risk in chewers of betel quid without tobacco is higher than non-users.23

While the use of smokeless tobacco is not widespread in the UK, it is relatively common among some South Asian communities (Figure 1.333). The prevalence of tobacco chewing increases with age, especially among Bangladeshi men and women. Betel quid (with and without tobacco) is the most commonly used product.25

Figure 1.3: Use of Smokeless Tobacco and Cigarette Smoking, UK South Asians, by Sex and Age, 2004

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section reviewed 01/06/05
section updated 01/02/09

While deaths from lung cancer account for around a 66% of smoking related cancer deaths in the UK,2 smoking is also an established risk factor for cancers of the oesophagus, larynx, pharynx, oral cavity, pancreas, bladder, nasal cavity and sinuses, stomach, liver, kidney, cervix and myeloid leukaemia.4 The International Agency for Research on Cancer in 2009 stated there is now sufficient evidence that smoking is also a cause of bowel cancer and ovarian (mucinous) cancer.14

After lung cancer, the upper aerodigestive tract cancers (larynx, oral and pharynx and oesophagus) have the highest smoking population attributable fractions (PAFs), of around 65% or higher.35

Also, alcohol consumption in combination with smoking greatly increases the risk of upper aerodigestive tract cancers (see section on alcohol).13

Smoking cessation reduces the risk for most of these cancers. The risk for cancers of the upper aerodigestive tract in ex-smokers becomes lower than that of a current smoker within five years, although risk is still higher than someone who has never smoked 20 or more years after stopping, and the risk for bladder cancer is also higher than in never-smokers 20 years after giving up.15-16,28

section reviewed 01/06/05
section updated 01/04/12

One in five British adults currently smokes. In 2010, as in 2008, the difference in smoking prevalence between men (21%) and women (20%) was not significant.37 The average consumption of cigarettes per smoker per day is 14 in men and 13 in women.19 The peak smoking prevalence is in younger adults, after which prevalence falls. Only 14% of British people over 60 years old smoke cigarettes. Almost 40% of regular smokers began smoking regularly before the age of 16.19

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As Figure 1.4 shows, smoking rates are higher in among manual workers compared with non-manual. Among managerial and professional workers in England, in 2009, smoking prevalence was 15%, compared with 28% of routine and manual workers.19 Geographical variations in smoking prevalence within the UK largely reflect these socioeconomic differences. Smoking rates in Scotland are higher than elsewhere in the UK with 25% of men and women smoking.19

The prevalence of smoking peaked in the late 1940s for British males at 82% and the 1970s for British females at 44%.26 The epidemic of smoking related cancers in the UK has peaked and recent years have seen record falls in death rates for smoking related diseases. (Figure 1.519)

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Currently in Britain, 28% of men and 22% of women are ex-smokers, and 63% of those who do smoke would like to quit.19

section reviewed 01/06/05
section updated 01/05/12