Tobacco and cancer risk statistics
This page presents information tobacco smoking and cancer, including lung cancer, other cancers caused by smoking and types of tobacco.
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.
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
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
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 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
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
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)
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
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- Peto R. Smoking and death: the past 40 years and the next 40. BMJ 1994; 309(6959):937-9.
- Peto R, et al. Mortality from smoking in developed countries 1950-2005 (or later). March 2012.
- Doll R, Hill AB. Smoking and carcinoma of the lung. Preliminary report. British Medical Journal, 1950;739-48.
- International Agency for Research on Cancer, Tobacco smoking, in IARC monographs on the evaluation of the carcinogenic risk of chemicals to humans. 1986, IARC: Lyon. p. 127-35.
- Rylander R, Axelsson G, Andersson L, et al. Lung cancer, smoking and diet among Swedish men. Lung Cancer 1996; 14 Suppl 1:S75-83.
- Crispo A, Brennan P, Jöckel KH, et al. The cumulative risk of lung cancer among current, ex- and never-smokers in European men. Br J Cancer 2004; 91(7):1280-6.
- Darby S, Hill D, Auvinen A, et al. Radon in homes and risk of lung cancer: collaborative analysis of individual data from 13 European case-control studies. BMJ 2005; 330(7485):223.
- Lee PN. Relation between exposure to asbestos and smoking jointly and the risk of lung cancer. Occup Environ Med 2001; 58(3):145-53.
- Taylor R, Najafi F, Dobson A, et al. Meta-analysis of studies of passive smoking and lung cancer: effects of study type and continent. Int J Epidemiol 2007; 36(5):1048-59.
- Jamrozik K. Estimate of deaths attributable to passive smoking among UK adults: database analysis. BMJ 2005; 330(7495):812.
- Stayner L, Bena J, Sasco AJ, et al. Lung cancer risk and workplace exposure to environmental tobacco smoke. Am J Public Health 2007; 97(3):545-51.
- Scottish Executive Health Department, Cancer Scenarios: An aid to planning cancer services in Scotland in the next decade. 2001. The Scottish Executive: Edinburgh.
- International Agency for Research on Cancer, IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Tobacco smoke and involuntary smoking. Volume83 ed. Vol. 83. 2004, Lyon: IARC Press.
- Secretan B, Straif K, Baan R, et al. A review of human carcinogens--Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncol 2009; 10(11):1033-4.
- Brennan P, Bogillot O, Cordier S, et al. Cigarette smoking and bladder cancer in men: a pooled analysis of 11 case-control studies. Int J Cancer 2000; 86(2):289-94.
- Brennan P, Bogillot O, Greiser E, et al. The contribution of cigarette smoking to bladder cancer in women (pooled European data). Cancer Causes Control 2001; 12(5):411-7.
- De Stefani E, Boffetta P, Oreggia F, et al. Smoking patterns and cancer of the oral cavity and pharynx: a case-control study in Uruguay. Oral Oncol, 1998. 34(5): 340-6.
- De Stefani E, Oreggia F, Rivero S, et al. Hand-rolled cigarette smoking and risk of cancer of the mouth, pharynx, and larynx. Cancer 1992; 70(3):679-82.
- Office for National Statistics: General Lifestyle Survey: Smoking and drinking among adults, 2009. London: ONS; 2011.
- Carstensen JM, G Pershagen, Eklund G. Mortality in relation to cigarette and pipe smoking: 16 years' observation of 25,000 Swedish men. J Epidemiol Community Health 1987; 41(2):166-72.
- Hsing AW, McLaughlin JK, Hrubec Z, et al. Cigarette smoking and liver cancer among US veterans. Cancer Causes Control 1990; 1(3):217-21.
- Boffetta P, Hecht S, Gray N, et al. Smokeless tobacco and cancer Lancet Oncol 2008;9(7): 667-75.
- Balaram P, Sridhar H, Rajkumar T, et al. Oral cancer in southern India: the influence of smoking, drinking, paan-chewing and oral hygiene. Int J Cancer 2002; 98(3):440-5.
- Critchley JA, Unal B. Health effects associated with smokeless tobacco: a systematic review. Thorax 2003; 58(5):435-43.
- NHS Health and Social Care Information Centre. Health Survey for England 2004: Health of Ethnic Minority Groups- Main Report. NHS Health and Social Care Information Centre, Public Health Statistics, 2006.
- Cancer Research UK. CancerStats: Lung Cancer and Smoking - UK. Cancer Research UK: London; 2004.
- Doll R, Peto R, Boreham J, et al. Mortality from cancer in relation to smoking: 50 years observations on British doctors. Br J Cancer 2005; 92(3):426-9.
- Bosetti C, Gallus S, Peto R, et al. Tobacco Smoking, Smoking Cessation, and Cumulative Risk of Upper Aerodigestive Tract Cancers. Am J Epidemiol 2008; 167(4):468-73.
- Bosetti C, Gallus S, Peto R et al. Tobacco Smoking, Smoking Cessation, and Cumulative Risk of Upper Aerodigestive Tract Cancers. Am J Epidemiol 2008; 167(4):468-73.
- Bjerregaard BK, Raaschou-Nielsen O, Sørensen M, et al. Tobacco smoke and bladder cancer-in the European prospective investigation into cancer and nutrition. Int J Cancer 2006; 119(10):2412-6.
- Jiang X, Yuan JM, Skipper PL, et al. Environmental tobacco smoke and bladder cancer risk in never smokers of Los Angeles County. Cancer Res 2007; 67(15):7540-5.
- Lee YC, Boffetta P, Sturgis EM, et al. Involuntary smoking and head and neck cancer risk: ooled analysis in the international head and neck cancer epidemiology consortium. Cancer Epidemiol Biomarkers Prev 2008; 17(8):1974-81.
- NHS Health and Social Care Information Centre. Health Survey for England 2004: The Health of Minority Ethnic Groups - headline tables. NHS Health and Social Care Information Centre, Public Health Statistics, 2006.
- Doll R, Fau PJ. Epidemiology of Cancer. In: Warrell D, Cox T, Firth J, Benz E, eds. Oxford Textbook of Medicine. 4th ed: OUP; 2003.
- Parkin DM. Tobacco-attributable cancer burden in the UK in 2010. Br J Cancer 2011; 105(S2):S6-S13.
- World Health Organisation (2011). Factsheet Number 339. Tobacco. World Health Organisation: Geneva. Accessed April 2012.
- Office for National Statistics General lifestyle survey 2010. Reference tables. Office for National Statistics: London. Accessed April 2012.