On World No Tobacco Day The Ubiquitous Hookah Comes Under Attack (NEWS BRIEF)

A Hookah lounge in the UK(HN, May 31, 2011) -- On World No Tobacco Day the World Health Organization (WHO) once again warns smokers and others of the dangers of smoking. While the dangerous habit is declining it is still the leading preventable cause of death.

This year, WHO says more than 5 million people will die from a tobacco-related heart attack, stroke, cancer, lung ailment or other disease. That does not include the more than 600,000 people – more than a quarter of them children – who will die from exposure to second-hand smoke.

Now with use of the so-called Hookah, or water-pipe (also known as "shisha" and "narghile"), proliferating globally - including in the United States - WHO is taking a tough stand on the exotic habit - saying it is no less safe than ordinary smoking.

That the practice is seen to be safe is an "unsubstantiated belief" and reinforced by misleading marketing, WHO says. In an advisory note, the Geneva-based organization says that the label of a popular water-pipe tobacco brand sold in South-West Asia and North America claims 0.5% nicotine and zero percent tar.

The New York Times reports today that many US campuses, where Hookah smoking is becoming extremely popular among college students, are banning the practice all together because of health concerns. Several municipalities are following suit. The habit is also popular among young people in Brazil and European countries.

Hookah pipes and accessories are now easily available online and there is no lack of on-line forums celebrating the practice, such as the Hookah Forum.

Hookah smoking is especially popular in US cities with large numbers of immigrants from the Middle East. The aromatic smoke, filtered through a water bowl, seems to lull users into thinking that the health effects are minimal.

But WHO says that, because the inhaled air passes over not just the tobacco but heated charcoal as well, that users are inhaling very harmful charcoal combustion products.

"Contrary to ancient lore and popular belief, the smoke that emerges from a water-pipe contains numerous toxicants known to cause lung cancer, heart disease and other disease," WHO says. It adds that because the tobacco products contain nicotine it can cause addiction.

Alarmingly, WHO calculates that because a typical Hookah session can last up to more than one hour and include as many as 200 puffs, the water-pipe smoker may therefore inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 cigarettes or more."

WHO says that in South-West Asia and North Africa, it is not uncommon for children to smoke with their parents.

Globally, the highest rates of water-pipe smoking are in North Africa, the Eastern Mediterranean region and South-East Asia, WHO says. Most street cafes in Cairo offer water-pipes, alongside cups of strong coffee, and the practice often replaces alcohol in bars and cafes during the holy month of Ramadan in such cities as Amman, Jordan.

The annual death toll from the global epidemic of tobacco use could rise to 8 million by 2030. Having killed 100 million people during the 20th century, tobacco use could kill 1 billion during the 21st century, WHO said.

- HUMNEWS staff

Cancer in Africa is 'Like a Runaway Train'

Of the 16 million new cases of cancer that are predicted to occur annually by the year 2020, the majority (70%) will be in developing countries.

A "call to action" to address cancer in developing nations was proposed last year by experts writing in the Lancet (2010;376:1186-1193), and the problem has been highlighted in the run-up to today's World Cancer Day.

Among the developing world, African countries are the least able to cope, according to Afrox, the Africa Oxford Cancer Foundation, a registered charity based in the United Kingdom.

"Lack of resources and basic infrastructure mean that most Africans have no access to cancer screening, early diagnosis, treatment, or palliative care. Consequently, a diagnosis of cancer leads, in most cases, to a painful and distressing death," AfrOx reports.

The rising incidence of cancer in Africa is like a runaway train.

"The rising incidence of cancer in Africa is like a runaway train coming down the track," said Alan Milburn, chair of AfrOx, and former British Secretary of State for Health.

"The global community must act now to prevent the situation from deteriorating," he said in a statement. "One third of cancers affecting people in the developing world are potentially preventable and another third treatable if detected early."

Highlighted in Latest Global Report

The problem of cancer in Africa is highlighted in a special section of a new report being publicized by the American Cancer Society: Global Cancer Facts & Figures . It is also emphasized in a report of global cancer statistics published online February 4 in CA: A Cancer Journal for Clinicians.

In Africa, the incidence of cancer is increasing, but it remains a low public health priority because resources are limited and there are other pressing medical problems, such as AIDS/HIV infection, malaria, and tuberculosis.

The International Agency for Research on Cancer estimates that there were 681,000 new cancer cases and 512,400 cancer deaths in Africa in 2008. These numbers are projected to nearly double by 2030 because of the aging and growth of the population; this rise might be even sharper, the report warns, because unhealthy behaviors and lifestyles associated with economic development and urbanization, including smoking, unhealthy diet, and physical inactivity, are increasingly being adopted.

The most dominant cancers in Africa relate to infectious agents (cervical, liver, Kaposi's sarcoma, urinary bladder). In 2008, cervical cancer accounted for 21% of all new cancer diagnoses in women, and liver cancer accounted for 11% of all new cancers in men.

Another issue is that most cancers diagnosed in Africa are at an advanced stage of the disease, the American Cancer Society notes in a commentary on the report. This is due to a lack of screening and early detection services, but there is also a limited awareness of the early signs and symptoms of cancers among the public and healthcare providers. In addition, there is a stigma associated with a diagnosis of cancer in most parts of Africa.

Survival after a diagnosis of cancer is much worse in the developing world than in the developed world, especially for cancers that can be detected by screening. For example, the 5-year survival rate for breast cancer in Gambia,

Uganda, and Algeria is less than 50%, in contrast to the 90% seen in the United States.

AfrOx Working With ESMO

AfrOx is working with the European Society for Medical Oncology (ESMO) to "galvanize the global community" into doing something about this problem.

ESMO president David Kerr, MD, professor of cancer medicine at the University of Oxford, United Kingdom, was one of the founders of AfrOx in 2007.

A series of cancer prevention and awareness posters designed for use in Africa has been developed in collaboration with the ESMO Developing Countries Task Force. These posters aim to demonstrate how simple lifestyle changes can greatly reduce the likelihood of developing many cancers, and highlight, among other things, smoking cessation, daily exercise, healthy diet, and the importance of hepatitis B vaccination in preventing liver cancer.

The posters have already been launched in Ghana, where several other projects have begun, all in collaboration with the Ghanaian Ministry of Health.

The initial focus is in Ghana, AfrOx explains, because of its historic ties with Britain, its record of good governance, and the commitment of local policy makers and clinicians to control cancer.

Ghana has a population of 23 million, and the most common cancers are liver, prostate, breast, and cervical. However, there are only 2 oncology centers (in Accra and Kumasi), only 4 oncologists, and no specialist cancer nurses.

"The long-term aim is to establish a framework in which Ghana could potentially serve as a regional hub for supporting the development of cancer services in neighboring countries in West Africa," AfrOx reports.

One focus is improving the treatment of childhood cancers, focusing in particular on Burkitt's lymphoma (which accounts for 50% tumors), Wilms' tumor, and retinoblastoma. All of these can be treated successfully at an affordable cost, the Foundation notes, but cure rates for childhood cancer are currently only around 5% in Africa, compared with 75% to 80% in the United Kingdom.

One of the projects involves a 5-year twinning program between a British hospital and the pediatric cancer unit at the Korle-Bu Teaching Hospital in Accra. Korle-Bu sees about 90 to120 new childhood cancer cases each year, and has access to good surgical and radiotherapy facilities, but there are major problems with understaffing and inadequate diagnostic capacity. Another problem is that the costs of drugs, blood products, and investigations are borne by the parents. AfrOx aims to set up "long-term sustainability funding" for this center, and hopes that it will be used as a template for developing other cancers centers in the region.

Other Projects in Africa

Other organizations also have ongoing projects to improve cancer care in Africa, as previously reported by Medscape Medical News.

In Malawi and Rwanda, Partners in Health, a nonprofit healthcare organization based in Boston, Massachusetts, is working with national ministries of health to operate health centers and hospitals in rural undeserved areas. That organization was cofounded by Paul Farmer, MD, PhD, chair of the Department of Global Health and Social Medicine, Harvard Medical School, in Boston, and Harvard-based facilities have provided support and training for local physicians and nurses. Even in the absence of oncologists, these trained healthcare personnel have begun to treat a variety of cancers that generally respond well to therapy, including breast, cervical, rectal, squamous head and neck cancer, Hodgkin's and non-Hodgkin's lymphoma, and Kaposi's sarcoma.

One success story in Africa has been the improvement already seen in some areas in the treatment of Burkitt's lymphoma, the most common childhood cancer found in Equatorial Africa. Much of that achievement is credited to Ian Magrath, MB, BS, president of the International Network for Cancer Treatment and Research, who has worked in Africa for decades.

In a recent article in Cancer World, Dr. Magrath reflects on some of the lessons he has learned from that experience. The obstacles to good cancer care in resource-poor countries are completely different than those in wealthier nations, he points out, and emphasizes the necessity of understanding local resource limitations. "You have to be prepared to train and educate the professional staff — select a disease or discipline, and 1 or more centers, and try to develop those into centers of excellence or reference centers," he says.

These centers then become resources in their own countries, and serve as training facilities and improve access to diagnosis, treatment, and palliative care in other countries, he notes.

-        Reprinted from Zosia Chustecka, Medscape, and CA Cancer J Clin. Published online February 4, 2011.

World Cancer Day, 2011. What you need to know.

What is it?

Cancers are caused by a series of mutations. Each mutation alters the behavior of the cell somewhat. (Credit: Wikipedia)Cancer is the uncontrolled growth and spread of cells. It can affect almost any part of the body. Other terms used are malignant tumours and neoplasm’s.  One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs.  The growths often invade surrounding tissue and can metastasize to distant sites. Metastases are the major cause of death from cancer. Cancer prevention is an essential component of all cancer control plans because about 40% of all cancer deaths can be prevented.  Many cancers can be prevented by avoiding exposure to common risk factors, such as tobacco smoke. In addition, a significant proportion of cancers can be cured, by surgery, radiotherapy or chemotherapy, especially if they are detected early. 

Q: Are the number of cancer cases increasing or decreasing in the world?

A: Cancer is a leading cause of death worldwide and the total number of cases globally is increasing.

The number of global cancer deaths is projected to increase 45% from 2007 to 2030 (from 7.9 million to 11.5 million deaths), influenced in part by an increasing and aging global population. The estimated rise takes into account expected slight declines in death rates for some cancers in high resource countries. New cases of cancer in the same period are estimated to jump from 11.3 million in 2007 to 15.5 million in 2030.

In most developed countries, cancer is the second largest cause of death after cardiovascular disease, and epidemiological evidence points to this trend emerging in the less developed world. This is particularly true in countries in "transition" or middle-income countries, such as in South America and Asia. Already more than half of all cancer cases occur in developing countries.

Lung cancer kills more people than any other cancer - a trend that is expected to continue until 2030, unless efforts for global tobacco control are greatly intensified. Some cancers are more common in developed countries: prostate, breast and colon. Liver, stomach and cervical cancer are more common in developing countries.

A number of common risk factors have been linked to the development of cancer: an unhealthy lifestyle (including tobacco and alcohol use, inadequate diet, physical inactivity), and exposure to occupational (e.g. asbestos) or environmental carcinogens, (e.g. indoor air pollution), radiation (e.g. ultraviolet and ionizing radiation), and some infections (such as hepatitis B or human papilloma virus infection).

Key risk factors for cancer that can be avoided are:

• tobacco use - responsible for 1.8 million cancer deaths per year (60% of these deaths occur in low- and middle-income countries);
• being overweight, obese or physically inactive - together responsible for 274 000 cancer deaths per year;
• harmful alcohol use - responsible for 351,000 cancer deaths per year;
• sexually transmitted human papilloma virus (HPV) infection - responsible for 235 000 cancer deaths per year; and
• occupational carcinogens - responsible for at least 152,000 cancer deaths per year.

(Credit: Globocan 2008)GLOBAL CANCER STATISTICS:

The problem

Cancer is a leading cause of death worldwide and accounted for 7.6 million deaths (around 13% of all deaths) in 2008.

The main types of cancer are:

• lung (1.4 million deaths)
• stomach (740 000 deaths)
• colorectal (610 000 deaths)
• liver (700 000 deaths)
• breast (460 000 deaths).

More than 70% of all cancer deaths occurred in low- and middle-income countries. Deaths from cancer worldwide are projected to continue to rise to over 11 million in 2030.

What causes cancer?

Cancer arises from one single cell. The transformation from a normal cell into a tumour cell is a multistage process, typically a progression from a pre-cancerous lesion to malignant tumours. These changes are the result of the interaction between a person's genetic factors and three categories of external agents, including:

• physical carcinogens, such as ultraviolet and ionizing radiation;
• chemical carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a food contaminant) and arsenic (a drinking water contaminant); and
• biological carcinogens, such as infections from certain viruses, bacteria or parasites.

Ageing is another fundamental factor for the development of cancer. The incidence of cancer rises dramatically with age, most likely due to a buildup of risks for specific cancers that increase with age. The overall risk accumulation is combined with the tendency for cellular repair mechanisms to be less effective as a person grows older.

Risk factors for cancers

(Credit: NIH) Tobacco use, alcohol use, unhealthy diet, and chronic infections from hepatitis B (HBV), hepatitis C virus (HCV) and some types of Human Papilloma Virus (HPV) are leading risk factors for cancer in low- and middle-income countries. Cervical cancer, which is caused by HPV, is a leading cause of cancer death among women in low-income countries.

How can the burden of cancer be reduced?

Knowledge about the causes of cancer, and interventions to prevent and manage the disease is extensive. Cancer can be reduced and controlled by implementing evidence-based strategies for cancer prevention, early detection of cancer and management of patients with cancer.

Modifying and avoiding risks

More than 30% of cancer could be prevented by modifying or avoiding key risk factors, including:

• tobacco use
• being overweight or obese
• low fruit and vegetable intake
• physical inactivity
• alcohol use
• sexually transmitted HPV-infection
• urban air pollution
• indoor smoke from household use of solid fuels.

Prevention strategies:

• increase avoidance of the risk factors listed above
• vaccinate against human papilloma virus (HPV) and hepatitis B virus (HBV)
• control occupational hazards
• reduce exposure to sunlight.

Early detection

Cancer mortality can be reduced if cases are detected and treated early. There are two components of early detection efforts:

• Early diagnosis: The awareness of early signs and symptoms (such as cervical, breast and oral cancers) in order to facilitate diagnosis and treatment before the disease becomes advanced. Early diagnosis programmes are particularly relevant in low-resource settings where the majority of patients are diagnosed in very late stages.
• Screening: The systematic application of a screening test in an asymptomatic population. It aims to identify individuals with abnormalities suggestive of a specific cancer or pre-cancer and refer them promptly for diagnosis and treatment. Screening programmes are especially effective for frequent cancer types that have a screening test that is cost-effective, affordable, acceptable and accessible to the majority of the population at risk. Examples of screening methods:
  • visual inspection with acetic acid (VIA) for cervical cancer in low-resource settings;
  • PAP test for cervical cancer in middle- and high-income settings;
  • mammography screening for breast cancer in high-income settings.

Treatment

Treatment is the series of interventions, including psychosocial support, surgery, radiotherapy, chemotherapy that is aimed at curing the disease or considerably prolonging life while improving the patient's quality of life.

• Treatment of early detectable cancers: Some of the most common cancer types, such as breast cancer, cervical cancer, oral cancer and colorectal cancer have higher cure rates when detected early and treated according to best practices.
• Treatment of other cancers with potential for cure: Some cancer types, even though disseminated, such as leukemias and lymphomas in children, and testicular seminoma, have high cure rates if appropriate treatment is provided.

Palliative care

Palliative care is treatment to relieve, rather than cure, symptoms caused by cancer. Palliative care can help people live more comfortably; it is an urgent humanitarian need for people worldwide with cancer and other chronic fatal diseases. It is particularly needed in places with a high proportion of patients in advanced stages where there is little chance of cure.

Relief from physical, psychosocial and spiritual problems can be achieved in over 90% of advanced cancer patients through palliative care.

Palliative care strategies

Effective public health strategies, comprising of community- and home-based care are essential to provide pain relief and palliative care for patients and their families in low-resource settings.

Improved access to oral morphine is mandatory for the treatment of moderate to severe cancer pain, suffered by over 80% of cancer patients in terminal phase.

WHO response

In 2008, WHO launched its Non-communicable Diseases Action Plan.

WHO and the International Agency for Research on Cancer, the specialized cancer agency of WHO, collaborate with other United Nations organizations and partners in the areas of international cancer prevention and control to:

• increase political commitment for cancer prevention and control;
• generate new knowledge, and disseminate existing knowledge to facilitate the delivery of evidence-based approaches to cancer control;
• develop standards and tools to guide the planning and implementation of interventions for prevention, early detection, treatment and care;
• facilitate broad networks of cancer control partners at global, regional and national levels;
• strengthen health systems at national and local levels;
• provide technical assistance for rapid, effective transfer of best practice interventions to developing countries; and
• coordinate and conduct research on the causes of human cancer, the mechanisms of carcinogenesis, and develop scientific strategies for cancer prevention and control.

RESOURCES:

The World Health Organization, Cancer site

Union For International Cancer Control

Center for Disease Control & Prevention

Cancer Schmancer

- HUMNEWS staff with information provided by the World Health Organization. 

Number of Young Women Smokers in Developing Countries Skyrockets

(HN, June 4, 2010) Young women in developing countries are being targeted by "seductive" advertising from the large tobacco companies and all governments must take immediate action to protect them from harmful messages, says the World Health Organization (WHO).

 WHO says female business owners are prime targets for seductive offers from tobacco companies, such as branded umbrellas or kiosks

The world health body says that if current trends continue, women could soon be on par with men in terms of rates of death due to smoking, creating what one expert called "a very perverse equality."

"The tobacco industry is spending heavily on seductive advertisements that target women - especially in low and middle income countries. The advertisements try to dupe women into believing that tobacco use is associated with beauty and liberation," Dr. Douglas Bettcher, Director of the WHO Tobacco Free Initiative, told a recent press briefing in Geneva. "In effect they have had to offshore their marketing strategies, look for greener pastures."

Of the world's more than one-billion smokers, only about 200 million are women - but WHO warns those numbers could change rapidly.

Experts believe the tobacco industry has made the shift towards women and young adults in order to compensate for the drop off in tobacco use from smokers who have died from cancer, emphysema, heart attacks, stroke, asthma, tuberculosis and other tobacco-related diseases. One WHO expert accused the major tobacco companies of using "predatory marketing strategies" to lure women in developing countries into taking up the smoking habit, adding that state-owned tobacco companies tend to be less aggressive than the multinationals.

Said Bettcher: "They need to always be refreshing these pools and that's why they are looking to low and middle income countries over the last decade - looking at new populations such as young women to light up and support their profit motives."

Among the venues used to lure women and young girls to tobacco are women's magazines and the fashion industry, WHO says. "The industry has studied what makes women 'tick' in the developed and developing countries," said the WHO's Peju Olukoya, adding that they use sporting and music events that draw many young people. In some countries, free cell phones and text messaging campaigns are used heavily to promote cigarettes.

In Egypt, one WHO expert said, tobacco companies are trying to lure more women by producing cigarette packages to resemble perfume boxes. In Nigeria, cigarette companies build stalls with branded umbrellas and even fund school supplies. "As a result of this, the acceptability for the use of cigarettes by women is gradually increasing., In the past cigarettes have always been associated with the red light district in town," said Olukoya, a native of Nigeria.

She added that Big Tobacco sends confusing messages in many developing countries - by promoting slimness in cultures where this is not necessarily valued and by putting forward smoking as liberating. As for messaging to young men: "It's all about the macho..a big man smokes a big cigarette."

Bettcher says the industry's marketing strategy is having its desired impact. In half of the 151 countries surveyed by WHO, about as many girls smoke as boys. "In some of the countries, in fact, even more girls smoke than boys." Countries where there are more girl smokers than boy smokers include: Uruguay, Mexico, Cook Islands, Croatia, Argentina, Senegal, Chile, Colombia and Bulgaria.

Said Bettcher of the rise of female smokers: "This is a serious red flag. It could mean that we are on the cusp of a much worse global tobacco epidemic amongst women. Girls and boys who smoke are likely to remain smokers as adults."

Bettcher said that one can expect "an explosion" in adult women's tobacco use rates in the coming years. "We simply cannot allow this trend to continue. All governments must take action to protect women from tobacco advertising and promotional sponsorship.

"We must empower women to protect themselves and their families from the harms of tobacco use."

Bettcher added that women need to be protected from second hand smoke, especially in countries where women feel powerless. Smoke-free areas in restaurants and help to cope with addiction are among the steps recommended.

Of the 430,00 adults who die from second-hand smoke each year, well over half - 64 percent - are women. And of the more than 5 million people who die from tobacco use each year, about 1.5 million are women. "Most of these tobacco-related deaths occur in low and middle income countries, which can least afford such dreadful losses," said Bettcher.

By 2030, there could be as many as 8 million people who die from tobacco, of which 2.5 million will be amongst women.

In the Asia-Pacific region, more than 8 per cent of girls between 13 and 15, or around 4.7 million girls, are using tobacco products, said WHO.

Betcher called the new trends - where women became as likely as men to die of smoke-related reasons - a "very perverse equality."

WHO chose as the theme for the recent World No Tobacco Day 2010 as "Gender and Tobacco With an Emphasis on Marketing to Women."  WHO recommends that tobacco advertising and sponsorship should be completely banned. In the US alone, 11 percent of advertising and promotional expenditures in 1996 came from the tobacco industry; in 2005 $13.11 billion was spent on tobacco advertising and promotions.

In 2006, only 17 countries in the world had comprehensive bans against tobacco advertising, and Bettcher said some wealthy countries "dont do very well" in terms of enforcing bans. In response to bans, tobacco companies have become more sophisticated, turning to such tactics as product placement in movies and sponsorships of popular events.

That tobacco companies are tailoring their marketing strategies increasingly towards women in developing countries is nothing new. In 2003, the American Cancer Society flagged the issue as very serious. "The tobacco industry has intensified its marketing strategies -- especially those targeting women -- in developing countries,” said Michael J. Thun, vice president of epidemiology and surveillance research for the American Cancer Society. “International measures such as the WHO Framework Convention on Tobacco Control are essential to help countries protect themselves.”

Staff, files