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Tobacco and cancer situation in Bangladesh

Dr M Mostafa Zaman
Cancer is a generic term for a group of more than 100 diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasms. One defining feature of cancer is the I rapid creation of abnormal | cells which grow beyond their usual boundaries and which can invade adjoining parts of the body and spread to other organs, a process referred to as metastasis. Metastases are the major cause of death from cancer.
Cancer situation in । Bangladesh
Cancer has been appearing as an important public health problem in Bangladesh. Due to the lack of reporting system and underdiagnosis of cancer, the real situation is unknown yet.
Population-based data on cancer are sparse. A recent WHO study estimated that there are 49,000 oral cancer, 71,000 laryngeal cancer and 196,000 lung cancer cases in Bangladesh among those aged 30 years or above in Bangladesh (asof2004).
The same study observed that 3.6% of the admissions in medical college hospitals for the same age group are due to these three cancers. A WHO supported hospitalbased registry in the National Institute of Cancer Research and Hospital indicates that lung cancer in men (30%), cervical (26%) and breast cancer (23%) in women are the leading cancers in Bangladesh. These three cancers constitute 37% of all cancers irrespective sexes.
The GLOBOCAN study (1998) reported that rates of deaths from respiratory tract (trachea, lung and bronchus) cancers are highest in Bangladesh compared to Sri Lanka, India, Afghanistan, Bhutan, Nepal, Pakistan.
In response, the national cancer control plan has been developed in collaboration with WHO Bangaldesh. Population-based cancer registry has also been estab
fished with technical assistance from WHO to facilitate evidence-based policies and programmes to combat cancers.
Tobacco as a cause of major cancers
There are many external factors either cause or facilitate the development of cancers. Tobacco use is the single most important cause of large variety of cancers such as lung, larynx, oesophagus (food pipe), stomach, bladder, oral cavity and others.
Dietary factors such as inadequate fruit and vegeta-
bles intake play important roleincausingcancer.
Excessive alcohol causes several types of cancer such as oesophagus, pharynx, larynx, liver, breast, and others.
Tobacco, through its various forms of exposure, constitutes the main cause of cancer-related deaths worldwide among men, and increasingly among women. Forms of exposure include active smoking, breathing secondhand tobacco smoke (passive or involuntary smoking) and smokeless tobacco (e.g., zarda, sada pata,gul,etc.).
The total death toll in 2005 from tobacco use was estimated at 5.4 million people, including about 1.5 million
cancer deaths.
If present usage patterns continue, the overall number of tobacco-related deaths is projected to rise to about 6.4 million in 2015, including 2.1 million cancer deaths. In 2030, the projected overall death toll will amount to 8.3 million.
Tobacco poses a double burden to Bangladesh because of high production and high consumption. According to 2005 estimate 30.9 million people aged 15 years and above consume tobacco in any form. Unlike developed countries, smokeless tobacco in vari-
ous forms adds an extra dimension to tobacco control. Bangladesh is among the world's 20 largest producers of tobacco and tobacco products.
Tobacco control is the key to cancer control At least 40% cancers can be prevented. Tobacco is the main culprit that should targeted for cancer prevention. You can help yourself. Just say "NO TO TOBACCO". If you are a non-user "NEVER TRY IT”. If you are a tobacco user "QIUT IT NOW". You definitely can do it.
The Ministry of Health and Family Welfare has been implementing its Strategic plan of action for tobacco control 2007-2010 in collab-
oration with WHO and other partners.
Strategies include taskforce committees for law enforcement; price and tax policies, protection from exposure to second hand smoke; bans on advertisement, promotion and sponsorship: public awareness; promotion of tobacco cessation; product regulations; packaging and labeling; surveillance; control of illicit trade and partnership building for tobacco control. All these are aligned with the WHO Framework Convention onTobacco Control.
Recently WHO has release a historic Report on the Global Tobacco Epidemic 2008. It estimated that in the 20th Century, the tobacco epidemic killed 100 million people worldwide and projected that during the 21 century, it could kill one billion unless urgent action is taken.
Dr Margaret Chan, WHO Director General in her message urged Member States for reversing this entirely preventable epidemic as a top priority public health problem adopting six policies of WHO's M POWER package:
•Monitor tobacco use and prevention policies
•Protect people from tobacco smoke
•Offer help to quit tobacco use
•Warn about the dangers oftobacco
•Enforce bans on tobacco advertising, promotion and sponsorship
•Raise taxes on tobacco
As mentioned above, Bangladesh strategic plan of action that was developed with technical assistance from WHO country office has already addressed theses MPOWER points.
Bangladesh once again has proved its pioneering role in tobacco control However it is essential to deploy all of its armours against this DEADLY epidemic. We all must act now.
The wnter is a Non-Communicable Disease Epidemiologist