Cancer attributable to tobacco smoking: a focus on primary prevention

Background: This paper reviews recent research findings on the population-attributable risk (PAR) of tobacco smoking in cancer incidence. It examines the components used in calculating PAR, specifically smoking prevalence and the relative risk of cancer associated with tobacco smoking.Current Concepts: The association between tobacco smoking and cancer risk is typically measured by the relative risk, which indicates how many times higher the cancer risk is in smokers compared to non-smokers. There is robust evidence that tobacco smoking is carcinogenic for cancers of the oral cavity, esophagus, stomach, colorectum, liver, pancreas, larynx, lung, cervix, ovaries, kidneys, bladder, and myeloid leukemia. Numerous epidemiological studies indicate that smoking increases the risk of these cancers by 2 to 10 times or more. The population attributable fraction of tobacco smoking for cancer quantifies the extent to which smoking contributes to cancer risk in a given population. Because PAR depends on smoking prevalence and relative risk, it is calculated and reported for each country and time point. According to a National Cancer Center report, in 2019 tobacco smoking accounted for 47% of esophageal cancers, 28% of stomach cancers, 27% of pancreatic cancers, 53% of lung cancers, and 43% of bladder cancers in Korean men.Discussion and Conclusion: The relative risk and population-attributable fraction serve as important indicators that inform policy development, prevention strategy formulation, resource allocation, health equity initiatives, public health awareness, and clinical practice.