Escalating burden and trend of cancer attributable to smoking in Southeast Asia, east Asia and Oceania from 1990-2021: A benchmarking systematic analysis.

10548 Background: Cancer (CA) is a leading cause of death and disability in Southeast Asia (SEA), East Asia (EA), and Oceania. Among the various risk factors, smoking is notably the most preventable. Its strong association with various CA types underscores the urgent need for effective tobacco control measures as a cornerstone of CA prevention strategies. Methods: This study utilized the standardized methodology of the Global Burden of Disease Study 2021 to estimate deaths, disability-adjusted life years (DALYs), and years lived with disability (YLDs) attributable to smoking for 16 types of CA in SEA, EA and Oceania, stratified by age, sex, year, and location from 1990-2021. The results are presented in absolute counts and age-standardized rate. Results: The annual percentage change (APC) in the total number of deaths due to CA attributable to smoking increased by +2.64%, DALYs by +2.16%, and YLDs by +3.57% from 1990-2021. Regionally, the highest increase in APC was observed in EA, with deaths at +2.67% and DALYs at +2.14%. For age-standardized mortality rates (ASMR), highest increases in APC were observed in Indonesia (+0.81%), Kiribati (+0.02%), Marshall Islands (+0.56%), and Niue (+0.16%), while declines were observed in most other regions. By cancer type, the highest increases in APC in deaths were observed due to kidney CA (+4.43%), pancreatic CA (+3.54%), tracheal, bronchus, and lung CA (+3.45%), lip and oral cavity CA (+3.29%), and prostate CA (+3.23%). Moderate increases were observed due to colon and rectum CA (+2.87%), leukemia (+2.76%), bladder CA (+2.13%), liver CA (+1.81%), breast CA (+1.76%), larynx CA (+1.59%), esophageal CA (+1.50%), other pharynx CA (+1.35%), stomach CA (+0.83%), and cervical CA (+0.62%). Nasopharynx CA was the only type to show a slight decline (-0.03%). By age, an APC of +0.90% was observed in deaths among individuals aged 20-54 years and +2.97% among those aged 55+ years. By gender, APC for deaths were +2.69% in males and +2.18% in females, DALYs were +2.19% in males and +1.80% in females, and YLDs were +3.63% in males and +3.04% in females. Conclusions: Deaths due to CA attributable to Smoking accounted for 60.31% of all attributable risk factors in 2021. The observed increases in the APC in deaths, DALYs, and YLDs due to smoking-attributable cancers highlight a significant and growing public health burden, particularly in EA and among males and older age groups. These trends emphasize the need for strengthened tobacco control policies, early CA detection programs, and targeted public health interventions to address regional and demographic disparities. For clinicians, these findings underscore the importance of prioritizing smoking cessation counseling, routine CA screenings, and personalized treatment strategies to mitigate the impact of smoking-related CA.