Oncologist says France's anti-tobacco ban strategy has failed
Anti-tobacco measures, including a ban on smoking in public places and an increase in cigarette prices, which many countries have undertaken over the past 20 years, have worked worse than expected. This was stated by David Khayat, a well-known French oncologist and professor at Pierre and Marie Curie University, at the St. Petersburg International Cancer Forum. According to him, more than 60% of people continue to smoke even after a cancer diagnosis, so other ways to fight tobacco addiction are needed, including those based on harm reduction strategies.The first national cancer control and prevention plan was adopted in France on the initiative of former President Jacques Chirac in 2003 and was in effect until 2007. According to Prof. Hayat, he was responsible for the cancer control plan, the key focus of which was to reduce tobacco smoking in the country. For this purpose, standard measures approved by the WHO (similar to those now applied in Russia) were taken - an increase in the cost of a pack of cigarettes (from 3 to 5 euros), a law banning smoking in public places. As a result, the number of smokers actually decreased by 1.8 million people. "But these measures were not enough," he stated. - Unfortunately, after a few years, many people returned to smoking cigarettes".
According to him, about 64% of smokers with already diagnosed malignant neoplasm continue to smoke. "WHO data show that about a billion people in the world smoke," the specialist said. - At the same time, one in eight of them develops lung cancer, which in numerical terms means up to 80 million cases of lung cancer. And most of these people, unfortunately, will die".
As an argument, the French oncologist also cited the data of his Russian colleagues. According to him, both in 1990 and in 2019, smoking led among all risk factors for malignant neoplasms, while alcohol went to the third position, giving way to obesity. "During this time, many measures have been taken to reduce the prevalence of tobacco smoking," said the professor. - However, after 30 years, smoking is still the leading cause of death in Russia. Thus, anti-tobacco measures have not worked in Russia as well as in France. I was responsible for this project, and I know that it has completely failed. If we want to find another way to fight tobacco use, instead of requiring patients to quit smoking, we need to look for alternatives."
For those who are not motivated to quit tobacco smoking, the oncologist suggested looking at the concept of harm reduction, which involves switching from more dangerous products - cigarettes - to less harmful ways of delivering nicotine. "In this way, on the one hand, we are trying to persuade people to give up a health-damaging behavior, and on the other hand, we are trying to at least minimize its consequences," he explained.
"We must realize that people smoke for a dose of nicotine, but they die from the combustion products of tobacco," David Hayat added. - Nicotine is an addictive chemical, but it does not cause cancer and is not a carcinogen. Thus, the WHO lists a complete list of carcinogens in tobacco smoke - but nicotine is not mentioned in it." As explained by the professor, in the process of tobacco smoking carcinogens begin to be released when the tobacco leaf is heated to temperatures above 350 degrees Celsius.
David Hayat cited data from a systematic review and meta-analysis of relative risk assessment of nicotine products: products where there is no combustion (including chewing tobacco, e-cigarettes, tobacco heating systems), according to the combined risk index is from 2 to 5% of that of a conventional cigarette. The professor also emphasized that the experience of the UK and Japan shows: an increase in sales of smokeless products leads to a subsequent decline in sales of conventional cigarettes.
"The problem is that many people don't believe or don't know that they can reduce their risk while still getting nicotine," Prof. Hayat summarized. - Tobacco smoking is the leading cause of lung cancer and, of course, it would be ideal to quit the habit completely. However, quitting smoking is not easy, so the current strategy implemented under the auspices of WHO has not worked".