Background Despite reductions in smoking prevalence over the past decades, smoking remains the most important preventable cancer risk factor in Germany. In contrast to a considerable attributable disease burden, Germany continues to be ranked among the most inactive countries in Europe in terms of implementing evidence-based tobacco control policies. The aim of this study is to provide projections of potentially avoidable cancer cases under different policy intervention scenarios.
Methods In order to estimate the proportion of potentially avoidable cancer cases under different policy intervention scenarios (tobacco tax increases, comprehensive marketing ban, plain packaging), we calculated cancer site-specific potential impact fractions (PIFs) stratified according to age and sex, for each year of study period (2020–2050), considering latency periods between the reduction in smoking prevalence and the manifestation in declining cancer excess risks. For the baseline scenario we assumed a continuation of recent smoking trends, and combined data of the German cancer registries with forecasted population sizes, published effect sizes, and national daily smoking prevalence data to obtain estimates of future incident case numbers. By applying the calculated PIFs to the projected cancer cases for each policy intervention, we estimated the number of future cancer cases that would be expected under the corresponding scenario.
Results Our preliminary results suggest that over a 30-year period, an estimated 11.5% (men 12.0%, women 10.5%) of smoking-related cancer cases could be prevented, if a combination of the observed tobacco control policy interventions were to be implemented in Germany. The most effective single intervention was found to be annual 10% price increases in cigarettes over 10 years, which may prevent about 6.8% of cancer cases (men 7.2%, women 6.3%), followed by plain packaging (men 3.8%, women 3.3%), a comprehensive marketing ban (men 2.0%, women 1.7%), and a single 10% price increase (men 1.0%, women 0.9%). The highest PIFs for all interventions combined were observed for lung cancer (men 16.8%, women 16.4%), cancer of the larynx (men 15.9%, women 15.6%), and the oral cavity (men 15.3%, women 13.8%).
Conclusion Although our simulation model relies on several assumptions, this modelling approach allows a comparison of the impact of different policy intervention scenarios on future cancer incidence. Our results suggest that the expected cancer incidence in Germany could be considerably reduced by implementing tobacco control policies as part of a primary cancer prevention strategy.
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