Cancer Causes & Control

, Volume 21, Issue 6, pp 959–965

Estimation of cancer incidence and mortality attributable to smoking in China

Original paper



Tobacco smoking, as a cause of cancer, is common in China. Few studies have been conducted to assess the burden of tobacco-related cancer in the Chinese population.


We calculated the proportion of cancers attributable to tobacco smoking to estimate the burden of tobacco-related cancer. Population attributable fraction was calculated based on the assumption of total avoidance of smoking. Data on smoking prevalence were from two large-scale national surveys of representative samples of the Chinese population. Data on relative risk were derived from the meta-analyses and large-scale studies. Cancer mortality and incidence were originated from the third national death cause survey and cancer registries in China.


We estimated that a total of 405,112 deaths of cancer were attributable to smoking in China in 2005, including 372,264 among men (32.7% of all cancer deaths) and 32,848 among women (5.0%). A total of 495,221 cancer cases were attributable to smoking, including 454,785 among men (30.0% of all cancer cases) and 40,436 among women (3.9%). Involuntary smoking was responsible for 11,507 lung cancer deaths (11.1%) among non-smoking women.


Tobacco smoking is responsible for one-third of the total cancer deaths among men. Involuntary smoking is an important individual risk factor for lung cancer among non-smoking women. There is a need to continue and strengthen tobacco-control programs and initiatives to reduce smoking-related cancer burden in China.


Smoking involuntary smoking Cancer Population attributable fraction 


  1. 1.
    Doll R, Hill AB (1950) Smoking and carcinoma of the lung: preliminary report. Br Med J 2:739–748CrossRefPubMedGoogle Scholar
  2. 2.
    International Agency for Research on Cancer (2004) IARC Monographs on the evaluation of the carcinogenic risk to humans, Vol. 83, Tobacco Smoke and Involuntary Smoking. IARC Press, LyonGoogle Scholar
  3. 3.
    Ministry of Health of the people’s republic of China (2008) Report on the Third national Retrospective Survey of Death causes in China. Chinese Academy of Medical Sciences & Peking Union Medical College Press, BeijingGoogle Scholar
  4. 4.
    World Health Organization (2002) The World Health Report 2002: Reducing Risks, Promoting Healthy Life. WHO, GenevaGoogle Scholar
  5. 5.
    Yang GH, Ma JM, Liu N, Zhou LN (2005) Smoking and passive smoking in Chinese, 2002. Zhonghua Liu Xing Bing Xue Za Zhi 26:77–83PubMedGoogle Scholar
  6. 6.
    Yang GH, Fan LX, Tan J et al (1999) Smoking in China: findings of the 1996 national prevalence survey. JAMA 282:1247–1253CrossRefPubMedGoogle Scholar
  7. 7.
    Lopez AD, Collishaw NE, Piha T (1994) A descriptive model of the cigarette epidemic in developed countries. Tob control 3:242–247CrossRefGoogle Scholar
  8. 8.
    Peto R (1994) Smoking and death: the past 40 years and the next 40. BMJ 309:937–939PubMedGoogle Scholar
  9. 9.
    Peto R, Lopez AD (1990) The future worldwide health effects of current smoking patterns: 3 million deaths per year in the 1990’s, but over 10 million annually. In: Program and abstracts of the 7th World Conference on Tobacco and Health. Perth, AustraliaGoogle Scholar
  10. 10.
    Niu SR, Yang GH, Chen ZM et al (1998) Emerging tobacco hazards in China: 2. Early mortality results from a prospective study. BMJ 317:1423–1424PubMedGoogle Scholar
  11. 11.
    Gu DF, Kelly TN, Wu XG et al (2009) Mortality attributable to smoking in China. N Engl J Med 360:150–159CrossRefPubMedGoogle Scholar
  12. 12.
    Doll R, Peto R, Wheatley K, Gray R, Sutherland I (1994) Mortality in relation to smoking: 40 years’ observations on male British doctors. BMJ 309:901–911PubMedGoogle Scholar
  13. 13.
    Weng XZ, Hong ZG, Chen DY (1987) Smoking prevalence in Chinese aged 15 and above. Chin Med J (Engl) 100:886–892Google Scholar
  14. 14.
    Liu BQ, Peto R, Chen ZM et al (1998) Emerging tobacco hazards in China: 1. Retrospective proportional mortality study of one million deaths. BMJ 317:1411–1422PubMedGoogle Scholar
  15. 15.
    Han MY, Yin GJ, Chen WQ (2005) Meta-analysis of risk factors associated with nasopharyngeal carcinoma in China. China Tropical Medicine 5:1442–1443Google Scholar
  16. 16.
    Tran GD, Sun XD, Abnet CC (2005) Prospective study of risk factors for esophageal and gastric cancers in the Linxian general population trial cohort in China. Int J Cancer 20(113):456–463CrossRefGoogle Scholar
  17. 17.
    Liu YX, Wang JZ (2002) Meta-analysis of the relationship between smoking and stomach cancer. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 24:559–563PubMedGoogle Scholar
  18. 18.
    Chen ZM, Liu BQ, Boreham J, Wu YP, Chen JS, Peto R (2003) Smoking and liver cancer in China: case-control comparison of 36, 000 liver cancer deaths vs. 17, 000 cirrhosis deaths. Int J Cancer 107:106–112CrossRefPubMedGoogle Scholar
  19. 19.
    Shi J, Ch WU, Liu S, Xie WF (2004) Meta analysis of risk factors for pancreatic cancer in China. Chin J Pancreatol 4:154–158Google Scholar
  20. 20.
    Dai Q, Mu BT, Xu M, Gao YT (1994) Analysis of attributable fraction for smoking and some main cancers in shanghai. Tumor 14:209–210Google Scholar
  21. 21.
    Gandini S, Botteri E, Iodice S et al (2008) Tobacco smoking and cancer: a meta-analysis. Int J Cancer 122:155–164CrossRefPubMedGoogle Scholar
  22. 22.
    Gao YT, Den J, Xiang YB et al (1999) Smoking, related cancers, and other diseases in Shanghai: a 10-year prospective study. Zhonghua Yu Fang Yi Xue Za Zhi 33:5–8PubMedGoogle Scholar
  23. 23.
    Wen WQ, Shu XO, Gao YT et al (2006) Environmental tobacco smoke and mortality in Chinese women who have never smoked: prospective cohort study. BMJ 333:376CrossRefPubMedGoogle Scholar
  24. 24.
    Chen WQ (2009) Estimation of cancer incidence and mortality in China in 2004–2005. Chin J Oncol 31:664–668Google Scholar
  25. 25.
    Levin ML (1953) The occurrence of lung cancer in man. Acta Unio Int Contra Cancrum 9:531–541PubMedGoogle Scholar
  26. 26.
    Ferlay J, Bray F, Pisani P, Parkin DM (2004) GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide. IARC CancerBase No. 5, version 2.0. IARC Press, LyonGoogle Scholar
  27. 27.
    Yuan JM, Ross RK, Wang XL, Gao YT, Henderson BE, Yu MC (1996) Morbidity and mortality in relation to cigarette smoking in Shanghai, China. A prospective male cohort study. JAMA 275:1646–1650CrossRefPubMedGoogle Scholar
  28. 28.
    Peto R, Lopez AD, Boreham J, Thun M (1994) Mortality from smoking in developed countries 1950–2000. Oxford University Press, OxfordGoogle Scholar
  29. 29.
    International Agency for Research on Cancer, Académie des Sciences–Institut de France, Académie de Médecine, Fédération Nationale des Centres de Lutte contre le Cancer (2007) IARC working group reports, Vol 3, attributable causes of cancer in France in the year 2000. IARC Press, LyonGoogle Scholar
  30. 30.
    Wells AJ (1988) An estimate of adult mortality in the United States from passive smoking. Environ Int 14:249–265CrossRefGoogle Scholar
  31. 31.
    Wells AJ (1992) An estimate of adult mortality in the United States from passive smoking; a further reply (letter). Environ Int 18:321–325Google Scholar
  32. 32.
    Doll R, Gray R, Hafner B, Peto R (1980) Mortality in relation to smoking: 22 years’ observations on female British doctors. Br Med J 280:967–971CrossRefPubMedGoogle Scholar
  33. 33.
    Boffetta P, Kreuzer M, Benhamou S et al (2001) Risk of lung cancer from tobacco smoking among young women from Europe. Int J Cancer 91:745–746CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Department of Epidemiology and StatisticsInstitute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical CollegeBeijingPeople’s Republic of China
  2. 2.Department of Cancer EpidemiologyCancer Institute, Chinese Academy of Medical SciencesBeijingPeople’s Republic of China
  3. 3.Chinese Center for Disease Control and PreventionBeijingPeople’s Republic of China
  4. 4.The Tisch Cancer Institute, Mount Sinai School of MedicineNew YorkUSA
  5. 5.International Prevention Research InstituteLyonFrance

Personalised recommendations