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[Analysis on the attributable burden of smoking-related cancers in Guangdong Province in 2020]

X L Wen¹, Y Liao², X M Lin¹

¹National Central Cancer Registry Office, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Zhonghua Liu Xing Bing Xue Za Zhi = Zhonghua Liuxingbingxue Zazhi

|April 22, 2026

Abstract:

Objective: To analyze the burden of cancer attributable to smoking in Guangdong Province, in order to provide scientific evidence for the precise implementation of tobacco control and cancer prevention strategies in the region. Methods: Using tobacco exposure data from the representative Guangdong Risk Factor surveillance in 2010 and relative risk (RR) values from Meta-analyses or national cohort studies, we applied Levin's formula to estimate the population attributable fraction (PAF) of cancer attributable to smoking. Cancer burden data from 40 cancer registries, stratified by sex, region, and age group, were combined with demographic data to estimate new cancer cases and deaths across Guangdong Province in 2020. These estimates were multiplied by the PAFs to obtain the number of attributable new cases and deaths for specific sexes, regions, and age groups. We then aggregated them to obtain the smoking-attributable burden of cancer new cases and deaths. Results: In 2020, 11.6% (33 535) of new cancer cases and 16.3% (21 331) of cancer deaths were attributable to smoking. PAFs for incidence (19.3%) and mortality (22.6%) among males were higher than those among females (3.1% and 4.6%). Rural residents exhibited higher PAFs for incidence (13.4%) and mortality (18.1%) than those among urban residents (10.5% and 14.9%), with a tendency to increase and then decrease with age. A total of 30 215 new cancer cases (PAF was 10.5%) and 19 814 cancer deaths (PAF was 15.2%) were attributable to active smoking. Tracheal cancer/bronchial cancer/lung cancer was the most significant smoking-related cancer, with active smoking accounting for nearly 50.0% of tracheal cancer/bronchial cancer/lung cancer cases in males (PAF for incidence was 49.4% and PAF for mortality was 47.9%) and second-hand smoking accounting for approximately 10.0% of tracheal cancer/bronchial cancer/lung cancer cases in females (PAF for incidence was 13.0% and PAF for mortality was 10.5%). Conclusions: Smoking is a major risk factor for cancer, with higher PAFs among males, rural residents, and middle-aged and elderly populations, while females were mainly affected by second-hand smoking. Effective tobacco control measures, exact interventions targeting high-risk groups, are critical to reduce cancer burden in the future.

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