Up-to-date research study indicates the smoking-attributable fraction of preventable deaths, which could potentially reduce lung cancer morbidity by 81% among men and by 58% among women
Quitting smoking is worth it: the downward trend in cancer diseases related to smoking among Jewish women and men and Arab women.
On the other hand, there has been an upward trend among Arab men who are still heavy smokers
A new Israeli research study investigates whether preventive radiation will constitute an alternative to preventive mastectomy
Israel Cancer Association Door Knock Fundraising Campaign 2016
The ICA in collaboration with the Ministry of Health presented Israel's latest statistics towards the Door Knock Fundraising Campaign Kick-off scheduled for 31 October 2016.
Prof. Lital Keinan-Boker, Deputy Director of the National Disease Control Center of the Ministry of Health, reports on new statistics of the National Cancer Registry in terms of smoking-attributable diseases, recounting that: "Tobacco and tobacco products, particularly cigarettes, are considered to be the most significant preventable cause of cancer.
A new up-to-date research study referring to the additional risk indicator associated with smoking proves that if exposure to smoking were completely prevented, lung cancer morbidity could be reduced by 81% among men and by 58% among women. The trends in types of cancers related to smoking according to statistics collected in Israel from 1990-2013 are characterized by an increase in cancer incidence among Arab men and by a decrease among Jewish women and men and Arab women. On the other hand, an increase has been recorded in some cancer diseases among Arab women and this can apparently be attributed to the fact that they are exposed to passive smoking of men in the family. These statistics have been published marking ICA's annual fundraising campaign, scheduled for Monday, 31 October 2016.
Miri Ziv, ICA Director General, indicates that: "The statistics indicate a direct and strong association between heavy smoking and preventable cancer diseases and prove that quitting smoking is worth it. We already know that smoking causes most lung cancers, which may be prevented, however the statistics also indicate a direct link to additional types of cancers, including pharyngeal cancer, urinary bladder cancer, nasal and oral cavity cancer, throat cancer, pancreatic cancer, kidney cancer, esophageal cancer and leukemia. An estimated 40% of cases are preventable. However, despite the decrease in smoking rates among Arab men, many are still heavy smokers, and they are the ones who develop smoking-attributable cancers more frequently".
It is known that smoking causes an estimated three out of every four cases of lung cancer, however smoking is also attributed to about twelve other types of cancers, the most common being pharyngeal cancer, urinary bladder cancer, nasal and oral cavity cancer, throat cancer, pancreatic cancer, kidney cancer and esophageal cancer. Whiteman & Wilson recently published a survey on the relative contribution of preventable risk factors (smoking, alcohol, nutrition, sedentary lifestyle, and others) to morbidity in several cancer types, while placing an emphasis on an indicator called Population Attributable Fraction - PAF. This indicator describes the proportion of a specific disease in a given population, which could have been prevented if the exposure of the population to a known risk factor had been prevented. The indicator takes into account both the intensity of the relationship between the risk factor and the disease as well as the level of exposure to the risk factor prevailing in the given population.
In order to give you a visual, upon interpreting the results, it may be concluded that if exposure to smoking had been completely prevented, lung cancer morbidity could have been reduced by 81% among men and by 58% among women, and urinary bladder cancer morbidity could have been reduced by 41% among men and by 21% among women; however, regarding colorectal cancer, for example, the results were less dramatic, as smoking contributed to a mere 7% of overall morbidity among men and women.
Median PAF (%) men
Median PAF (%) Women
Oral cavity and pharyngeal cancer
Urinary bladder cancer
Kidney, renal pelvis and ureter cancer
Summary of Cancer Statistics Collected from 1990-2013
Spanning the entire period, from 1990-2013, a total of 232,688 new cases of smoking-attributable cancer were diagnosed, and the relative fraction of the overall 551,905 new cases diagnosed during that same period was 40%.
In 1990, the relative proportion of cancer types attributed to smoking was 44% of overall new diagnoses among Israel's population, while in 2013, their relative proportion was 38%. In stratification according to population group and gender, it emerged that the relative proportion of smoking related cancers decreased from 1990-2013, among Jewish men, Jewish women and Arab women alike, however, it increased among Arab men.
When the groups of diseases are analyzed separately, it appears that the relative proportion of cancer of the respiratory system out of total new cases diagnosed remained steady in the general population (8% in 1990; 9% in 2013), and among Jewish men and Arab women, while among Jewish women, this relative proportion incerased and among Arab men, this relative proportion decreased.
The relative proportion of cancer of the urinary system of all the new cases diagnosed tended to decline in all population groups with the exception of Arab males, among whom an increase was observed.
The relative proportion of gastro-intestinal and upper respiratory tract cancers of all the new cases diagnosed decreased in the general population and in all population groups.
The relative proportion of liver and pancreatic cancer of all the new cases diagnosed remained steady in the general population and in the Jewish population, however, it increased in Arab men and decreased in Arab women.
The relative proportion of myeloid leukemia of all the new cases diagnosed remained steady in the general population and in all the population groups, with the exception of Arab women, among whom a decline was observed.
The relative proportion of colorectal cancer of all the new cases diagnosed decreased in the general population and in the Jewish population, however it tended to increase in the Arab population (men and women).
Title: Proportion of the types of cancer associated with smoking of all the new cases diagnosed, Israel, 1990, 2013, by population group and gender
Percentage of total new cases diagnosed
From left to right:
Grey - the general population
Yellow/Beige - Jewish men
Blue - Arab men
Orange/pink - Jewish women
Yellow/light yellow - Arab women
Statistically significant changes were observed among Arab women in the following trends. Some of the increase in morbidity among Arab women is apparently attributable to the fact that they are exposed to passive smoking of men in the family. Such that the following was observed:
Please click here for the National Cancer Registry statistics - in detail (Hebrew file)
Over the past two decades, celebrities in Israel and worldwide have courageously revealed their personal struggle with smoking-attributable cancer diseases, and most of them died untimely deaths. First and foremost is actor Yul Brenner who developed lung cancer, and before his death recorded a public service announcement for the American Cancer Society which was also aired in Israel in 1986.
Additional celebrities, among them, mythological animator and entertainment entrepreneur Walt Disney (1901-1966) who died at 65 of lung cancer, Disney was a heavy smoker for most of his life, and that was the cause of his death, charming actor Humprehy Bogart (1899-1957) who died of esophegeal cancer at the age of 57, entertainer, singer and actor Sammy Davis Junior (1925-1990) - who died at the age of 64 of throat cancer; Davis was a heavy smoker. In Israel took, many celebrities died an untimtely death from smoking-attributable disease, among them actor and mime artist Shaike Ophir (1928-1987). Ofir was a heavy smoker and died of lung cancer at the age of 58. Another heavy smoker was Poet and Israel Prize Laureate, Lea Goldberg (1911-1970), who died at the age of 59 of lung cancer.
The ICA endeavors to eradicate the smoking epidemic in Israel on all fronts, and in all sectors, as well as in Arab society, by advocating for legislation and enforcement, providing public information and education on smoking prevention and cessation, promoting research, developing innovative projects, distributing public information materials and delivering smoking prevention training sessions among teens. In February 2015, a 'Lifetime Achievement' award was presented to the ICA for promoting action in the fight against the tobacco pandemic in Israel. Among the activities conducted in Arab society, the following should be underscored:
The ICA funds the salary of professional lecturers, mostly medical and science students, who deliver lectures in Arabic on the hazards of cigarette and hookah smoking, in educational institutions, and at companies and organizations.
The ICA distributes free public information materials on diversified subjects in Arabic, such as the hazards of cigarette and hookah smoking, including brochures, posters and stickers.
Each year, marking World No Tobacco Day, the Annual School Competition on Tobacco Prevention, in memory of the late Dr. Marcus is held in collaboration with the ICA, Shefi-the Psychology and Counseling Unit of the Ministry of Health- and the League against Tuberculosis and Lung Diseases. In recent years, Arab schools have also reached the finals, displaying fascinating projects, initiatives and personal stories.
A national school competition challenging students to design warning labels on cigarette packs was held for the very first time this year in Israel; this was a joint initiative of the Ministry of Health, the Ministry of Education and the ICA. Al Andalus Junior High School of Baka El Garbiya was among the four winners.
New Initiative - Learning Kits on Smoking - 200 "Diffusing the Smoke Screen" learning kits in Arabic were produced and distributed at schools in Arab society, as part of the productive collaboration between the ICA, the Ministry of Health and the Counseling & Psychological Services of the Ministry of Health. The unique kits on smoking are tailored to 6th graders and constitute part of the 'life skills' program taught at primary schools.
'SMS Stop' Program Pilot in Arab set to be launched - this program, developed and funded jointly by the ICA, the Ministry of Health and the School of Public Health of Hebrew University-Hadassah, is tailored to support smoking cessation via text messages (SMS) sent to cellphones, and includes an interactive message system and many elements of personal smoking cessation consultation.
Anti-smoking Campaign - next month, the ICA will launch an extensive public information campaign against smoking in Arabic, Russian and Hebrew.
Prof. Eliezer Robinson, ICA Chairman, who served as Past President of the UICC - Union for International Cancer Control, will serve as this year's Chairman of the Door Knock Fundraising Campaign thanks to an anonymous donation that the ICA received in his honor. Prof. Robinson calls upon the public to lend an outstretched hand and take part in the campaign and open their hands, hearts and doors to collect resources for the ICA's extensive activities - for the patients and against the disease. And adds that: "A long and extensive research study conducted at Harvard University which monitored subjects over a span of 30 years proved unequivocally that one may reduce cancer morbidity and mortality by adopting a healthy lifestyle.
According to this study, the group that maintained a healthy lifestyle had an estimated 35% fewer malignant tumors, and a 50% lower mortality than the second group. Meaning, morbidity and mortality significantly decreased as a result of a healthy lifestyle. In short, in the State of Israel, 30,000 new cases of cancer are diagnosed each year, and an estimated 10,000 patients succumb to the disease. There is currently no medication that can reduce the number of patients and the number of deaths at such a high percentage. I call upon the public to adopt these recommendations in order to continue to maintain their health".
A first-of-its-kind Israeli research study is being conducted at several medical centers across the country. The investigators are examining whether radiation therapy on a healthy breast will help reduce the risk of future cancer in this breast. As part of this research study, genetic carriers receiving radiation therapy for an infected breast are also advised to undergo radiation on the healthy breast at the same time.
Dr. Ella Evron of Tel Aviv Sourasky Medical Center, and Dr. Meirav Ben David of Tel Hashomer, lead this study, which is being funded by the ICA.
This is a multi-center Israeli research study being conducted at Sheba Medical Center, Tel Aviv Medical Center (Ichilov), Rambam Health Care Campus in Haifa, Assaf Horfeh Medical Center, the Medical Center in Nahariya and at Soroka in Be'er Sheva. Female genetic mutation carriers who meet the criteria can join the research study at one of the medical centers.
This study aims to investigate whether preventive radiation on a healthy breast will reduce the high risk of future development of cancer in this breast. The research staff presents a cautious yet optimistic summary of the preliminary results.
If the research hypothesis is proven, in the future we may be able to suggest an preventive radiation as an alternative to preventive mastectomy, for genetic mutation carriers who have developed breast cancer in one breast, or perhaps for genetic mutation carriers who have not developed breast cancer at all, such as for instance, Angelina Jolie, who underwent a preventive double mastectomy and oophorectomy (ovary removal).
Click here to read the interim report of the research on the ICA website (Hebrew file)
Prof. David Levi1, Dr. David Abrams2, Jeffrey Levi3, Dr. Lea Rosen4
A new research study estimates that the implementation of the WHO program will lead to a significant decrease in the prevalence of smoking and untimely smoking-attributable mortality.
In 2011, the State of Israel passed a government decision to adopt the national program to reduce smoking and its hazards. The national program is partly based on the WHO Framework Convention on Tobacco Control (FCTC), which Israel signed in 2005, and on a program called MPOWER, which was designed to provide practical guidelines for the implementation of this treaty.
Researchers from Tel Aviv University and leading research centers in the United States used a simulation model called SimSmoke, in order to examine how the complete implementation of the MPOWER policy package in Israel would affect the prevalence of smoking and untimely smoking-attributable mortality. According to the investigators, despite the government decision in Israel, the recommendations are not being fully implemented.
Of the 1.1 million smokers in Israel in 2014, the researchers estimate that 550-710 thousand smokers will die untimely deaths as a result of smoking. Based on the research, it emerges that the complete implementation of the MPOWER policy package will eventually lead to a 34% reduction in smoking rates within the next 40 years. Consequently, 188-243 thousand untimely deaths will be prevented. The investigators emphasize the importance of an additional tobacco tax hike, increased law enforcement to prevent smoking in public places, launching media campaigns and significant expansion of restrictions on tobacco marketing. The researchers believe that more significant graphic health warnings on cigarette packages and more comprehensive assistance in smoking cessation also play an important role in reducing tobacco related mortality, although to a lesser degree. In addition, the investigators anticipate that the implementation of the recommendations will have additional benefits, such as decreasing morbidity among smokers, reducing the number of those who start smoking and limiting non-smokers' exposure to secondhand smoke.
This research study was published in the September 2016 issue of the Israel Journal of Health Policy Research
Please click here to view the abstract of this article in English
The ICA Information Center Presents New Research Studies
A new research study of several universities in Australia, Norway and Canada established that physical activity can weaken the link between alcohol consumption and cancer, and reduce alcohol-attributable mortality.
For the purposes of this research, the investigators took information from extensive health surveys that were conducted among the British population from 1994-2003. All the subjects who participated in these surveys were asked, inter alia, to complete a questionnaire regarding alcohol consumption as well as to answer questions regarding their weekly physical activity.
Physical activity was evaluated by the MET (Metabolic Equivalent of Task) index which evaluates the intensity of activities (the more intense physical activity is - the higher the MET). 36,370 men and women aged 40 and over participated in this research study, of whom, 5,307 participants indicated that they do not consume alcohol, 9,756 indicated that they did not consume alcohol for about a week prior to completing the questionnaire, and therefore, were classified as those who occasionally consume alcohol; 462 indicated that they drink according to the suggested servings of alcohol per week in Britain - 14 units a week for women and 21 units a week for men (one unit = 25 ml of alcohol). 4,845 participants indicated that they consumed quantities of alcohol that exceeded the recommended amount. The researchers monitored the participants up to 2011. During the course of this period, 5,735 participants died.
Statistical analyses were conducted in order to evaluate the relationship between alcohol consumption and cancer-attributable and all-cause mortality: in order to prevent deviation of the results, the following data was taken into account: age, employment, smoking, background diseases, etc.
Based on the research results, it emerges that subjects who consumed alcohol that exceeded the suggested serving per week, were found to have a 50% higher risk for cancer mortality, compared to those who do not drink at all. Participants who declared that they occasionally drink alcohol were found to be at a merely 8% higher risk for cancer mortality, compared to those who do not drink. In addition, the results indicated that the risk for cancer mortality was higher among participants who consumed large quantities of alcohol, and engaged in little physical exercise (according to MET index), as opposed to participants who did not consume alcohol.
Similarly, a 25% drop in risk for mortality was observed among individuals who engaged in physical activity exceeding 15 MET units per week (intense physical activity, such as running at 16km/ph) and occasionally consumed alcohol. In short, the investigators indicate that physical activity plays a significant role in maintaining one's health, even when if this lifestyle comprises less healthy components, such as alcohol consumption. This research study was published in the British Journal of Sports Medicine in August 2016 and was translated by the ICA Information Center.
Please click here for the research abstract in English.
A new study conducted in China, investigated the link between garlic consumption which is known for its healthful properties, and lung cancer morbidity. 399 lung cancer patients aged 20 and over participated in the study; these patients had been admitted to the hospital in the past as a result of their disease. The control group comprised 466 healthy individuals with similar age statistics. Demographic and medical data were collected form the participants, as were data on nutrition habits and lifestyle. They were also asked about their level of raw garlic consumption and smoking habits. Based on the collected research results, it emerged that the greater and more frequent the raw garlic consumption, the lower the lung cancer incidence. In other words, the more garlic was consumed and the greater the frequency of consumption, the lesser the risk for smoking-attributable cancer. The following are the research data on garlic consumption percentages, according to its consumption, among the patient group and healthy group:
Garlic consumption level
Non-consumption of garlic
Garlic consumption at some point in life
Occasional consumption of garlic (less than twice a week)
Frequent consumption of garlic (twice a week or more)
In the study, a slightly greater impact on reducing the risk for lung cancer was observed in women and young people (aged 55 and younger) who are garlic consumers, as opposed to the rest of the participants. The researchers assume that smoking habits contributed to these differences, as most of the women who participated in the research never smoked and most of the young participants were women. Based on the research statistics, a link between smoking status among garlic consumers and cancer morbidity was also observed: among individuals who never smoked, the greater the consumption of raw garlic, the lower the lung cancer morbidity. Among garlic consumers who are also smokers, a similar link was not observed.
To conclude: the research results indicate that raw garlic consumption may reduce the risk of developing lung cancer, respective of the level of consumption. The researchers are of the opinion that additional research studies are required to examine this link, among larger and more diversified population groups. This research study was published in the April 2016 issue of the Cancer Epidemiology, Biomarkers & Prevention Journal and was translated by the ICA Information Center.
A new study conducted by researchers from various medical centers in China, examined the gender-related impact on the link between BMI and the risk for 16 different types of cancers. The research study was based on 51 different studies from around the world, and analyzed statistics of an estimated 155 thousand women and men including their BMI, according to the classification of underweight, normal weight, excess weight and obesity, as well as categorization according to different types of cancers.
Based on the research results, it emerged that gender has a significant effect on the link between BMI and the risk for several types of cancer. In a comparison between men and women who are obese (BMI exceeding 30), the risk of obese men to develop liver cancer was 29% higher than that of women in this weight group. In the case of colorectal cancer, men's risk was 17% higher than that of women. Specifically, in terms of intestinal cancer, men were at a 27% higher risk than women, and their risk of rectal cancer was 16% higher.
Conversely, women's risk for developing lung and kidney cancer in this weight group was 20% higher than men's risk in the same group. In a comparison between obese men and women (BMI of 25-30), obese men's risk for colorectal cancer was 9% higher than that of women in this weight group, and specifically, in terms of rectal cancer, men's risk was 6% higher than that of women.
On the other hand, the risk of women in this weight group for lung and kidney cancer was significantly higher than that of men in the same group, and stood at 14% increased risk for lung cancer, and 15% increased risk for kidney cancer. In a comparison between underweight men and women (BMI less than 18), women in this weight group had a 17% lower risk of stomach cancer and liver cancer than men in the same group. Conversely, women in this weight group had a 25% higher risk of bile duct cancer than men in the same weight group.
In a nutshell, gender had a significant impact on the link between BMI and the risk of developing several types of cancers. The difference is particularly significant in colorectal cancer, in all groups. According to the research data, obesity was linked mainly with an increased risk for liver and bile duct cancer; whereas underweight was associated with a lower risk for stomach and liver cancer in women and in bile duct cancer in men. This study was published in the September 2016 issue of the European Journal of Cancer Prevention and was translated by the ICA Information Center.
Please click here for the abstract of this article in English
A long, comprehensive and new study conducted by Harvard University in the U.S., monitored subjects in a study spanning 30 years and examined the impact of lifestyle among the male and female population in the United States on the scope of morbidity and mortality for various cancer types. The research study was based on data from 2 long-term research studies comprising an estimated 90,000 white females and 46,000 white males in the United States. The study participants were asked to complete detailed questionnaires pertaining to their lifestyle and health condition at the beginning of the research study, and once again every two years until the completion of the surveillance period spanning 30 years. For the purposes of this study, the participants were divided into 2 risk groups according to 4 criteria which reduce the risk for cancer. Participants who met all the parameters were included in the low risk group and the rest belonged to the high risk group.
1. Smoking - not at all, or a history of smoking up to one pack per day for a maximum of five years.
2. Alcohol consumption - not at all or moderate consumption (up to one drink a day for women and up to 2 drinks a day for men).
3. Body weight - Body Mass Index (BMI) of 18.5-27.5 at the most.
4. Weekly vigorous - intensity aerobic activity for 75 minutes or 150 minutes of moderate-intensity aerobic activity.
According to the findings, the researchers arrived at the conclusion that the risk of developing cancer in general stood at a 25% increased risk among women and a 33% increased risk among men in the high risk group as opposed to the low risk group. In the low risk group, as opposed to the general population, women had a 41% increased risk and men had a 63% increased risk.
The overall cancer mortality risk stood at a 48% increased risk among women and a 44% increased risk among men in the high risk group, as opposed to the low risk group. In the low risk group, as opposed to the general population, women had a 59% increased risk and men had a 67% increased risk.
Differences between men and women in risk of cancer incidence and mortality for specific cancer types emerged from the research findings. For example, in the case of lung cancer, the risk for cancer was 82% higher in men and 78% higher in women in the high risk group, as opposed to the low risk group.
In pancreatic cancer, the risk of developing cancer was 30% higher in men and 29% higher in women in the high risk group, as opposed to the low risk group. The risk of developing colorectal cancer in the general population as opposed to the low risk group stood at a 59% higher risk among men and a 60% higher risk among women.
The mortality risk for these four cancers was similar among both sexes.
Consequently, the researchers concluded that adopting a healthy lifestyle, according to the four categories defined in this study, which are avoiding smoking, moderate alcohol consumption, maintaining a healthy body weight, and engaging in aerobic activity, can significantly reduce cancer morbidity and mortality. This study was published in the May 2016 issue of the JAMA Oncology medical journal and was translated by the ICA Information Center.
Cancer patients and their families are welcome to call ICA's 24-hour Telemedia teleinformation hotline at: 1-800-599-995 if they have any questions, or to receive free brochures on coping strategies for patients to face cancer, treatments, rights and services, clinical research studies, events and seminars for patients; they are also encouraged to visit ICA's website.
Israel Cancer Association