Cancer rarely appears overnight. It develops over time, often without obvious signs, and by the time it is detected, the damage is already significant. Globally, it remains one of the leading causes of death, responsible for roughly one in every six deaths.
In Pakistan, the burden continues to rise. Estimates suggest more than 180,000 new cancer cases each year, along with over 118,000 deaths. Late diagnosis, limited treatment access, and gaps in the healthcare system all contribute to this trend.
Lung cancer stands out within this broader picture. Data indicates around 22,000 new cases annually, with nearly 19,000 deaths, making it one of the most fatal cancers in the country. Among men, it is particularly common, and survival rates remain low due to delayed detection.
The primary cause is not unclear. Smoking remains central to this burden.
The reason smoking is so harmful is not simply the presence of tobacco or nicotine, but the act of burning. When a cigarette is lit, it produces smoke containing a complex mix of chemical compounds, many of which are harmful. These substances are created during combustion and are not present in the unburnt material.
Nicotine is what keeps people smoking because of its addictive nature. However, the diseases most commonly linked to smoking, including lung cancer, heart disease, and vascular damage, are driven by repeated exposure to toxic substances produced through burning. These chemicals damage cells, trigger inflammation, and increase the likelihood of cancer over time.
Estimates from global health bodies suggest that a large majority of lung cancer deaths are linked to smoking, a pattern that holds true across many countries, including Pakistan.
Public health efforts have long focused on prevention and encouraging people to quit, and this remains essential. Quitting smoking is still the most effective way to reduce risk. But quitting is not easy. Many smokers attempt to stop multiple times and still relapse, often because of addiction rather than lack of awareness. In Pakistan, access to structured cessation support remains limited, making this challenge even greater.
This creates a gap in policy. While quitting is the goal, it is not always immediately achievable for everyone. Many smokers continue despite knowing the risks, which means exposure to harmful smoke continues.
This does not change the importance of quitting. Instead, it highlights the need to focus on where the harm comes from, the repeated exposure to toxic substances created by combustion.
It is also important to recognise that cigarettes are not the only source of this exposure. Shisha use, for example, also involves burning tobacco and produces similar harmful by-products. The underlying mechanism remains the same: combustion generates the substances that cause damage.
In Pakistan, a large proportion of lung cancer cases are linked to tobacco use, although other factors such as air pollution and occupational exposure also contribute. Together, these risks increase the overall burden.
Most smokers are already aware that smoking is harmful. The challenge lies in what follows that awareness. Addiction makes quitting difficult, and continued smoking keeps the body exposed to harmful substances over time.
Reducing the impact of lung cancer in Pakistan will require more than repeating warnings. It requires a clearer understanding of how harm is created and policies that reflect both the science and the realities faced by smokers.
