Estimating the burden of cancer attributable to tobacco in Bangladesh in 2020

Background: Information on the attributable fraction (AF) of cancer in Bangladesh is scarce. We aimed at estimating the AF of tobacco-related cancer in Bangladesh in 2020. Methods: Data on prevalence of tobacco use (smokeless, smoking products, and second-hand smoke [SHS]) were derived from the Global Adult Tobacco Survey report (2009), while data on relative risks were derived from meta-analyses and large-scale Indian studies. The GLOBOCAN 2020 database was used to obtain the number of cancer cases and deaths. Concomitant use of both tobacco products was accounted for. Sex-specific and combined estimates were calculated, based on the counterfactual scenario of no exposure to tobacco. Results: Smokeless tobacco was primarily responsible for oral (55.3 %), esophageal (37.1 %), laryngeal (33.4 %) and pharyngeal (31.5 %) cancer. Cigarette smoking was responsible mainly for esophageal (40.1 %), pancreatic (34.2 %) and lung (26.0 %) cancer, while bidi caused mainly pharyngeal (49.2 %), laryngeal (36.4 %) and esophageal (33.3 %) cancer. Overall, smokeless tobacco caused 14.6 % of cases and 15.1 % of deaths, while cigarette smoking caused 11.8 % of cases and 15.3 % of deaths and bidi smoking 14.1 % of cases and 15.8 % of deaths. SHS caused 0.10 % and 0.13 % of cases and deaths respectively. The combined use of tobacco products particularly contributed to esophageal and pancreatic cancers. Conclusions: Tobacco was a major cause of cancer in Bangladesh in 2020, with smokeless and bidi smoking overcoming cigarette's contribution. Its control would greatly reduce cancer burden.