For decades, misinformation and misconceptions about nicotine’s role in cancer and tobacco-related diseases have dominated public health discussions. These misconceptions are not limited to the general public; even among medical professionals, confusion persists. A Rutgers-led study found that about 80 percent of physicians surveyed believed nicotine directly causes cancer.
Speaking during a session on Lessons in Tobacco Harm Reduction, where he shared insights from an oncologist’s perspective, Professor David Khayat said nicotine misinformation remains widespread among doctors and physicians.
“We see that there are many physicians who still think that nicotine causes cancer,” said Professor Khayat. “There is a lot of misinformation. I was shocked because I lecture all around the world about smoking, radiation, and cancer. Recently, I was in Mexico at a medical university with about 800 doctors and medical students in the room. I asked, ‘Who thinks nicotine causes cancer? Please raise your hand.’ More than 80 percent raised their hands. They still believe nicotine causes cancer, which is absolutely wrong.”
For years, medical and public health efforts have relied on nicotine replacement therapy (NRT) to help people quit smoking.
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“Every doctor in the world has been prescribing nicotine replacement therapies to people trying to quit smoking. Have we prescribed a carcinogen? For forty years, we have given them gums and patches. Are we providing them with something that gives them cancer? Not at all. How can you believe it is good to prescribe nicotine replacement therapies and at the same time believe nicotine causes cancer?”
A Broader Look at Cancer Causes
Professor Khayat is one of the world’s leading oncologists. Beyond oncology practice and academic teaching, he is also a chef and the author of The Anti-Cancer Diet, a recipe book promoting cancer prevention through healthy eating. He believes cancer is largely a lifestyle-related disease, linked to diet and exposure to carcinogens from smoking combustible tobacco and environmental sources.
“The more red meat you eat, the higher your risk of colorectal cancer. The more you stay in the sun, the higher your risk of skin cancer,” he added.
Although smoking-related deaths have declined globally, cancers linked to tobacco remain high despite strict regulations, high taxation, and widespread public health campaigns. Smoke-free products have not yet been fully endorsed by global health authorities as less harmful alternatives.
“In 1990, tobacco smoking was the leading cause of cancer. In 2021, thirty-one years later, tobacco was still the leading cause. If we had succeeded in treating cancer, tobacco’s ranking should have gone down, but it hasn’t. We have failed. There were 1.2 billion smokers then; there are still 1.2 billion smokers today. We must accept an alternative. If people continue to smoke tobacco, many of them will die,” he said.
The Role of Oncologists in Tobacco Harm Reduction
The World Health Organization estimates that tobacco causes up to 25 percent of all cancer deaths globally, making it the single greatest avoidable risk factor for cancer mortality. Tobacco use is linked to more than 20 different cancer types.
It is therefore crucial for oncologists to use their voices to communicate accurate science about Tobacco Harm Reduction. Oncology is the branch of medicine dedicated to the study, diagnosis, treatment, and prevention of cancer.
“As oncologists, we have to trust the science,” said Professor Khayat in an interview with AllAfrica. “Science tells us nicotine does not cause cancer, so let’s stick to that. People smoke because they want nicotine, so let’s give them nicotine without the tobacco. Doctors have trusted voices in society, and we must use those voices, as I am doing here.”
He also reflected on the emotional and economic toll of cancer on families and nations.
“I have witnessed thousands of deaths from tobacco-related cancers. I would like the next generation of oncologists to see fewer of these deaths,” said Professor Khayat.
The Economic Burden of Tobacco-Related Cancer in Africa
The Seventh Tobacco Atlas Report (2022) revealed that smoking prevalence is increasing in several African countries. This trend is expected to continue, especially in nations with low Human Development Index (HDI) scores. Rising incomes, greater cigarette affordability, and aggressive marketing by the tobacco industry have contributed to this growth.
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Professor Khayat did not mince his words about the projections for cancer in Africa over the next two decades.
“None of the countries in Africa are prepared for the coming cancer epidemic. In all of Africa except South Africa, there are only six or seven radiotherapy centers. In some countries like Namibia, there is just one oncologist for the entire nation. They are not prepared. They lack facilities, and medical professionals are not adequately trained,” he said.
The cost of cancer affects not only human lives but also the economic well-being of nations. When breadwinners die young, productivity drops, and Gross Domestic Product (GDP) growth slows.
“The only way to stop this tragic situation is through prevention. If we know tobacco is a major cause of cancer, we must focus on tobacco. According to WHO projections, within 20 years, 75 percent of cancer-related deaths will occur in countries that collectively contribute less than 5 percent of the world’s GDP. Sadly, many of these nations are in Africa. They are not prepared. This is our last chance to act,” he said.
