title: Smoking-attributable burden of lung cancer in the Philippines.
abstract: BACKGROUND
  In the Philippines, smoking is highly prevalent and tobacco control policies fail to fully implement the WHO Framework Convention on Tobacco Control provisions. To aid in policy change, intervention implementation, monitoring and evaluation, this study aimed to provide the first internally consistent and latest Philippine estimates of the following: disability-adjusted life-years (DALYs) lost due to lung cancer; population-attributable fractions (PAFs) of smoking; and smoking-attributable lung cancer DALYs.
  
  
  METHODS
  This study applied the Global Burden of Disease and Comparative Risk Assessment frameworks to secondary data, supplemented by expert opinion. A comprehensive internally consistent assessment of disease epidemiology was conducted using DISMOD II and disease impact was quantified as DALYs. PAFs were calculated using the smoking impact ratio and Monte Carlo uncertainty analyses were conducted.
  
  
  RESULTS
  For 2008, lung cancer incidence and mortality estimates were 10 871 cases and 9871 deaths respectively. Lung cancer accounted for an estimated 267 787 DALYs lost, 99% of which were due to years of life lost. Overall, the PAF of smoking was 65% and a total of 173 103 DALYs were smoking-attributable. There were increasing trends in incidence, mortality and DALY rates with age. The majority of incidence (72%), mortality (71%) and disease burden (72%) occurred among men, who also had higher PAF estimates.
  
  
  CONCLUSIONS
  Considerable health gains could be achieved if smoking exposure were reduced in the Philippines. Strong enforcement of measures like increasing taxation to the WHO-endorsed rate, expanding smoke-free environments, and requiring large graphic warnings within a comprehensive tobacco control programme is recommended.
authors.affiliation: Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Ver Luanni Feliciano
authors.initials: VL
authors.lastname: Bilano
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Manila, Philippines.
authors.forename: Maridel P
authors.initials: MP
authors.lastname: Borja
authors.affiliation: School of Multidisciplinary Studies, De La Salle-College of St Benilde, Manila, Philippines.
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Cruz
authors.affiliation: Research Institute for Tropical Medicine, Manila, Philippines.
authors.forename: Alvin G
authors.initials: AG
authors.lastname: Tan
authors.affiliation: Department of Medicine, Clinical Trial Unit, Research Development Office, MCU-FDTMF Hospital, Caloocan City, Philippines.
authors.forename: Lalaine L
authors.initials: LL
authors.lastname: Mortera
authors.affiliation: Section of Cardiology, UP College of Medicine and Philippine General Hospital, Manila, Philippines.
authors.forename: Paul Ferdinand M
authors.initials: PF
authors.lastname: Reganit
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D017281:Cost of Illness; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000139:chemically induced* / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D010679:Philippines / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects*
keywords: Low/Middle Income Country; Smoking Caused Disease; Surveillance and Monitoring