World Cancer Day was celebrated on February 4, providing an opportunity for oncologists and scientists to discuss new ways to combat this devastating disease. During his visit to Dakar in Senegal, Professor David Khayat, a medical oncologist at the Bizet Clinic in Paris and former president of the French National Cancer Institute, gave an exclusive interview to allAfrica. In the interview, he advocates for a pragmatic approach to smoking control, emphasizing harm reduction strategies.
Failure of Traditional Anti-Smoking Policies?
“Few people know why February 4 is World Cancer Day,” Prof. Khayat explains. “The reason dates back to February 4, 2000, when I co-authored and signed the UNESCO Charter Against Cancer with several oncologists, alongside the Director-General of UNESCO and former French President Jacques Chirac. That charter strongly emphasized prevention.”
He highlights that harm reduction in smoking is crucial in public health because total smoking cessation is often unrealistic for many smokers. While 95% of cancers are linked to environmental and behavioral factors—including smoking, alcohol consumption, poor diet, sun exposure, and pollution—anti-smoking policies have largely failed to significantly reduce the number of smokers.
According to Prof. Khayat, traditional anti-smoking measures, such as price increases and awareness campaigns, have not had the desired impact. “Twenty-five years ago, in 1990, smoking was the leading cause of cancer worldwide. In 2021, it was still the leading cause. We raised cigarette prices, placed shocking images on packs, but it didn’t work,” he observes.
Nicotine addiction makes quitting extremely difficult. He cites a U.S. study showing that 64% of lung cancer patients continue smoking, even after diagnosis and despite knowing the risks. “You can tell someone to quit, but they won’t, even if they know it could kill them. Instead of demanding total cessation, we should focus on reducing their exposure to risk,” he explains.
Prof. Khayat stresses the widespread misconception that nicotine is the main cause of smoking-related cancers. “Nicotine does not cause cancer. This has been confirmed by every major global health agency. Yet the myth persists,” he states.
He clarifies that it is the combustion of tobacco, not nicotine, that produces toxic, carcinogenic substances. That is why he supports transitioning smokers to smoke-free alternatives, such as e-cigarettes and heated tobacco products, which deliver nicotine without exposing users to harmful combustion byproducts. “These alternatives are not risk-free, but they significantly reduce exposure to carcinogens—by up to 98%,” he explains.
Harm Reduction: An Ethical and Political Debate
For some public health experts, the only acceptable solution is total smoking cessation. However, Prof. Khayat argues that this stance is unrealistic and dogmatic. “I’ve seen too many lung cancer patients die to simply tell them, ‘Too bad for you, you shouldn’t have smoked,’” he declares.
He also criticizes the World Health Organization (WHO) for its rigid opposition to harm reduction alternatives.
“The WHO takes an extreme position, as if banning smoking is enough to solve the problem. But prohibition has never worked—whether it was alcohol in the 1920s in the U.S. or tobacco today,” he argues.
In January 2020, U.S. President Donald Trump announced the withdrawal of the United States from the WHO, citing lack of transparency, poor handling of COVID-19, and excessive political influence. Similarly, the WHO’s management of the Framework Convention on Tobacco Control (FCTC) and its Conference of the Parties (COP) has faced growing criticism.
On this issue, Prof. Khayat shares his perspective: “I think the reasons given are not false. The WHO lacked transparency with the Covid crisis. They took months before saying that it was an epidemic and the investigations went to China, they came back with analyzes revealing that it was not China. This lack of transparency and objectivity is concerning. As a practitioner, I see it now. Whether the sanction is to stop financing or not, I cannot say.”, he said.
“During the pandemic, people who were inactive at home, anxious, smoked a lot,” he adds. “Unfounded studies have said that those who smoked have a lower risk of catching Covid. The problem today is that social networks amplify anything, which increases misinformation. It should be noted that smoking is always harmful. The lack of transparency, the much too strong political influence on the WHO are things that pose a problem.”
What Lies Ahead?
Prof. Khayat calls for a policy shift based on technological innovation and appropriate regulation. He cites Sweden as an example, where the use of snus (a smokeless tobacco product) has helped achieve one of the lowest lung cancer rates in Europe. “We need strict regulations to prevent misuse—especially among young people—but we must also accept that harm reduction is a pragmatic solution,” he insists.
He also warns that other factors could soon surpass smoking as the leading cause of cancer. “Obesity is set to overtake smoking as the number one risk factor for cancer by 2030. Air pollution, particularly fine particulate matter, is also becoming a major contributor,” he cautions.
In conclusion, Prof. Khayat delivers a clear message to smokers: “If you can quit, do it. But if you can’t, at least reduce your exposure to carcinogens by switching to safer nicotine alternatives. That’s your best chance to lower your cancer risk.”
With traditional anti-smoking efforts stagnating for decades, his call for a science-based, harm-reduction approach could be the key to finally decreasing lung cancer rates worldwide.
