Smoking and lung cancer: why deaths keep rising in Spain

The decline in smoking does not contradict the rise in lung cancer deaths: cancer takes decades to develop, so the deaths recorded in 2018 reflect tobacco consumption in the 1980s and 1990s, when smoking was far more common.

The figure is striking. In **1990**, **34%** of the Spanish population smoked and around **13,000** people died of lung cancer. In **2018**, **19%** smoked and deaths rose to **22,000**. Fewer smokers, more deaths. The apparent contradiction has an explanation, and there is no need to resort to strange theories.

## Tobacco kills with a delay of decades

Lung cancer does not appear the year after lighting the first cigarette. Most tumours are diagnosed in people who smoked for decades and, in many cases, had already quit. The deaths of **2018** largely correspond to those who smoked heavily in the 1970s and 1980s, when consumption was much higher than today. The decline in smoking only began to show up in mortality figures much later.

## Why clean air does not offset tobacco

Air pollution does play a role in lung cancer, but its impact is small compared with tobacco. Cleaner cars have indeed reduced urban pollution, but that does not erase the effect of a habit that multiplies the risk. **Tobacco** remains the leading preventable cause of lung cancer in Spain. No environmental improvement can make up for what was already smoked.

## Mortality is also rising because there are more older people

Spain has aged. In **1990**, life expectancy was lower and the population younger. Lung cancer is a disease concentrated in older ages, so an older population produces more cases and more deaths even as the percentage of smokers falls. The absolute number of deaths is not the same measure as the age-adjusted rate.

The figures are not opinions, but they do not speak for themselves either: they must be read with a clock in hand. If in doubt about tobacco and health, consult a healthcare professional.