Islamic teachings and cancer prevention.

It was widely reported that 80 to 90 percent of all cancers are related to life style and environmental factors, which could be is some way preventable. Lung cancer is the most vivid example, where 80 to 85 percent of these cases are directly related to smoking. Worldwide tobacco smoking and chewing is responsible for 2.5 million deaths annually.Tobacco smoking and chewing is responsible for many cancers beside lung cancer, eg. cancer of the Month, cheeks, tongue, lips, pharynx, larynx and esophagus. It is also a contributing factor in cancers of the bladder, kidney, pros-tate, cervix and stomach.Islamic teachings prohibit smoking. There are hundreds of Fatwas (decrees) that prohibit smoking and chewing of tobacco since its first introduc-tion to Islamic countries ie. 100 H / 1591 A.D.If the Muslims adhere to these Fatwas, they will eradicate a major cause for cancer. It will also reduce the deaths due to other lung diseases and ischemic heart diseases which showed relentless increase in most Islamic countries.

INTRODUCTION

It is estimated that 80 to 90 percent of all cancer cases are related to environmental and life style influences1. The majority of human cancers are preventable, and many cancer research centers estimate that 80 to 90 percent are preventable.2 Extrinsic factors include, beside chemicals, infections (viral and parasitic), nutritional and a variety of other factors determined wholly or partially by personal behavior. Though genetic factors and age affect cancer onset rates, they do not alter the conclusion that much human cancer is avoidable2.

Islamic teachings which control human behavior and personal life-style can dramatically influence the rate of incidence of many malignancies. Many cancers are related to the chewing and smoking of tobacco, the consumption of alcohol, homosexuality, promiscuity and excessive exposure to solar radiation such as in sunbathing, which are prohibited in Islam. Adherence to these teachings will curtail the incidence of many malignancies and curb the spreading epidemic, at least in Muslim populations, amounting to one billion.

Dr. John Hill, a London Physician, reported an increase of lip cancer in pipe smokers in 1761 and Sir Percival Pott reported cancer of the scrotum in a chimney sweep in 1777, which he attributed correctly to lodgement of soot in the rugose scrotal skin. This type of cancer was virtually eliminated by simple personal hygiene.3 Later, many chemicals were found to be carcinogenic with the result that many cancers caused by these chemicals are now thought to be avoidable with careful handling. Ionizing radiation is still an important hazard preventable by meticulous care.

TOBACCO AND CANCERS

In many countries cancer is the second most important cause of death. In the U.S.A. and many developed countries, it accounts for 20 percent of all deaths.1–2 It is estimated that a million of the 6 million new cases of cancer that occur worldwide annually are caused by the chewing and smoking of tobacco4. It is also estimated that 30-40 percent of all cancers are related to tobacco which makes it the most important single factor in cancer causation. The death toll due to malignant disease in the U.S.A. amounts to 400,000-450,000 annually of which 100,000 are due to lung cancer,12 85 to 90 percent of this is due to cigarette smoking.

No other single agent which has been examined in as much detail, is more firmly established as a causal agent or as responsible for more cancer deaths than cigarette smoking.6 The risk of cigarette smokers developing lung cancer increases with the number of cigarettes smoked, the duration of smoking, and the type of smoking done. Approximately one sixth of those who smoke two packs of cigarettes per day will eventually develop lung cancer. Those who smoke 40 cigarettes per day have a 25 fold increased risk compared to non smokers.6–8 Cigarette smoking causes all of the major types of lung cancer including squamous cell carcinoma, adeno carcinoma, oat cell and large cell carcinoma.6 Cancer of the lung was a rare form of cancer at the beginning of this century, even in developed countries. As smoking increased dramatically among men after World War I and among women after World War II, the incidence of cancer of the lung continued to increase until the seventies, after which in men it began to decrease, but it took another decade for that trend to occur in women. Nevertheless, cancer of the lung is still the primary killing cancer among men and women in manydeveloped and developing countrics79–13 In Hong Kong, the rate for women is now the highest in the world.13 Lung cancer rate in Chinese men, for example, in Shanghai 50.2 per 100,000 which is higher than in many North American and European populations.13 It is the leading cause of cancer mortality among males in Bulgaria, Cuba, former Czechoslovakia, Egypt, Greece, Hong Kong, Hungary, Israel, Philippines, Poland, Romania, Singapore, Thailand, Uruguay, and Zimbabwe. The risk is particularly high among cigarette smokers, and a clear-cut dose-response relationship has been confirmed. The risk is greater among those who started smoking at a young age and those who smoke high yield tar cigarettes.214–16

Laryngeal cancer is the second cancer caused by cigarette smoking, but the total number of cases is smaller than lung cancer and the survival is much better.6 Cigarette smokers are five times more likely to develop cancer of the oral cavity and the esophagus compared to non smokers.678 There is synergism between alcohol and cigarette smoking in causing cancer of the larynx, esophagus and oral cavity.617–21

Cigarette smoking is also an important contributing factor in cancers of the bladder, kidney and pancreas.6–814–1622 An association between gastric cancer and smoking has been noted.23–26

Cigarette smoking has even been implicated in cancers of the breast, kidney, liver, cervix, uteri and many others.27–29 It is also known to be related to childhood cancer as a result of prenatal exposure to parents’ smoking.30 Passive smoking has been implicated in many cases of cancer.31–33

SMOKELESS TOBACCO

Long term chewing of tobacco or the use of snuff has been linked to cancer of oral cavity, cheek, gums and oropharynx.6 Oral cancer is one of the ten most common cancers in the world. In Bangladesh, India, Pakistan and Sri Lanka, it is the most common malignant disease and it accounts for a third of all cancers. More than 100,000 new cases occur annually in South and South East Asia.13 The commonest cause for oral cancer is tobacco chewing, usually in the form of betel quid which consists of betel vine leaf (pipe betel), areca nut, lime and tobacco.133 Tobacco chewing is also widespread in parts of Yemen, Sudan and Southern Province of Saudi Arabia. The so-called “shamma” is mixture of tobacco, lime and ash. It has been implicated in many cases of oral cancer in these areas.3536

Smokeless tobacco was publicised in developed countries by tobacco companies after the decline of cigarette smoking there. The 39th World Health Assembly in 1986 adopted Resolution WHA39 which declared that “the use of tobacco in all its forms is incompatible with the attainment of health for all by the year 2000”37 The study group concluded that the use of smokeless tobacco caused cancers in humans; the evidence of casualty being strongest for cancers of the oral cavity. It also increased the risk of cancers of the nasal cavity, pharynx, larynx, esophagus, pancreas and urinary tract. Laboratory studies clearly supported the observation that smokeless tobacco caused a number of precancerous oral lesions.37

CARCINOGENS IN TOBACCO SMOKE

Tobacco smoke is an aerosol consisting of about 2000 different substances, 50 of which are already proven to be human carcinogens e.g. Benz-a- pyrines, Benz-a- anthracene, Benzo flouranthene, Benzene and other Benzyl derivatives, cadmium, chrysene, 5 methylchrysene methyl flouranthene andnitroso compounds.3839

There are ample clinical and laboratory data to prove the association of cancer and tobacco smoke. Cigarette smoke also contains significant amounts of radioactive substances such as thorium Th228, polonium-210 and radium-Rd226. These compounds lodge in the lungs where they constantly irriadiate the nearby cells and as a result facilitate malignant change.38 Even the urine of cigarette smokers contains mutagenic substances for bacteria, and substances that cause changes in the chromosomes of human cells in tissue culture.

Side stream smoke which is inhaled by the non smokers contains 50 fold greater concentration of nitrosamines than mainstream smoke. In one hour of breathing in a smoke filled room, a non smoker may inhale an amount of nitrosamines equivalent to the amount inhaled after smoking 15 filtercigarettes.38

CESSATION OF SMOKING

The risk after the cessation of smoking decreases dramatically. The risk to light smokers 10 to 15 years after the cessation of smoking is approximate to the risk to non-smokers. Heavy smokers have a residual two to three fold increase after cessation.26 The mechanism of lung carcinogeneses and smoking cessation has been extensively studied.40

WOMEN AND SMOKING

Women started smoking long after men and hence there is a time lag of the onset of lung cancer. In the early eighties the incidence of lung cancer had already decreased for men in most developed countries while it was still increasing for women. In 1984, 32 percent of the women in Britain as compared with 36 per cent of the men smoked.41 In 1961, 60 percent of the men in Britain as against 40 percent of women smoked. The average woman smoked half as many cigarettes as her male contemporary in 1950, while in the eighties they smoked almost the same quantities viz 16 for a man and 14 for a woman.41

During the second decade of anti-smoking campaign in Britain, smoking among women too began to decrease. Though it was slow at first the rate of decrease is accelerating.42 Similar trends are found in all developed countries. In countries such as Australia, smoking among young and middle-aged women rose in the early eighties.54344 The proportion of men who smoked fell in 19 of 22 developed countries, while for women it rose or stabilized in 11countries.42–44 In Austria, Germany, Italy, Japan, and the former U.S.S.R., smoking among women continued to rise in the early eighties.42

Lung Cancer is the primary killing cancer in men and women in many developed countries. It has already surpassed breast cancer as a daunting killer. Non smoking wives of smoking husbands are also afflicted with lung cancer,631–3337 so are non smoking women who share space with smokers in their work places.

SMOKING TRENDS IN DEVELOPED AND DEVELOPING COUNTRIES

Anti-smoking campaigns have been launched in the developed countries in the last three decades with tremendous achievements. In Britain, 60 percent of the men were smokers in 1961 (the year before the first report of the Royal College of Physicians on smoking was published). By the time the second report was published in 1971, this figure had dropped to 47 percent, by 1984 only 36 percent were smoking, and by 1992 less than 25 percent of the adult males smoked. It took another decade for the trend in women to show a similar decline. From 1961 to 1971, the percentage of women smokers remained static at 40 percent, but by 1984, the number had dropped to 32 percent4245

Similar trends were observed in the U.S.A., Europe and other developed countries.42–44 About 30 million people in the U.S. and 10 million British had stopped smoking by the mid-eighties. Cigarette sales have consequently plummeted by an impressive 28 percent.42 The trend means 5-10 percent loss of revenue to the tobacco industry annually.

This achievement has been countered with the promotion of cigarette marketing in the poor Third World which is already suffering from serious health hazards. Consumption of tobacco in the Third World has seen a horrendous increase. W.H.O. noted that tobacco related diseases are on the increase in developing countries.

All developing countries have shown a marked increase in tobacco smoking during the last three decades. In Senegal, the percentage of men in urban areas who smoke has reached an unprecedented 80 percent. In Bangladesh, 70 percent of the adult male population smoke. In Lagos, 72 percent of the Faculty of Medicine male students smoked.46

It is clear that the tobacco companies which manufacture 10 billion cigarettes daily are making up their losses in the developed countries by increasing their sales in the poor developing countries.

Tobacco is imported into Saudi Arabia and the statistics from the Chamber of Commerce show an unbelievable increase of tobacco imports from 4,575,267 kgs in 1972 to 27,026,836 kgs in 1977 which rocketed in 1981 to 36,732,500 Kgs and to 42 million kgs in 1984,47 an increase of 900 percent. Since then the increase has been modest, though Saudi Arabia was the world's third leading importer of U.S. made cigarettes in 1984.48 It is not surprising to find that the incidence of lung cancer in Saudi Arabia has jumped by leaps and bounds. It was the 12th most common cancer in a 1950-1961 study,49 but it became the third most common cancer in the 1979-1984 study.50 It is expected to be the leading cancer in the nineties as the effects of smoking unfold.

The unscrupulous tobacco companies have launched the most aggressive promotion campaigns in the Third World where devious methods of corruption are used with government officials to allow promotion policies. In 1982, the head of the Malaysian parliament retired and went to work as a chairman of Rothmans, Malaysia's largest cigarette manufacturer.4851 Ethiopia imported 200 million expensive British cigarettes in 1984 when a large portion of its population were starving.52 In Bangladesh, smoking of five cigarettes daily robs the family of a quarter of its food supply, which results in an estimated 18,000 deaths among children annually.53 Unfortunately, the World Bank and Western Governments co-operate with the seven giant tobacco companies (3 American, 3 British and one French). The World Bank has given Pakistan 60 million dollars in loans to grow tobacco and The United States Food for Peace Programs have spent 2 billion dollars in loans to developing countries for the purchase of U.S. tobacco and for the establishment of tobacco projects and factories.4851 Tobacco needs curing with heat, which is obtained by burning wood. This results in deforesting 7 million acres annually, with its attendant detrimental effect on the ecology. The cultivation of tobacco requires a heavy use of pesticides, many of which are carcinogenic. In developing countries, they are used without protective measures and result in many fatalities.

Tobacco promotion is not banned in Third World countries and many of the brands marketed contain high yield tar. Cigarettes smoked in China, India, Pakistan, Sri Lanka, Philippines etc., contain 21-33 mg tar and 2-3 mg nicotine; while in the developed countries of the U.S.A., Canada, Western Europe, it is illegal to market cigarettes containing more than 15 mg tar and I mg nicotine.134648

China consumes one third of the worlds production of cigarettes, the other developing countries consume another third.4854 and the Eastern and Western block combined consume the remaining third.

W.H.O. emphasizes the need for a ban on tobacco promotion. The ban should be fully implemented, well publicized, given major priority by governments and health authorities and maintained on a long-term basis.13

ISLAM AND TOBACCO

Muslim Muftis and grand ulema proscribed smoking tobacco soon after it was introduced to Turkey around 1000 H (1573 AD). Sultan Murad of the Othman Caliphate officially proscribed tobacco use and made it a capital offence in 1663. The previous grand Mufti of Saudi Arabia, Sheikh Mohammed bin Ibrahim cited in his fatwa the names of numerous grand Ulemas and Muftis who proscribed tobacco use since its first appearance in Turkey and Maghrib (Morocco).55 From Turkey, Sheik Mohammed Alkhawajah and Sheikh Isa Asshahawi Al Hanafi; from Egypt Sheikh Ahmed Assanhoori Al Bohooti and Sheikh Ibrahim Allakani; from Maghrib Abu AI Ghaith, Al Gashash Al Maliki; from Syria Sheikh Al Najem Al Ghazi A1 Aamri and from Yemen Sheikh Ibrahim bin Jamaan and Sayed Abubaker Al Ahdal.55 All the Saudi Arabian Muftis and Grand Ulema emphatically prohibited tobacco use in any of its forms. Until quite recently a tobacco smoker in Riyadh was given 40 lashes. To mention a few, Sheikh Abdulla bin Sheikh Mohammed bin Abdulwahab, Sheikh Abdulla Babatin, Sheikh Mohamed bin Ibrahim and the present grand Mufti Sheikh Abdul Aziz bin Baz, all prohibited tobacco use, its promotion, sale, cultivation or dealing with it in any way except to destroy it.

The “Ulema” and “Muftis” of Hadramout (South Yemen) stood firm against tobacco use. Imam Hussein bin Sheikh Abubaker bin Salim spent some of his wealth in buying tobacco farms, destroying the plant and replacing it with cereals, fruits and other crops. Imam Abdulla Al Hadad, Sayed Ahmed Al Hondowan, Sheikh Abdulla Basodan, Sayed Abdulla Asshateri and grand Mufti Abdul Rahman Al Mashoor and many others considered the use of tobacco as “haram”, i.e. prohibited.56

Similarly, many Ulemas of Mekkah and Medina e.g. Sheikh Abdulla Al Osami, Sheikh Mohammed bin Allan, Sayed Omer A1 Basri, Sayed Saad Al Balkhy and Sayed Mohammed Al Barzangi, all considered tobacco “haram”.

More recently, the 1st International Islamic Conference of Ulemas on Drugs, Narcotics and Liquors held in Medina (Saudi Arabia) March 22-25, 1982, under the auspices of Crown Prince Abdulla bin Abdul Aziz passed a resolution prohibiting the use of tobacco in any of its forms, its cultivation, manufacturing, trading, selling or promoting it in any way.57 W.H.O. Eastern Mediterranean office publication in 1988 entitled “Al Hokom AL Shari Fi Al Tadkhin” “i.e. Islamic jurisprudence decision on smoking” which involved the Fatwas of the ten leading ulemas of Egypt, including Sheikh AI Azhar, explicitly considered tobacco use as “haram”.58

All these Fatwas considered tobacco use as haram on the following bases:

It is detrimental to health. The Holy Quran states clearly “ don’t kill yourselves,59 and in another aya”, and make not your own hands contribute to your destruction”.60 Islamic teachings and hundreds of Hadiths (sayings) of the prophet (P.B.U.H) encourage muslims to be in good health and abstain from things injurious to health.

Tobacco use wastes huge sums of money. Saudi Arabia annually spends more than one billion Riyals on tobacco imports.61 Unfortunate poor Muslim countries spend more money on smoking and other tobacco products than on health promotion or education. The Holy Quran deplores those who squander wealth and property, “but squander not your wealth senselessly. Squanderers are indeed the like of satans.”62

Smoking is bad and impure “Khabath”, and the Holy Quran declares that the prophet (P.B.U.H) “forbids all that is bad and impure and allows all that is good and clean”.63 Smoking is bad and impure, as it causes environmental pollution and untidiness. The smoke of the tobacco is unpleasant and can cause serious injury even to those who do not smoke. Injuring others is completely prohibited in Islam and is considered one of the worst sins the Muslim can commit. There is a great need to keep Muslim communities well informed about these fatwas, and Muslim governments should stand firm against tobacco use. If Islamic teachings against tobacco are adhered to, Muslim countries will succeed in avoiding the perils and tragic loss of life and wealth caused by tobacco consumption.