To the editor—Your August editorial1 calls attention to one of the most dire threats to global health—smoking. According to the World Health Organization (WHO), four million people die each year from tobacco-related illness, and that figure is expected to rise to about ten million by the year 2030 (ref. 2).

In Japan in 1998, the number of deaths due to lung cancer (50,867) exceeded stomach cancer deaths (50,662), making lung cancer Japan's leading cause of death due to malignant tumors3. Lung cancer now accounts for 17.8% of all cancer deaths—a tenfold increase since 1950. Although tobacco undoubtedly contributes to this increase, Japan has done little to respond to this growing problem, and as a result lung cancer and other tobacco-related diseases are on the rise.

The WHO estimated that in 1994, 59.0% of Japanese men and 14.8% of women smoked. Although the percentage of male smokers has dropped from a staggering 83.7% in 1966, it is still far higher than that in many other developed countries (and almost equals that in China (61.0% in men), a country that is now facing an immense problem with tobacco4). Although a smaller percentage of Japanese women smoke than in most developed countries, the rate is not falling. Even more worrying is a demographic switch that sees an increase in the proportion of younger women smokers5. Smoking among Japanese teenagers is also a serious concern. Although Japan prohibits smoking until the age of 20, this legislation is mostly ineffective, as tobacco is readily available to teenagers through vending machines and convenience stores.

In Japan, the number of excess deaths due to tobacco is estimated at around 100,000 per year5. Although this is more than 10 times the number of deaths due to road traffic accidents, resources and efforts allocated for tobacco control are minimal compared with those allocated for traffic safety. Smoking as a cause of death has been neglected in spite of the fact that it is our leading preventable cause of death. It is time for Japan to take effective action to stop tobacco from killing yet another generation.