Tobacco as One of Nigeria’s Top Preventable Cancer Drivers: Gaps and Recommendations

The Cancer-Tobacco Burden in Nigeria
Following the conclusion of Cancer Prevention Week 2026, it is important to highlight one of the most preventable drivers of cancer in Nigeria: Tobacco use. 

Globally, tobacco use has been identified as the leading preventable cause of cancer, responsible for 15% of all new cancer cases. Tobacco smoke contains 7,000 chemicals and at least 70 known carcinogens that directly damage human cells and trigger cancers of the lung, mouth, throat, stomach, cervix and several other organs. Tobacco-related cancers contribute significantly to mortality, with an estimated  40,000 annual cancer deaths in women and 30,000 deaths among men. These risks are compounded by the rapid emergence of new and emerging nicotine and tobacco products such as shisha, e-cigarettes, heated tobacco products and nicotine pouches. 

Nigeria is already experiencing a growing cancer burden, with an estimated 120,000 new cases and over 72,000 deaths recorded annually. Although national programs have focused on diagnosis and treatment, tobacco-related prevention has garnered minimal attention, despite smoking being a significant factor in the country's increasing cancer rates. Tobacco use prevalence in Nigeria is at 3.4%, while cigarette smoking remains the most common form of consumption.  The risk of tobacco-related cancer extends far beyond direct smokers. Secondhand smoke (SHS), which is the tobacco smoke inhaled by non-smokers, exposes non-smokers in homes, workplaces, markets, motor parks and public transportation to the measurable harmful impact of tobacco use. 

Evidence from Nigeria further highlights the scale of exposure. A cross-sectional study in Lagos motor parks found that  54.6% of non-smokers reported SHS exposure, with  68.2% of daily park users more exposed. This amount of exposure increases the risk of cancer by 20% to  30%. Research also shows that nicotine-derived nitrosamine (NNK), which is a harmful substance in tobacco smoke, encourages the growth of tumour cells and changes healthy breast cells into cancer cells. Additionally, 72% of respondents in Enugu and Ilorin are reportedly aware of the effects of SHS on their health. In Edo state, tobacco use accounted for 27.5% of the 4,937 cancer cases reported by the Edo-Benin Cancer Registry (EBCR).

Beyond health risks, tobacco consumption imposes significant direct and indirect economic costs on Nigerians. The entire yearly economic burden of tobacco use was estimated to be ₦634 billion (roughly USD 2.1 billion) in 2019. The direct cost of treatment was estimated at ₦GN526 billion (US$1.7 billion),  nearly one-tenth of all healthcare costs in Nigeria. Indirect costs, which include employee absenteeism, reduced or lost productivity due to tobacco-related illness or disability and premature death, were estimated at NGN 107 billion (approximately US$0.4 billion). The estimated cost of treating lung cancer per case was over $3 million in 2019. 

The illicit tobacco trade further worsens the problem by fuelling low prices and flooding markets with products that evade graphic health warnings. The tobacco control data reports that approximately 17 billion cigarettes are sold annually, costing Nigerians US$ 931 million in 2019 (over N300 billion) in revenue loss. This revenue loss occurs when tobacco products are smuggled, under-declared or illegally manufactured, allowing them to evade excise duties, VAT, import tariffs and tax stamp requirements mandated under Nigeria’s tax and regulatory system. 

Why Tobacco Remains a Major Cancer Driver  in Nigeria

1. Tobacco Control is not fully integrated into the cancer prevention strategy: Nigeria relies on the National Tobacco Control Act (2015), which is critically outdated due to regulatory gaps on emerging products and weak enforcement, and the National strategic cancer control plan 2023-2027. However, neither document explicitly links tobacco reduction targets to measurable cancer-reduction outcomes. This disconnect implies a lack of coordination between Nigeria's cancer and tobacco control policies, hindering the implementation of      coordinated preventive measures. One implication of this disconnect is weak enforcement of extant laws. For example, despite the existence of smoke-free laws through the NTCA of 2015, its 2019 regulations, and the national tobacco control enforcement plan of 2025, WHO assessments indicate that Nigeria has not yet achieved the highest level of enforcement. This weakened enforcement maintains involuntary exposure, which contradicts cancer control efforts by increasing cancer risk among non-smokers.
2. There is no regulation for new or emerging tobacco and nicotine products. While Nigeria’s National Tobacco Control Act (2015) is technically outdated, it does provide a framework for tobacco regulation covering emerging nicotine products such as e-cigarettes, but shisha and heated tobacco products are currently not regulated. Hence, enforcement and regulatory clarity remain nonexistent. This regulatory gap risks creating new cohorts of tobacco and nicotine products, thereby increasing long-term cancer risks.
3. Tobacco taxation levels remain insufficient to drive long-term tobacco-related cancer reduction: Tobacco tax is one of the most influential factors for the initiation or cessation of tobacco use. WHO advises that the total tax burden should be  at least 75% of the retail price, while ECOWAS guidelines require a minimum of 50% ad valorem duty of the importation or factory price, plus a specific duty of not less than US$0.02 (₦27) per stick or $0.40 (₦545.33) per pack of 20 sticks. As of 2024, the tobacco excise tax on a pack of  20 sticks of cigarettes increased to ₦104 from ₦94 in 2023. Taking into account the  30% ad valorem tax on the manufacturer's price, the total tax burden is still inadequate compared to global (World Health Organization Framework Convention on Tobacco Control) and regional (ECOWAS) recommendations. The weak tax structure keeps tobacco products relatively affordable, which sustains initiation and tobacco-related cancers.
4. Prevalence of illicit trade: When untaxed or under-taxed products are widely available, tobacco remains affordable, undermining efforts to reduce consumption and structurally embedding future tobacco-related cancer incidence in the population.

Implications of Tobacco-related Cancers

Nigeria’s total economic burden attributed to tobacco was estimated at US$2.1 billion (₦2.8 trillion) in 2019.1 Tobacco-driven cancers have severe economic implications, draining household incomes through catastrophic out-of-pocket health expenses, lost productivity due to illness and premature death of the working population, and overwhelming Nigeria’s fragile healthcare system, where only 8 oncology centres serve over 200 million people. Socially, tobacco-related cancers fracture families, as caregivers sometimes abandon livelihoods, deepening poverty cycles, which further exacerbates the economic burden on households already struggling with healthcare costs and loss of income.

Recommendations: 

To effectively lower the incidence of cancer, tobacco control must be repositioned and implemented as a major cancer prevention tool. In line with the National Cancer Control Plan of 2026-2030, cancer control programmes should be integrated into other health programmes, especially those addressing tobacco use, as it is a major risk factor for cancer. 

1. The Federal Ministry of Health and the National Institute for Cancer Research and Treatment should incorporate goals related to reducing lung, cervical, oral, breast, and other cancers caused by tobacco into Nigeria's National Cancer Control Plan (NCCP) for cancer prevention, with clear and measurable indicators, and designate a body responsible for monitoring and tracking these indicators.
2. The Federal Ministry of Health in collaboration with the National Orientation Agency, should develop and implement “Tobacco Causes Cancer” media awareness campaigns to link tobacco use to the most prevalent cancers in Nigeria, using local data and stories of survivors as case studies.
3. The National Tobacco Control Committee (NATOCC) and the Tobacco Control Unit (TCU) under the Federal Ministry of Health, along with State Commissioners for Health, should strongly enforce 100% smoke-free policies in high-exposure informal settings (motor parks, markets, public transport, etc.), which have been identified as having high levels of SHS exposure, as part of a plan to reduce cancer risk.
4. The Federal Competition and Consumer Protection Commission (FCCPC), which is responsible for enforcing graphic health warnings, should mandate large, rotating, cancer-specific graphic warnings about lung, oral, breast, and other cancers on the front and back of all tobacco and new emerging nicotine products, including shisha packaging and vape packaging.
5. The government should urgently raise Tobacco Taxes to lower future cancer incidences. Excise taxes should be aligned with WHO best practices to prevent initiation among youth as well as lower future cancer incidence. High Price through increased taxes is one of the most effective tobacco-cancer prevention strategies.
6. The government should create a system that connects tobacco use information with the national cancer registry to calculate how much cancer is caused by tobacco each year, helping to track tobacco cancer incidence and outcomes to shape better policies.
7. The Nigerian government needs to immediately operationalise effective anti-illicit trading systems by enhancing borders and track-and-trace systems to prevent cheap tobacco products from undermining cancer prevention policies.

Conclusion

Repositioning tobacco control as a cancer prevention priority offers Nigeria one of the most cost-effective opportunities to save lives, reduce healthcare costs, and protect future generations. Tobacco control policies should be treated not only as a public health measure but also as a core cancer prevention strategy within national cancer planning. Stronger taxation, enforcement of smoke-free environments, regulation of emerging nicotine products, and improved surveillance systems can significantly reduce tobacco-attributable cancers in the years ahead.

Preventing cancer must start long before a diagnosis. By acting now to reduce tobacco exposure, Nigeria can prevent thousands of avoidable cancer deaths and move closer to a healthier, more productive population.