Tobacco smoking significantly increases the risk of developing various types of cancer. In the Netherlands, lung cancer continuous to be among the most common cancer types, also among women. Due to smoking behaviours dating back to the 1960s and 70s, incidence rates have been rising in recent years (NCR Data). Furthermore, smoking prevalence, as well as daily and heavy tobacco use, is significantly higher among individuals with lower income and/or lower educational levels, as they are more likely to smoke and face barriers to cessation (IKNL, 2024a). While smoking rates in the Netherlands have gradually declined, approximately one in five Dutch adults still smokes. Without more ambitious policy action, younger generations remain at risk of developing tobacco-related diseases.
To protect minors from ever starting and to help current smokers quit, strong and sustained policy efforts are essential. The Dutch National Cancer Control Programme (“Nederlandse Kanker Agenda”) sets an ambitious goal: reduce smoking prevalence to no more than 5% of adults and 0% of minors by 2032 (Nederlands Kanker Collectief, 2024). However, current government investment and policy support fall short of what is needed to reach this target. Without adequate funding and prioritization of prevention, the opportunity to significantly reduce cancer burden through tobacco control is at risk of being missed.
In response, the Netherlands Comprehensive Cancer Organisation (IKNL) undertook a national modelling study to quantify the potential impact of strengthened tobacco control on cancer prevention. Using data from the Netherlands Cancer Registry (NCR), Statistics Netherlands (CBS), and Trimbos/RIVM (Netherlands Institute of Mental Health and Addiction/National Institute for Public Health and the Environment), the analysis projected how many cancer cases could be avoided if the country achieved its tobacco reduction targets. The study focused on three major cancers with strong links to tobacco use: lung, bladder and oesophageal cancer.
The results are compelling: achieving the national smoking targets could prevent more than 120,000 cancer cases between 2024 and 2045, including approximately 89,000 cases of lung cancer, 16,000 of bladder cancer, and 15,000 of oesophageal cancer. These findings demonstrate the powerful potential of prevention and reinforce the importance of sustained, data-driven tobacco control policy (IKNL, 2024b).
This modelling work provides clear, quantifiable evidence supporting tobacco control as a cornerstone of cancer prevention policy. By translating ambitious public health targets into tangible outcomes, the analysis helps policymakers, civil society and the public understand the benefits of prevention. The analysis was shared widely with government officials, partner organizations, including the Dutch Cancer Society, and the public. The findings received significant media attention, generating over 110 news items and reaching an estimated audience of 10.5 million people.
While direct policy impacts are difficult to measure, particularly amid ongoing political negotiations, the study has clearly helped raise awareness and contributed to shaping the national dialogue on tobacco control and prevention.
Enablers: Several factors enabled the success and visibility of this initiative. A key enabler for the success of these calculations was the availability of high-quality, trusted data (Information). This included cancer incidence data from the Netherlands Cancer Registry and population-level data from partner institutions. The willingness of partner organizations to share their data openly and collaborate was instrumental. In addition, learning from international experts who had previously conducted similar analyses and demonstrated policy impact helped in selecting appropriate models and designing a credible and transparent approach. Another critical success factor was the involvement of skilled professionals, both in epidemiological modelling and in strategic communication and public affairs (Resources). Their expertise ensured not only the robustness of the calculations but also wide visibility and media reach. The compelling figures equipped members of parliament with evidence to support calls for stronger prevention policies.
Barriers: Despite growing public and political interest, prevention remains a lower priority in national health policy, with many prevention programmes facing either underfunding or discontinuation. Moreover, persistent lobbying by the tobacco industry continues to hinder progress, delaying the translation of evidence into legislative action.
By integrating data from the Netherlands Cancer Registry, IKNL delivers clear, quantifiable evidence that positions tobacco control as a key pillar of cancer prevention policy. Widespread public attention to the results prompted policymakers, civil society and the public to recognize the concrete value of prevention. These benefits extend beyond health outcomes alone, contributing to broader health system goals, such as the promotion of equity. Since tobacco-related cancers disproportionately affect lower socioeconomic groups, the burden of tobacco-related cancers is unequal. Therefore, targeted interventions are needed to reduce health inequalities.
IKNL demonstrates how smoking prevention and smoking cessation can prevent a large number of cancer cases. Thus, by reducing future disease burden, these interventions help relieve long-term pressure on the healthcare system and allow resources to be reallocated to other areas of care. Moreover, by making the health gains of prevention visible and measurable, INKL’s initiative enhances transparency and accountability in policy. It enables informed decision-making based on robust data, which is essential for long-term, high-quality health system improvement.
Finally, the Dutch National Cancer Control Programme’s vision of a tobacco-free generation can be seen as an inspiration, especially for young people, to lead healthier lives and avoid preventable diseases. Framing prevention as a lifelong benefit empowers individuals and supports the shift from reactive to proactive healthcare.
Lessons learned: A key lesson was the importance of collaboration, both nationally and internationally. Bringing together data from various national cancer stakeholders and registries created a robust evidence base to inform health policy. International cooperation also added substantial value. International partners, such as International Agency for Research on Cancer (IARC) and NORDCAN countries contributed valuable experience in similar modelling efforts and demonstrated policy impact in their own contexts. Their input was essential to selecting sound methods and ensuring policy relevance. Moving forward, deeper and more structured cross-country collaboration could strengthen the reach and credibility of such analyses.
Expanding this work at the European level, through harmonized modelling and coordinated approaches, would support EU-wide action on tobacco control and help build political momentum toward a tobacco-free Europe.
