In the wake of acting legend Ahmed Zaki's death of lung cancer, Yasmine Fathi investigates the deathly scope of the ubiquitous cigarette The look was as irresistible as the talent: soulful eyes, ancient Egyptian facial features, rough cut build -- and cigarette hanging suggestively from the corner of the mouth. But Ahmed Zaki paid a high price for a habit that became inseparable from his image; a year's struggle with lung cancer finally took his life last week. Among the millions mourning his death, many are eager to stress the lesson learned: "Egypt has lost one of its greatest actors to smoking; and I hope Egyptians will have got the message: smoking is fatal." Thus oncologist Tamer El-Nahhas, who was on the medical team responsible for Zaki's treatment. The actor was a very heavy smoker, he insists: "He was 56 years old, and had been smoking for 40 years." Nor is El-Nahhas the only doctor now hoping that Zaki's death will bolster awareness of the role of smoking in lung cancer. According to Sherif Omar, former dean of the Cancer Institute at Cairo University, the incidence of lung cancer in Egypt has increased significantly over the last few decades. "In the 1960s and 1970s," he explained, "lung cancer was very rare indeed. Today it is in the top five cancers in the country." The causes of lung cancer are as complicated as the disease itself. "Pollution is a major factor," Omar indicated, pointing an accusing finger at car exhaust: "The 1994 environmental law is supposed to have limited that, but it is obvious to the naked eye that it's as bad as ever. We've got taxis that are over 30 years old, and with such engines it's impossible to diminish dangerous emissions." For his part Hassan Meibed, head of the surgery department at the Cancer Institute, Cairo University, takes issue with asbestos, a chemical used in construction: "If you live in a building that has asbestos in it and you inhale, it's fatal. The government must regulate the use of asbestos; in other countries it's under very strict control." People who work in the cement industry, he added, much like coal miners, are at a higher risk; so are those who subsist on a poor diet, especially one lacking vitamin C, or are subjected to radiation. But it is smoking that remains the uncontested number one cause of lung cancer. "It's the number one, two, three and four cause," Meibed reiterated. Indeed, according to the World Health Organisation (WHO) 85-90 per cent of the cases of lung cancer worldwide are due to smoking. Smokers are more than 20 times and up to 30 times more likely to develop the disease than non-smokers. According to El-Nahhas, a cigarette contains hundreds of such carcinogenic chemicals as hydrocarbons, nitrosamines, the effect of which is directly proportional to the duration of smoking, number of cigarettes consumed, and degree of inhalation. Yet no amount of smoking is safe. "A small bullet kills just as surely as a large one," as Meibed puts it. "All smoking is deadly -- it's as simple as that." Despite the 2002 law banning tobacco advertising -- so pointed out Fatimah El-Awa, regional adviser for the WHO Tobacco-Free Initiative, Regional Office for the Eastern Mediterranean -- "now there are those who sell pretty cigarette boxes in which you can insert the real box, thus hiding the health warning". Along with every social sect, the media too should play a role, El-Awa added with exasperation: "Look at the popular movie Enta Omry (You are my Life). The lead character is supposed to be suffering from leukemia, yet he's always lighting up." For his part Omar stressed the need for a more aggressive anti-smoking campaign. "We have the anti-smoking week, but is a week really enough?" he asked rhetorically. The point was very well taken by El-Awa: "The cigarette industry is very clever. For every step they take we should take five." In the light of the circumstances, indeed, even the anti-smoking campaigners' five steps may prove to be insufficient. According to the WHO 2004 report Tobacco and poverty: a vicious circle, Egypt is the largest cigarette manufacturer in the Middle East, with 0.7 per cent of the world's total output produced here. A WHO 2003 country profile examining smoking habits in Egypt between 1995 and 1999, moreover, showed an alarming increase in cigarette consumption: in four years the daily average had risen from 8.8 to 13.7 cigarettes. Nor will Zaki's high profile prove much of an aid to the anti-smoking struggle. According to El-Nahhas, even the actor's closest companions were undeterred: "Almost all of those friends and family who visited were smoking. These were the closest people, the ones who went into his room and saw him suffering. And they still smoked." Indeed the fight is unlikely to gain momentum until Egyptians adopt a more positive outlook on health issues, he went on: "People have this fatalistic belief that whatever happens just will -- that you can't prevent things from happening -- and it's wrong." At the oncology department in Germany, where he worked for a year, not one doctor smoked; while in its Egyptian counterpart some 90 per cent do: "How can we expect people to stop when the envoys of good health themselves don't." Indeed, according to the WHO 2004 report, in Egypt 45 per cent of teachers, and 43 of doctors, are regular smokers. Omar, who has spent years campaigning, finds the attitude of many Egyptians positively absurd: "People are scared of eating or drinking certain products because they might be carcinogenic. But then you have a product like cigarettes, which says on its box that it is hazardous to the health, and people consume it without worries..." Nor do those interviewed by Al-Ahram Weekly contradict this line of thinking. "Look, Ahmed Zaki would have died at 56 whether or not he smoked." Thus Laila Fayeq, 24, who smokes a pack and a half a day, and has been smoking since the age of 14. "Everyone will die when their time comes. I can go out now and get hit by a car. Besides," she insisted, somewhat preposterously, "people get lung cancer without smoking." Fayeq's attitude is symptomatic. "I've had lung cancer patients who continued to smoke after diagnosis and I've seen sons smoking while burying fathers who died of lung cancer," Meibed recounted. Even those who have been directly affected by smoking are rarely convinced. "I've been smoking since I was 18," 23-year-old Mohamed Omar testified. "Both my uncles died of lung cancer. I'm trying to stop now, but not for this reason, to be perfectly honest with you. I want to stop, rather, because my fiancé hates it." On the other hand Nada Mohsen, 23, a smoker since the age of 12, managed to quit after her father died of cancer. "Cancer runs in the family, and I didn't want to increase my risk," she said. "I'm the one who got all my friends smoking. I try to tell them to stop now but they don't pay attention and I'm not going to play the mother. To stop you really have to feel it, otherwise it's as useless as the warning on the box."
