CHEAP AND DEADLY: A Hà Nội citizen buys cigarettes from a shop on Nguyễn Siêu Street. VNS Photo Đoàn Tùng

More than 100,000 people die each year from cancer in Việt Nam, and medical experts believe the fatality rate will rise because more and more young people are starting to smoke.

Việt Nam is among the cheapest places in the world to buy cigarettes, with one packet costing as little as VNĐ10,000 (US$0.4).

Doctors describe the price as way too low and are urging the government to rethink the cost of cigarettes by insisting on a price rise and adding tax.

"We think that the price of cigarettes in Việt Nam is too cheap compared to many other countries," said Prof Trần Văn Thuấn, director of Hospital K, Việt Nam's largest cancer medical centre.

"We believe that besides educating people about the harmful effects of cigarettes, we need to raise taxes and increase the price so that smokers not only see the harmful effects of cigarettes to themselves, their families and others, but also hesitate to spend money on them. Only then can the prevention of tobacco harm be effective."

According to Prof Thuấn Việt Nam has around 165,000 new cases of cancer each year with 115,000 people dying every 12 months from the disease.

Cancer fatalities are ten times higher than the number of people killed in traffic accidents. The director believes there are many reasons for the large number of cancer patients.

"Cigarettes alone account for more than 30 per cent of human cancer cases," he added. "Young people think it's cool. At first, young people start smoking to try and be like adults. They smoke, and then become addicted to cigarettes."

Dr Nguyễn Thị Thái Hòa, head of the National Hospital K's treatment department, said: «Based on our observations, the number of young people with lung cancer has increased recently, and so has the number of female patients."

One reason experts say more women are developing the disease is because they are victims of passive smoking.

"Our patients and their families are not actually aware of the danger of passive smoking, for example, their husbands and fathers smoke, and that automatically turns them into passive smokers without knowing it's one of the main causes of lung cancer," Dr Hòa said.

Even though cigarettes in Việt Nam cost a fraction of what they do elsewhere in the world, there are still many cases of cigarette smuggling in the country.

In the last four years more than three million packets of smuggled cigarettes have been seized by the authorities. Officials say more than VNĐ10 trillion ($431 million) of the state budget is lost each year because no tax is paid on cigarettes smuggled into the country.

But despite the best efforts of border patrols, very few violators are prosecuted. This, they say, is because anyone caught smuggling more than 1,500 packets faces criminal proceedings, so most gangs bring in under the penal threshold to avoid prosecution if they are apprehended. 

Six years ago, a law was passed in a bid to reduce tobacco use and outlaw the sale of cigarettes to children under the age of 18. The law on anti-harmful effects of tobacco also prevented smoking in places where children, pregnant women, the sick and elderly people were likely to be. 

Smoking was also banned in health centres, certain education facilities, places where children were and public transport. Other measures of the law included designated areas for smokers in tourist facilities which included correct signage and fire prevention equipment.

Despite all these measures, the director of Hospital K, Prof Thuấn, believes the best thing a smoker should do is simply quit. «We think smoking is a habit, not an addiction," he said.

"Alcohol can be addictive but smoking is just a habit. "This is a habit that we can completely give up with discipline." VNS

Increase cost, decrease cancer
 The Roy Castle Lung Cancer Foundation is the only charity in the UK dedicated to helping people with the disease

Based in Liverpool in the north west of England, the charity was named after musician and television star Roy Castle. Despite never smoking, he developed lung cancer in 1992, blaming the illness on passive smoking caused through playing the trumpet in smoky jazz clubs.

Since his death, the foundation has raised millions of pounds to fund research into the disease and develop early detection programmes.

 Lorraine Dallas, Director of Prevention, Information and Support, Roy Castle Lung Cancer Foundation

Director of Prevention, Information and Support, Lorraine Dallas, said a large price-hike in the cost of cigarettes in the UK helped reduced lung cancer patients.

"Accelerating the cost of cigarettes has been part of the UK's strategy towards reducing smoking rates," she said. «It has had a demonstrable effect on smoking rates in the adult population.

"Cost does tend to have a bigger impact on those who are less affluent, the evidence in the UK is also that smoking rates tend to be higher in more socially deprived populations.

So in England there is a variation between 1 in 10 people who are employed in managerial roles smoking and 1 in 4 of those who are employed in manual labour.

"The concern here is that in some communities people will smoke, perhaps leaving no money for food, power or other core costs.

"Affordability is a driver that can influence smoking rates, however it needs to be part of a strategy that educates the population on the damage of tobacco, provides methods of addressing addiction and tackles the power of the tobacco industry promoting smoking as socially normal behaviour."
Vietnamese tradition or dangerous hobby?
Whether you are in a bar or a restaurant, or even just on the side of the road, in Việt Nam you are never too far away from a thuốc lào (black tobacco) pipe, or bamboo hookah.

Made mainly from pieces of bamboo, these pipes can be seen, and more often than not heard through the gurgling noises they make, across the country.

From downtown Hà Nội, to the mountainous regions of the north, you will find men young and old passing around pipes.

21-year-old Ngô Trường Sơn who has been smoking for two years. VNS Photo Đoàn Tùng

The first noted use of the pipes dates back to the fifteenth century.

"Most of the customers are youngsters and middle-aged people, because it's something traditional," he said. "They come here to find a hobby, and this pipe smoking hobby has a very long history. It's not something imported from elsewhere. In fact, it is very traditional. People smoke it to reduce stress. "In fact, water pipe tobacco is used widely, because it is something historical, traditional and can be passed through generations as our grandfathers smoked it, our fathers smoked it and now their children also smoke it."
Cancer patient urges young smokers to quit before it’s too late
For most of his life Phạm Nguyên Phung has been a smoker.

Now aged 80 and undergoing intense bouts of chemotherapy, he deeply regrets taking up the habit when he was a teenager.

"I had no symptoms. I had a cold so I went to a hospital to check, and the doctors said I had cancer and sent me to the National Hospital K. I was feeling absolutely fine before that. I was feeling fine too when I first got here.

But I got more tired after each chemical dose," he told Việt Nam News.

REGRETS: Cancer patient Phạm Nguyên Phung in a ward at National Hospital K. VNSPhoto Đoàn Tùng

"I have been smoking since I was 15-16 and only stopped recently. Cigarettes  and pipes.

I did it all. "Before I was diagnosed with cancer I smoked a pack of cigarettes a day. Some days half a pack. Or black tobacco pipes once in a while. 

"I regret smoking now. When I was a teenager my parents forbade me to smoke, but I did it anyway. When I reached adolescence I became even more liberated. But I regret it now that I've got cancer.

"Now my wife and children have to take care of me. And we've spent a lot of money. About VNĐ400-500 million (US$17,000-22,000) on my treatment now. It's not cheap.

"I would tell young people not to smoke. Life is easier for them now. Back then it was very difficult for us to buy cigarettes, but it is easy now.

"Our culture has made it easy. Tobacco, liquor, beer are so easy to get. But don't indulge too much or it will harm your health. And it'll be too late by the time you regret it, like I do."

Ngô Trường Sơn, 21, regularly smokes tobacco bamboo pipes. He has been smoking for two years.

"I smoke all kinds of tobacco, I try many different kinds. I don't really know (why I started)," Sơn said.

"I saw other people smoking and getting high, so I just followed them. Maybe it's a habit, and I feel more comfortable when smoking.

"For me, the feeling when there's no tobacco to smoke is really unpleasant."

Sơn believes that if the price of cigarettes and tobacco were to increase, it would not stop people smoking.

"To be honest, nicotine addicts will still smoke," he said.

"This policy might limit smoking, but to tell them to quit, even the price is not something that really matters.

"They will only give it up when diagnosed with diseases. So even if the price increased, it's not certain they would quit."
Time really is of the essence
Early detection of lung cancer is paramount to curing the disease and one top doctor says people in Việt Nam should be screened more, to have a better chance of survival.

Dr Nguyễn Thị Thái Hòa

Dr Nguyễn Thị Thái Hòa is the head of the National Hospital K's treatment department.

She says often patients may be carrying the disease for many years completely oblivious to the fact they have cancer.

And if they do get checked earlier, treatment could yield better results.

"We are currently providing treatment for about 1,000 inpatients and outpatients," Dr Hòa said.

"The biggest regret that we doctors feel for a lot of our patients is they didn't know they should have had lung cancer screening so they can detect and have proper diagnosis of the disease in its early stages.

"If they had known that, when they entered a certain age, for example, from 50 for men, especially smokers, they would have conducted health checks more frequently for earlier detection of cancer.

"We should have been able to provide diagnosis of the disease in its earlier stages and the treatment could have had better results.

"We have had a lot of patients who showed up without any symptoms of lung cancer. They could have just had a periodic health check or a regular medical examination and discovered they had lung cancer, even in the very final stages, without any symptoms. So lung cancer screening is of utmost importance." VNS