The Chinese symbol for crisis is composed of two distinct words: “danger” and “opportunity”. The global tobacco epidemic qualifies as a global crisis. The danger is clear, yet there is also opportunity to learn and apply vital lessons from experience gained to date. Only two causes of death are large and growing worldwide: HIV and tobacco. Although most countries have begun to respond to HIV, the response to the global tobacco epidemic is only beginning to emerge.

The findings from the study by Mzileni and colleagues in this issue ofTobacco Control (page 398) provide some compelling information about the spread of the tobacco epidemic and tobacco related diseases in South Africa. The authors found an increased risk of lung cancer for both males and females who smoke. This is not a surprising finding. What is new is: the size of the odds ratios; the increased risk among women, whose smoking prevalence is very low; and the location in which these events occur.

The model of the smoking epidemic,1 based on evidence from countries with the longest history of smoking, describes the typical evolution of cigarette smoking and subsequent mortality …