Sir: Over 100 million people died due to tobacco use in the last century and if current trends continue, one billion people will die in the 21st century alone. The World Health Organisation claims that eight million deaths will take place annually if immediate action is not taken to stop tobacco use, a majority of them in low-income countries like Pakistan. Research by Shaukat Khanum Memorial Cancer Hospital and Research Centre shows that nearly 40 percent of men admitted for treatment became victims of cancer due to tobacco use. Tobacco, no matter which form it is, like cigarettes (even light or filtered), cigars, chewable tobacco, huqqa or even the popular sheesha, is a silent killer. It does not kill anyone directly but approximately 4,000 toxic chemicals including nicotine as well as a direct irritant effect of the inhaled smoke causes various illnesses, cancers, cardiopulmonary and pregnancy related complications being the few notable ones. Smokers are said to have a death rate twice that of non-smokers. DR AHSAN AZHAR Via e-mail