Introduction Smoking is the main preventable cause of death worldwide. The World Health Organization estimates that smoking causes 5 million deaths annually, a figure that could double shortly if the present trend in tobacco product consumption continues.

 Objectives Estimate smoking-attributable mortality in the Cuban population and provide information needed to carry out effective public health actions.

 Methods This is a descriptive study using smoking prevalence and mortality data in Cuba for 1995 and 2007. Causes of death were grouped in three categories: malignant tumors, cardiovascular diseases and chronic respiratory diseases. Etiological fractions and attributable mortality were calculated by cause and sex.

 Results Of deaths recorded in 1995 and 2007, 15% and 18% of preventable deaths were attributed to smoking, respectively. In Cuba in 2007, smoking caused 86% of deaths from lung cancer, 78% of deaths from chronic obstructive pulmonary disease, 28% of deaths from ischemic heart disease, and 26% of deaths from cerebrovascular disease.

 Conclusions Smoking is responsible for high rates of preventable mortality in Cuba. There is willingness on the part of administrative and political authorities to discourage smoking, and more than half of smokers in Cuba wish to quit smoking. Given awareness that reducing smoking is the most effective means of decreasing preventable morbidity and mortality, the country is moving steadily toward concrete, sustainable steps leading to increased life expectancy and quality of life for the Cuban population.

 Keywords Smoking, preventable mortality, preventable morbidity, Cuba

Cuba’s National Cancer Registry records 29,000 new cases of cancer annually, some 50% of which are among persons living in the western provinces, and 55% among persons aged ≥65 years.[1] Cancer in Cuba is associated with a rapidly aging population and risk factors linked to certain social determinants of health—both social conditions and lifestyles. At current rates of growth, incidence is projected to reach 30,000 cases by 2010.

Despite significant development of Cuba’s universal public health system, national cancer programs, biomedical research, and oncology and related medical fields, cancer incidence and mortality continue to climb in the Cuban population of 11.2 million. This contrasts with generally decreasing adjusted mortality from heart and cerebrovascular disease—the other killers in the top-mortality triad. If these trends continue, cancer will soon become the number one cause of death in Cuba, a status it already claims in 8 of the country’s 14 provinces.[1]