Mojgan Karbakhsh - Department of Community and Preventive Medicine, Tehran University of Medical Sciences, Tehran, Iran

Breast cancer has now overrun lung cancer as the world’s most commonly diagnosed cancer, based on the latest estimates released by the International Agency for Research on Cancer.۱ To prevent an estimated ۲.۵ million deaths per annum, it is crucial to focus on increasing public awareness for risk reduction and early diagnosis, especially in the regions with increasing rates and unequitable resources.۲ Tobacco smoke is the most important human carcinogen and passive and active smoking is among the known risk factors of breast cancer.۳ Although much evidence exists for a moderate increase in the risk of breast cancer in tobacco smoking women,۴,۵ much less is known about potential association between waterpipe smoking and breast cancer risk. Waterpipe (also known as hookah, hubble-bubble, narghile, shisha, borry or goza) is a form of tobacco consumption where the smoke bubbles through water before reaching the smoker. The highest rates of waterpipe use have been reported from the Middle East, Asia and Africa, but it has rapidly become an emerging problem in the United States as well as Europe.۶ The reasons for increasing popularity include misconceptions about safety (in comparison to cigarette smoking, as the smoke passes through water,) introduction of flavoured tobacco, social acceptability and lack of waterpipe-specific control policy and regulations.۷,۸ Women and young people seem more likely to be choosing waterpipe over cigarettes, with the prevalence surpassing cigarette smoking in some areas.۸