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What is already known on this topic In a prospective study of British doctors, those who smoked cigarettes throughout their adult life died about 10 years earlier than lifelong non-smokers, while in the US Framingham Heart Study life expectancy in continuing smokers was also nearly 10 years lower than in lifelong non-smokers In contrast, analyses of data from four large prospective studies in Japan had suggested that smoking reduced life expectancy by only about four years What this study adds Japanese smokers born before about 1920 smoked fewer cigarettes per day on average than those born more recently, and many Japanese smokers born before 1945 did not start smoking until well into adult life Japanese smokers born since 1920 and who started to smoke early in adult life had smoking habits similar to those of smokers in the British Doctors Study and the Framingham Heart Study and, as in those studies, continuing smokers lost about 10 years of life compared with lifelong non-smokers Previous Japanese studies have underestimated the effect of smoking for modern Japanese adults because they included large numbers of people born in the first few decades of the 20th century who had started smoking at later ages and smoked at lower intensities than is typical of Japanese smokers born more recently The findings of this paper are of relevance to all populations where the epidemic of smoking-related diseases is not yet sufficiently mature for the full risks of smoking to be apparent Notes Cite this as: BMJ 2012;345:e7093 Footnotes Our main thanks to the thousands of people who took part in this study, and to the study staff who interviewed them and managed the data in Japan