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Some More Reasons Not To Smoke.
Information you Can Use

Nearly everyone can appreciate the link between cigarette smoking and lung cancer. But how many people are aware that smoking can also increase the risk of other types of cancer as well. For example, it increases the risk of renal cancer, esophageal cancer and stomach cancer. Not only that, but smoking can aggravate many other conditions. For instance, in those with asthma, cigarette smoking accelerates lung decline, in those with diabetes, cigarette smoking increases the risk of heart disease and kidney failure. In those with the sexually transmitted disease, genital warts, smoking can increase the risk of oral cancer. As if all this is not bad enough news, there is also evidence that if a person starts smoking at an early age, and then quits, they still have an increased risk of lung cancer at a later age.

What follows is just a sampling of the recent research on smoking, taken from scientific journals during the last six months. This is by no means a comprehensive summary of smoking research, rather it just represents the "tip of the iceberg. Nonetheless, it is educational and sobering. You may find this data useful in your own individual life or you may be able to integrate it into your nursing practice.

If you begin smoking as a teen and then stop, you still have increased risk of cancer in later life-

Source: Journal of the National Cancer Institute 1999; 91: 578- 579, 614-619

    Findings: In a study of 143 patients who were being treated for lung cancer, a team of  researchers found that there were a number of DNA changes (presence of DNA adducts). These changes were as follows:
a those who had never smoked- average of 32 DNA adducts,
b patients who were current smokers- 8x the number of DNA adducts compared to non smokers,
c patients who had started smoking in adolescence but then had quit for many years- 3.5 x the number of DNA adducts as compared to non smokers. (this was higher then the number of DNA adducts in those who had taken up smoking as adults)

    Pathophysiology- DNA adducts are altered forms of DNA that occur as the result of     exposure to carcinogens (in the case of smokers these would be the carcinogens present in cigarette smoke). A DNA adduct, once formed, can be duplicated and passed onto daughter cells. In the case of those who develop lung cancer it is hypothesized that the DNA adducts increase the instability of the cell, making it more likely to become cancerous. In adolescents, the lung cells are more vulnerable (at this point in life) to the formation of DNA adducts on exposure to cigarette carcinogens. Once formed, the DNA adducts persist throughout life, so that even if the adolescent stops smoking and no new DNA adducts are formed, the old ones persist and can, eventually, lead to lung cancer

    Significance: This study shows the increased vulnerability of lung damage during the adolescent years and, therefore, the increased importance of educating the young to the risks of smoking and the need for other prevention tactics. The best policy is to never start smoking in the first place. However, it is still better to quit then to continue to smoke (8x the number of DNA adducts in current smokers compared to 3.5 in ex smokers)

Smoking Causes Renal Cancer

Source: Journal of the National Cancer Institute 1999; 90: 1685- 1686, 1720 – 1723

Findings: Research shows that smokers show an increased risk of developing renal cell carcinoma (RCC), the most common form of kidney cancer in adults

Pathophysiology: RCC is caused by a mutation in a gene called the von-Hippel-Lindau gene (VHL). Carcinogens from cigarettes enter the bloodstream and can cause mutations in this gene. Particularly, a constituent of cigarette smoke, called NMDA, has been implicated in causing this particular mutation

Significance: In the United States the incidence of RCC has increased more than 45% between 1973 and 1995. In 1999, about 30,000 people in the US will be diagnosed with this cancer and 11,000 will die. Nearly everyone can appreciate the connection between smoking and lung cancer, but here is proof that smoking can also cause other types of cancer as well

Smoking Causes Cataracts and Cardiovascular Disease

Source: Molecular Medicine 1998; 4: 594- 601

Findings: Advanced glycation end products (AGE’s) are found in higher levels in the lenses of non diabetic smokers compared to nonsmokers and there is a significantly elevated level of AGE’s in the coronary arteries of smokers versus nonsmokers

Pathophysiology: AGE’s come from several sources; these include diabetes, aging and, tobacco smoke. AGE’s are generated during the tobacco curing process. AGE’s add aroma and flavoring to tobacco products. As AGE’s accumulate in the tissue over time they cause damage to the tissue. Hence, as they accumulate in the lens of the eye, they lead to increased incidence of cataracts. As they accumulate in the coronary arteries, they lead to increased atherosclerosis.

Significance: You may not be able to eliminate AGE’s entirely from your tissue, but smoking increases the deposition of AGE’s and, therefore, the associated damage to tissue. Once again, although the public can often make the connection between cigarette smoking and lung cancer, we now have evidence for a connection between cigarette smoking and cataracts and heart disease. Epidemiologically., there is an increased rate of cataracts among smokers versus nonsmokers and a much higher rate of heart disease.

Smoking Accelerates Lung Decline in Asthmatics

Source: New England Journal of Medicine 1998; 339: 1194- 1200

Findings: 1,095 adults with asthma and 16, 411 people without asthma were studied over a course of 15 years. Asthmatics had an overall greater decline in lung function then did non- asthmatics. However, in both groups (asthmatic versus non asthmatic) smoking accelerated the decline in lung function

Pathophysiology: Decreases in lung function increases the risk of death. In asthma the airways become inflamed and produce an excess of mucus. Cigarette smoking causes inflammation of the lungs and also produces mucus. (in both asthmatics and non asthmatics) The greater the amount of mucus preset in the lungs over a long period of time, the worse the lung function. If you are an asthmatic and smoke at the same time, your mucus level is rising not only because of your inherent asthma but also because of your exposure to smoke; hence you get even greater levels of mucus and more accelerated lung decline

Significance: This shows the importance of teaching asthmatics the dangers of cigarette smoking. It is a clear example of how cigarette smoking can have a synergistic effect in an already established illness, making the situation even worse.

Smoking Increases Blood Pressure in Diabetics

Source: American Journal of Hypertension 1998; 11: 1093- 1099

Findings: The study compared 24 diabetics who smoked to 24 non smoking diabetics. The participants were matched for age, gender and length of time they had diabetes. The diabetic smokers had significantly higher levels of blood presure and heart rates then did the non smoking diabetics.

Pathophysiology: diabetes increases the risk of heart disease and kidney disease, as does increased blood pressure. Smoking raises blood pressure and, therefore, increases the risk of kidney disease and heart disease. Those with both diabetes and the habit of smoking put themselves in "double jeopardy" for the formation of heart disease and kidney disease.

Significance: Smoking is another additional risk factor for diabetics. By eliminating smoking they can decease the risk of heart disease and kidney failure. Once again, we can see the synergistic effect between smoking and already established disease. Obviously, it is important to try to get diabetics to stop smoking.

ALSO…….

From, Journal of the National Cancer Institute 1198; 90; 1626- 1636, evidence that smoking increases the risk of oral cancer in those who have human papilloma virus (HPV). HPV is a sexually transmitted disease which can cause genital warts, cervical cancer and (in a small proportion of those afflicted) oral cancer. BUT- smoking and HPV together increases the risk of oral cancer- another example of the synergistic effect of smoking and an established disease.

AND

From: Cancer 1998; 83: 2049-2053, evidence that cancer of the esophagus and stomach (which has been dramatically rising in the US in the past two decades) is also linked to smoking. Other risk factors for these cancers include obesity and heavy alcohol consumption and certain dietary factors such as low intake of fruits and vegetables and a high intake of red meat, fat and calories. Again, smoking is a risk factor and, may very well have a synergistic effect with these other risk factors.

    http://www.acsh.org/publications/booklets/iesmoke.html    - Download the complete text of the American Council on Sciecne and Health's report: "The Irreversible Health Effects of Cigarette Smoke"

http://www.lungusa.org/  American Lung Association Homepage- a good gateway to information on smoking and lung related diseasesl