Page 6 Complete Your CE Test Online - Click Here the number of years smoked; cancer and other health risks also increase with number of cigarettes smoked per day. Some of the risk increase relates to the smoker’s age. In the general population (which includes both smokers and nonsmokers), the average probability of a man developing lung cancer goes from one in 608 to age 49, to one in 16 when the man is 70 or older. Current smokers, on average, have about 20 times the risk of lung cancer compared to nonsmokers. It is easy to see that young smokers who just started smoking are at much less immediate risk than someone who is older and has smoked 30 years. Daily smoking means constant exposure to harmful chemicals. Of the more than 7,000 chemicals in tobacco smoke, at least 250 are known to be harmful, including hydrogen cyanide, carbon monoxide, and ammonia. Among the 250 known harmful chemicals in tobacco smoke, at least 69 are considered carcinogens. These cancer-causing chemicals include the following: ● ● Acetaldehyde. ● ● Aromatic amines. ● ● Arsenic. ● ● Benzene. ● ● Benzo[a]pyrene. ● ● Beryllium (a toxic metal). ● ● 1,3–Butadiene (a hazardous gas). ● ● Cadmium (a toxic metal). ● ● Chromium (a metallic element). ● ● Cumene. ● ● Ethylene oxide. ● ● Formaldehyde. ● ● Nickel (a metallic element). ● ● Polonium-210 (a radioactive chemical element). ● ● Polycyclic aromatic hydrocarbons (PAHs). ● ● Tobacco-specific nitrosamines (TSNAs). ● ● Vinyl chloride. Because smoking is the kind of exposure that is fairly easy to measure, this extensive body of evidence has led to the estimation that cigarette smoking causes 30% of all cancer deaths in the U.S. Smoking avoidance and smoking cessation result in decreased incidence and mortality from cancer. According to the American Cancer Society, smoking shortens the lives of men and women by an average of 12 and 11 years. Most practicing health professionals know that illness and disability associated with smoking usually begins long before death. Although quitting smoking at younger ages preserves life and health better, quitting can prolong life at almost any age even after a lung cancer diagnosis. Studies have shown that continued tobacco use after cancer diagnosis is linked to worse outcomes, such as decreased survival and cancer recurrence. In addition, smoking increases the risk of surgical complications and other comorbidities that can increase deaths from other causes in people with cancer. Evidence-based practice: Drug treatments, including nicotine replacement therapies (e.g., gum, patch, spray, lozenge, and inhaler), selected antidepressant therapies (e.g., bupropion), and nicotinic receptor agonist therapy (varenicline), result in better smoking cessation rates than placebo. Secondhand smoke Solid evidence indicates that exposure to secondhand smoke causes lung cancer as well as other health risks. The U.S. Environmental Protection Agency, the U.S. National Toxicology Program, the U.S. Surgeon General, and the International Agency for Research on Cancer have all classified secondhand smoke as a known human carcinogen. Approximately 3,000 lung cancer deaths occur each year among adult nonsmokers in the U.S. as a result of exposure to secondhand smoke. Compared with nonsmokers who are not exposed to secondhand smoke, nonsmokers exposed to secondhand smoke have approximately a 20% increased risk of lung cancer. Note that this is relative risk, so it is 20% above the average lung cancer risk in unexposed nonsmokers, not a 20% absolute risk. Cancer risks from alternative tobacco products As cigarette smoking decreases, tobacco companies and other commercial interests are coming up with alternative tobacco products: ● ● Hookahs, also called water pipes: These are used to smoke special tobacco that comes in different flavors, such as fruits, mint, chocolate, coconut, licorice, and cappuccino. ● ● Bidis: These small, flavored, hand-rolled cigarettes from southeast Asia are wrapped in a tendu or temburni leaf and often secured with a colorful string at the end. ● ● Kreteks, or cigarettes made with tobacco, cloves, and other flavors: These were banned by the 2009 Family Smoking Prevention and Tobacco Control Act because of their clove flavoring but have recently been reintroduced into the U.S. as little cigars. ● ● Cigars, including little cigars and cigarillos. ● ● Smokeless tobacco. ● ● Electronic nicotine delivery systems, such as e-cigarettes, vape pens, and other vapor systems. These alternative products are increasingly being used by teens and young adults. Between 2000 and 2011, the consumption of other combustible tobacco products has increased 123% (that increase does not include smokeless and vapor products). Younger people adopt alternative tobacco products for a number of reasons: ● ● The products are not well regulated. ● ● There is the mistaken perception that the products are safer or more natural than cigarettes. ● ● The products are flavored to make them more palatable to nonsmokers. ● ● They often cost less than cigarettes. ● ● Many of these products are not even labeled as harmful to health. Given that most current adult smokers started when they were in their teens or youth, this does not bode well for the future of cancer prevention. Historically, out of every three young smokers, one will quit and one will die of a tobacco-related illness. Electronic cigarettes and other vape products have not been well researched regarding their long- term health hazards. Cigars, hookahs, bidis, and kreteks all carry the known health risks of combustible tobacco, very much like cigarettes. Smokeless tobacco has known cancer risks, but some of the other oral tobacco products (e.g., tobacco lozenges, orbs, strips, sticks, meltaways) need more research on their health effects. The one thing all of these alternative products have in common is that they deliver nicotine and are addictive. Cigars Although cigarette consumption declined by one-third in the U.S. between 2000 and 2011, cigar consumption doubled. Cigar smoke has higher levels of tobacco-specific nitrosamines (TSNAs) than cigarettes have and higher levels of carbon monoxide, and carries much the same risk as cigarettes and other combustible tobacco. Most cigars are composed of air-cured and fermented tobacco, with a tobacco wrapper. They can vary in size and shape and contain between 1 and 20 grams of tobacco. Cigars sold in the U.S. are categorized by size: ● ● Large cigars can measure more than 7 inches, and they typically contain between 5 and 20 grams of tobacco. Some premium cigars contain the tobacco equivalent of an entire pack of cigarettes. Large cigars can take between one to two hours to smoke. ● ● Cigarillos are a type of smaller cigar. They are somewhat bigger than little cigars and cigarettes and contain about 3 grams of tobacco. ● ● Little cigars are about the same size and shape as cigarettes, are often packaged like cigarettes (20 little cigars in a package), and contain about 1 gram of tobacco. Also, unlike large cigars, some little cigars have a filter, which makes it seem they are designed to be smoked like cigarettes (that is, for the smoke to be inhaled). Many “little cigars” are smoked exactly like cigarettes, and, in most states, they cost less because of tax loopholes. Chang and colleagues (2015) looked at 22 studies of cigar smokers and death. They confirmed a strong dose relationship between the number of cigars smoked per day and how deeply the smokers inhaled the smoke and the development of oral, laryngeal, lung, pancreatic, and esophageal cancers as well as coronary heart disease and aortic aneurysm. Even