Smoking and Cancer

An overview of the Risk

By

Allan R. Handysides, M.B., Ch.B.. FRCPc ,FRCSc, FACOG. Director, GC Health Ministries Department

Relative Risk in the smoking community

Cancer Lip & Oral Lung Larynx Esophagus Kidney Bladder Pancreas Male 27.5 22.4 10.5 7.6 3.0 2.9 2.1 Female 5.6 11.9 17.8 10.3 1.4 2.6 2.3

Attitude of the Patient with Cancer

Patient feels he or she is diseased not just a body part

Declining cancer incidence in the USA

Declining by 2% annually since 1992 This is the number of new cancers per unit of the population In 2000,1,220,000 new cases of invasive cancer In 2000; 552,200 deaths from cancer
4

Smoking related deaths

Cancer
Lung

Males
89,000

%
14

Females
74,600

%
12

Oral
Bladder Pancrea s

20,000
38,300 13,700

3
6 2 14,900 14,600 2 2
5

Cancer is the second Leading cause of death

After 70 years of increasing smoking cancer deaths, the rate began to decrease in 1997, ie 5 years after the incidence of smoking in the USA began to decline. 5 year survival rates 39% in 1960-1963 went to 61% in 1989-1995 in whites, but only to 48% in blacks, the racial or ethnic factors are not clear.6

Diagnosis
Must be tissue based Staging clinical P/E, Xrays, U/S, C/T etc. Surgical T.N.M. system Increased use of biological features, eg. oncogenes, drug resistance genes,receptors etc.

The number one cancer reducing activity

Smoking cessation
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Potential Harvest
400,000 Americans die prematurely annually The risk is 1 in 3 of dying prematurely 20% of 12-18yr olds smoked a cigarette in the last month 80% of American smokers started

Process of cessation
Precontemplat ion Contemplation Active cessation

Precontem plation

Contemplat ion

Active cessation

Maintenanc e
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Cigar vs Cigarette vs Smokeless

Cigarette smokers tend to inhale more than cigar smokers Smokeless relates strongly to oral cancers systemically absorbed chemicals such as the nitrosamines cause cancer in the laboratory animal
11

Lung Cancer
Affects 90,000 males and 75,000 females annually 86% of whom will be dead within 5yrs of diagnosis
THIS IS THE LEADING CAUSE OF CANCER DEATH IN ALL GENDER AND ALL RACES IN THE USA
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Lung cancer
Peak age is 55-65yrs Accounts for 33% of all male cancer deaths and 25% of all female cancer deaths Smoking cessation efforts have slowed the rate of cancer deaths in men now down to 70/100,000 males/year The rate in women continues to rise now it is 35/100,000 female population per year.

13

Lung Cancer
15% localized to the lung at diagnosis 25% is spread to the local lymph nodes 55%+ have distant metastases at diagnosis SURVIVAL = 50% if localized 20%than if regional These poor figures are 100% better 30yrs ago
14 14% overall

Lung cancer A Major health problem with a grim Prognosis

15

Major types of Lung cancer

Squamous (epidermoid) carcinoma Small cell (oat cell) Adenocarcinoma Large cell carcinoma

16

Changes in type
Adenocarcinoma has overtaken squamous as the most prevalent Small cell carcinoma is most likely to be spread at the time of diagnosis though if caught early respond well to surgery, radiation and chemotherapy
17

90%OF ALL TYPES OF LUNG CANCER OCCUR IN CURRENT OR FORMER SMOKERS

18

Lung Cancer
Concept of PACK YEARS is more related to cancer risk 2 packs a day for 20 years = 40 pack years which = a 60-70 fold increased

risk for carcinoma

Women have a relative risk higher than men when they get into heavier smoking patterns

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Lung cancer and genetic changes in pulmonary cells

Regulator genes are damaged by smoking so that perhaps 10 segments in the DNA are damaged before a cancer shows up. Chromosome 3p is involved in nearly all lung cancers and p53 and rb genes are damaged in more than 90% of small cell lung cancers( possibly inherited defects) Nicotine itself seems to play a strong carcinogenic role
20

Detection requires
Routine Chest X-ray Awareness that infection may occur in persons with CA Tumor may cause dysfunction in adjacent organs Metastasis may be from the lung

21

Para neoplastic symptoms

Anorexia Cachexia Weight loss Fever Suppressed immunity

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Endocrine syndromes
Hypercalcemia PTH Hypophosphatemia Hyponatremia ADH Electrolyte disturbances ACTH Coagulopathies Neurologic/myopathic syndromes

23

Oral cancers
Alcohol and Tobacco the major determinants Smokeless tobacco

Marijuana, factors like nickel refining, textile fibers, and woodworking may also play a role

24

Chewing tobacco and Leukoplakia

Metaplasia Dysplasia Leukoplakia In situ changes Frank Neoplasia
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Smoking cessation a major health benefit

Rates fall in nearly all situations where smoking cessation is implemented Prevention even better hence the need to work with the youth. At risk behavior best modified in a MENTOR situation

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Smoking and Cancer

Live Longer

Breathe- Free