Tue. Nov 19th, 2019

TOBACCO USE AND CANCER

Tobacco consumption is considered as a major social issue in India, particularly among adolescents and young. In terms of cancer, tobacco is responsible for more than 60% cancers among men and nearly 20% of cancers among

Dr. Balagopal P G
Addl Professor,
Surgical Oncology, RCC
Trivandrum

females. In addition, tobacco is also responsible for high incidence of cardiovascular disease and chronic obstructive lung disease(COPD).It is now estimated that the tobacco related death will cross 1.5 million annually by 2020.

Tobacco is responsible for cancers of oral cavity, lung, stomach, urinary bladder, pancreas, breast, and colon. The prevalence of smoking among males in Kerala is28.7, females0.4, but the prevalence of chewing among males is 9.4 and females is 10.1.

A study conducted at Tata Memorial Hospital, Mumbai revealed, 300000 tobacco related cancers occur annually and 2000 deaths per year in India, which is one of the highest in the world.

Smokers topography

Smokers can affect the amount of nicotine they draw from a cigarette

  • By altering the number of puffs taken.
  • Puff size
  • Frequency
  • Duration
  • Velocity

Electronic cigarettes : The relatively recent introduction of electronic cigarettes (i.e., e-cigarettes, e-cigs, nicotine vaporizers, or electronic nicotine delivery systems (ENDS)) is noteworthy.  These electronic or battery-powered devices activate a heating element that vaporizes a liquid solution contained in a cartridge, and then the user inhales this vapor.

The international Agency for Research on cancer (IARC) has classified both cigarette smoke and smokeless tobacco as Group 1 carcinogens.

Group 1 (carcinogenic to humans),          (72 Compounds)          2A (Probably carcinogenic to humans).          2B(possibly carcinogenic to humans)

How tobacco use lead to cancer

Hecht suggested the pathway how tobacco use lead to cancer

Carcinogen exposure-leads to DNA Adducts-it in turn lead to mutations-if these mutations are not repaired or removed by apoptosis- lead to cancer.

Neurobiology of Tobacco Dependence

Nicotine is the primary addictive component of tobacco.  It increases extracellular concentrations of dopamine in the nucleus accumbens and stimulates the mesolimbic deperningergic system-resulting in  nicotine’s rewarding effect experienced by tobacco users.  Activation of the nucleus accumbens has further been implicated in drug reinstatement or relapse.

Smoking Cessation

As described in the PHS Guidelines, the principal steps in conducting effective smoking cessation interventions are referred to as The % A’s

  1. Ask about tobacco use for every patient.
  2. Advise every tobacco user to quit.
  3. Assess the willingness of patients to quit.
  4. Assist patients with quitting through counseling and pharmacotherapy.
  5. Arrange follow-up cessation support, preferably within the first week after the quit date.

Treatment strategies Used for Tobacco Cessation Treatments

  1. Provide and monitor the use of nicotine replacement or other pharmacotherapy.
  2. Provide the health education regarding the health effects of tobacco use and its addictive and relapsing nature.
  3. Identity and change environmental and psychological cues for tobacco use.
  4. Generate alternative behaviours for tobacco use.
  5. Provide motivational interventions as needed throughout the treatment.
  6. Identify relaxation techniques such as guided imagery and progressive muscle relaxation.
  7. Provide behavioural strategies to address depressed mood.

 

 

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