SMOKING AND LUNG CANCER DR. BASSEM TOEMA Medical Oncology Specialist Saad Specialist Hospital ESMO Member
Smoking Prevalence Cigarette Smoking in US Male 32% Female 27%Cigarette smoking among educated groups in USCollege graduate 12% Some College 20% High School 31% Physician 3%
Smoking Prevalence Smoking in Saudi Arabia in Adults (30-70 Years Old) Males 19.1% Females 8.3% Overall 13.4% Smoking in Saudi Arabia in Youth Males 20.2% Nursing Doctors Pharmacy Smoking in SaudiArabia in Hospital Staff 8.6% 20% 14.3%
Annual Consumption of Cigarettes per Adult in Saudi Arabia
Globally47% Male 12% FemaleDeveloping Countries Developed Countries48% Male 7% Female 42% Male 24% Female
Death Average Lung Cancer mortalityAge group and Average intensity duration (Deaths/100,000 gender (person-years) (Cigarettes/day) (Years) persons) 40-49 Men 18 (75,938) 25 29 24 Women 40 (138,275) 20 27 29 50-59 Men 326 (221,677) 23 36 147 Women 249 (278,591) 20 33 89 60-69 Men 699 (161,945) 23 44 432 Women 435 (197,527) 19 40 220 70-79 Men 470 (50,371) 20 51 933 Women 217 (63,636) 17 46 341
In UK one case diagnosed every 15 min with lung cancer
The Evidence for a Causal Association• The lifetime risk of developing lung cancer in smokers is approximately 10%.• Lung cancer is directly related to smoking. Over 40 carcinogens have been identified in cigarette smoke. Examples include particulate phase carcinogens as Benzo[a]pyerene, Nicotine, Tobacco specific nitrosamines, Nickel, Cadmium; Also Gaseous phase carcinogens as Hydrazine and Vinyl Chloride.• Carcinogens act by mutating certain dormant Oncogenes (as Ras oncogene) activating them and mutating certain active Tumor suppressor genes ( as P53) inhibiting them.
The Magnitude of the Problem• Here in Saudi Arabia, Lung cancer is ranked as the seventh most common cancer among the Saudi citizens (both males and females) with an overall prevalence rate of 4.7%.• Among the Male Saudi citizens, the lung cancer is ranked as the fourth most common cancer with an overall prevalence rate of 7%.
Late is never too late• The overwhelming majority of lung cancers, greater than 90%, are caused by cigarette smoking. Therefore, by avoiding smoking from the start, more than 90% of lung cancers can be preventable.• Some risk of lung cancer persists for many years following smoking cessation, yet this risk diminishes with the passage of time.• Protection of non-smokers: Smoking is banned or restricted in government offices and nurses, doctors, teachers are encouraged to refrain from smoking in the presence of children. Airline companies have banned smoking on all domestic and international airline flights.
Tobacco control measures• Control on tobacco products: The GCC proposed stringent measures to be adopted by the Gulf States, including limits on tar and nicotine levels for cigarettes of 12 and 0.8 mg. respectively; a health warning in Arabic and English to be printed on cigarette packets "Smoking is the main cause of lung cancer, lung diseases and of heart and arteries disease"; import duties on cigarettes to be increased from 30% to 50%; the import of chewing tobacco to be banned and the imposition of curbs on the advertisement and promotion of cigarettes. The import of products that could promote smoking by children, such as sweets designed to look like cigarettes or cigarette packets is banned.