* Average annual number of deaths, 2000—2004.
Figure 50-1 Deaths attributable each year to smoking. (From CDC Office, on Smoking and Health. http://www.cdc.gov/tobacco/data_statistics/tables/index.htmj
• A dose-response relationship exists between the number of cigarettes smoked and the risk of cancer. Those smoking more than one pack a day have 20 times the risk of nonsmokers.
• Smoking formerly labeled "low-tar" and "low-nicotine" cigarettes provides no benefit over smoking regular cigarettes.
• Less than half of all smoking deaths are from cancer; the rest are from heart disease, chronic lung disease, and stroke.
• Tobacco use increases the risk of cancer in most organs.
About 30% of all cancer deaths are attributable to cigarette smoking, with the evidence increasingly stronger. Box
50-1 lists diseases, including many cancers, for which the
Box 50-1 Evidence-Based Relationship between Smoking and Disease
The evidence is sufficient to infer a causal relationship between smoking and:
Cancer of the bladder, cervix, esophagus, kidney, larynx, lung, oral cavity, pharynx, pancreas, stomach
Acute myeloid leukemia
Abdominal aortic aneurysm
Stroke (cerebrovascular accident)
Coronary heart disease
Chronic obstructive pulmonary disease (COPD) Acute respiratory infections, including pneumonia Reduced lung function in infants
Impaired lung growth during childhood and adolescence Respiratory symptoms in children and adolescents, including cough, phlegm, wheezing, and dyspnea
Asthma-related symptoms (e.g., wheezing) in childhood and adolescence
Premature onset of age-related decline in lung function
All respiratory symptoms among adults, including coughing, phlegm, wheezing, and dyspnea
Poor asthma control
Sudden infant death syndrome (SIDS)
Reduced fertility in women
Fetal growth restriction and low birth weight
Premature rupture of membranes, placenta previa, and placental abruption
Preterm delivery and shortened gestation Cataracts
Increased absenteeism from work
Adverse surgical outcomes related to wound healing and respiratory complications
Low bone density in postmenopausal women Peptic ulcer disease
The evidence is suggestive of a causal relationship between smoking and:
Colorectal cancer Liver cancer
Increased prostate cancer mortality
Acute respiratory infections in persons with COPD
Increased lower respiratory tract illnesses during infancy
Impaired lung function in childhood and adulthood (with maternal smoking)
Poorer prognosis for children and adolescents with asthma Increased nonspecific bronchial hyperresponsiveness Ectopic pregnancy Spontaneous abortion Cleft palate
Low bone density in older men Dental caries Erectile dysfunction Macular degeneration Graves' disease
From US Surgeon General. The Health Consequences of Smoking: a Report of the Surgeon General, 2004. Rockville, Md, US Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2004.
evidence is sufficient to infer a causal relationship, as well as those for which the evidence is sufficient only to suggest a causal relationship. Reviewing tobacco's role in carcinogenesis, Hecht (2008) discusses several mechanisms that contribute to cancer, including metabolic changes in DNA and formation of DNA-carcinogen adducts, leading to mutation; inhibition of genes such as p53, a tumor suppressor; and mutations in the K-RAS oncogene (Fig. 50-2).
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