Smoking related cancer

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Morbidity & Mortality

Smoking contributes to approximately one in three cancer deaths

Smoking is a significant risk factor for the following cancers:

  • Lung
  • Head and neck: lip, oral cavity, pharynx and larynx
  • Upper GI tract: oesophagus, stomach and pancreas
  • Renal tract: bladder and kidney

It is also a risk factor for cancer of the cervix and vulva, uterus and bowel and acute myeloid leukemia.1

Alcohol appears to potentiate the carcinogenic effect of tobacco, significantly increasing the risks of cancer of the head and neck, stomach, liver and pancreas.

Overall, cigarette smoking contributes to approximately one in three cancer deaths.

Any exposure to tobacco increases the risk of cancer

At an individual level, the risk of developing cancer is related to the life-time exposure to tobacco, the quantity smoked each day, the total number of years smoked and the age that smoking started.2 Of all these factors, the length of time that someone smokes seems to be the most significant. For example in people who have smoked for 45 years the risk of lung cancer is 100 times greater than for individuals who have been smoking for 15 years even if the amount smoked each day is less.3

There is no safe level of tobacco exposure. There is measureable risk of cancer with low levels of smoking,4,5 occasional smoking,6 low tar cigarette smoking and passive smoking.7,8

Stopping smoking reduces cancer risk

Stopping smoking reduces the risk of smoking-related cancers. This effect is most pronounced at younger ages but stopping smoking at any age confers benefit. People who stop smoking at age 30 years reduce their risk to almost that of non-smokers, those at age 50 years can halve the excess risk of cancer,9 and mortality is even reduced in people who stop smoking in their seventies.10

The effect of stopping smoking varies depending on the cancer:11

  • The risk of lung cancer halves in about ten years
  • The risk of oral and laryngeal cancer takes at least 20 years after stopping to reduce to that of non-smoker
  • The risk of bladder cancer takes at least 25 years after stopping to reduce to that of non-smoker

It remains controversial as to whether there is any real benefit from cutting down the number of cigarettes smoked each day.12 However this may be a strategy for those unable to quit completely.13

Lung cancer

Nine out of ten lung cancers are directly related to smoking and the inhalation of second hand smoke is estimated to be responsible for one in four of the lung cancers found in non-smokers.14

Upper aerodigestive cancer

Smoking is associated with around nine in ten cancers of the lip, oral cavity, pharynx, larynx and oesophagus.15 All types of tobacco exposure carry a risk of developing these cancers including chewing tobacco, using snuff, smoking cigars or smoking marijuana as well as the more obvious risk from cigarette smoking.

By the age of 75 a smoker has a one in 16 chance of developing these cancers compared to a one in 125 chance in a non-smoker.16

Stomach and Pancreatic cancer

Smoking contributes to over one in four pancreatic cancers17 and one in five stomach cancers.18

Urinary tract cancers

Smoking increases the risk of bladder cancer by three to five times19 and contributes to two out of three cases in men and one in three cases in women.

The risk of kidney cancer is doubled by smoking. It contributes to one in four cases in men, and one in ten cases in women.20

References

  1. Gandini S, Botteri E, Iodice S, et al. Tobacco smoking and cancer: a meta-analysis. Int J Cancer 2008;122:155-64.
  2. Wiencke JK, Thurston SW, Kelsey KT, et al. Early age at smoking initiation and tobacco carcinogen DNA damage in the lung. J Natl Cancer Inst 1999;91(7):614-9.
  3. Doll R, Peto R. Cigarette smoking and bronchial carcinoma: dose and time relationships among regular smokers and lifelong non-smokers. J Epidemiol Community Health 1978;32:303-13.
  4. Bjartveit K Tverdal A. Health consequences of smoking 1-4 cigarettes per day. Tobacco Control 2005;14(5):315-20.
  5. Polesel J, Talamini R, La Vecchia C, et al. Tobacco smoking and the risk of upper aero-digestive tract cancers: A reanalysis of case-control studies using spline models. Int J Cancer 2008;122(10):2398-402.
  6. Bjerregaard BK, Raaschou-Nielsen O, Sørensen M, et al. The effect of occasional smoking on smoking-related cancers: in the European Prospective Investigation into Cancer and Nutrition (EPIC). Cancer Causes Control 2006;17(10):1305-9.
  7. Stayner L, Bena J, Sasco AJ, et al. Lung cancer risk and workplace exposure to environmental tobacco smoke. Am L Public Health 2007 Mar;97(3):545-51.
  8. Jamrozik K. Estimate of deaths attributable to passive smoking among UK adults: database analysis. BMJ 2005 Apr 9;330(7495):812.
  9. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 2004;328(7455):1519.
  10. Wakai K, Marugame T, Kuriyama S, et al. Decrease in risk of lung cancer death in Japanese men after smoking cessation by age at quitting: pooled analysis of three large-scale cohort studies. Cancer Sci 2007;98(4):584-9.
  11. Dresler CM, Leon ME, Straif K, et al. Reversal of risk upon quitting smoking. Lancet 2006;368:348-9.
  12. Tverdal A, Bjartveit K. Health consequences of reduced daily cigarette consumption. Tobacco Control 2006;15(6):472-80.
  13. Godtfresden Ns, Prescott E, Osler M. Effect of smoking reduction on lung cancer risk. JAMA 2005;294(12):1505-10.
  14. Taylor R, Najafi F, Dobson A. Meta-analysis of studies of passive smoking and lung cancer: effects of study type and continent. Int J Epidemiol 2007;36(5):1048-59.
  15. Johnson N. Tobacco use and oral cancer: a global perspective. J Dent Educ 2001;65(4):328-39.
  16. Bosetti C, Gallus S, Peto R, et al. Tobacco smoking, smoking cessation, and cumulative risk of upper aerodigestive tract cancers. Am J Epidemiol 2008;167(4):468-73.
  17. Iodice S, Gandini S, Maisonneuve P, Lowenfels AB. Tobacco and the risk of pancreatic cancer: a review and meta-analysis. Langenbecks Arch Surg 2008;393(4):535-45.
  18. Ladeiras-Lopes R, Pereira AK, Nogueira A, et al. Smoking and gastric cancer: systematic review and meta-analysis of cohort studies. Cancer Causes Control 2008;19(7):689-701.
  19. Brennan P, Bogillot O, Cordier S, et al. Cigarette smoking and bladder cancer in men: a pooled analysis of 11 case-control studies. Int J Cancer 2000;86(2):289-94.
  20. McLaughlin JK, Lindblad P, Mellemgaard A, et al. International renal-cell cancer study. I. Tobacco use. Int J Cancer. 1995 Jan 17;60(2):194-8.
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