The effects of tobacco smoke: first the bad news
It was over sixty years ago that Sir Richard Doll’s pioneering work first demonstrated a causal link between tobacco smoking and an increased risk of lung cancer. The lessons drawn from it have undoubtedly saved millions of lives over the years, but it is disappointing that according to the recently published European cancer mortality predictions for 2013, lung cancer remains the biggest cause of cancer death in male EU residents, and is predicted to become the biggest cause of cancer mortality in women in the near future, overtaking deaths from breast cancer.
The trend is similar in the US. A recently published paper in the New England Medical Journal, which involved data from more than two million women at three different time periods, showed that women who smoke currently are at a far greater risk of death from lung cancer than were women who smoked in the 1960s and the 1980s; the risk is now equal for both genders. While other factors that increase the risk of lung cancer, such as asbestos and radon gas exposure, have now been identified, tobacco smoke is still thought to be responsible for around 90% of lung cancer cases.
During the decades since Doll’s work it has, of course, been demonstrated that the risk of death from many other diseases, including other cancers, ischemic heart disease, stroke, chronic obstructive pulmonary disease and asthma, is augmented by smoking tobacco. More recently it has been recognized that passive smoking can also increase the risk of smoking-related diseases, and that prenatal exposure to tobacco smoke increases the risk of low birth weight and premature neonates, as well as SIDS and asthma in infancy. But in spite of the concerted efforts that have been made to educate the public about the dangers of tobacco smoke over more than half a century, a substantial minority of the population, including many physicians, still smokes.
Now for the good news. Several comparative studies indicate that public smoking bans now operating in much of the developed world are already affecting the rate of cardiovascular and respiratory disease. And a very recent robust study from Belgium, giving data from the three phases of the ban in that country, where smoking was first prohibited in the workplace (2006), then in restaurants (2007) and finally in bars serving food (2010), demonstrates a fall in the premature birth rate after each phase. So finally at least those of us who have heeded the oft-repeated health message may benefit fully from our prudence!