How can health risks be reduced in active smokers?

Cancer diseases may soon become the leading cause of death in the European Union. Already, according to estimates by the European Commission, they are responsible for around 1,3 million deaths among EU citizens. One of the main and direct inducing factors of cancer is smoking. In Poland, drugs supporting quitting smoking are not reimbursed by the National Health Fund, and in addition, their effectiveness in most smokers is low. We talk to Wojciech Rogowski, MD, PhD, specialist in clinical oncology and radiotherapy, coordinator of the Department of Clinical Oncology of the Provincial Specialist Hospital in Słupsk, about the possibilities of reducing health risk in such people.

The latest data indicate that neither the recently introduced ban on the sale of flavored cigarettes in Poland, nor the lockdown related to the COVID-19 epidemic have significantly affected the habits of smokers
Worryingly, in the case of women and young adults, lockdown often favored a return to smoking after a period of abstinence.
What can a smoker who is unable to quit but is concerned about his health to do? The possibilities are wide: pharmacotherapy, nicotine replacement therapy and oral alternative products – explains Wojciech Rogowski, MD, PhD
More information about the coronavirus can be found on the TvoiLokony home page

Monika Zieleniewska, MedTvoiLokony: The European Plan against Cancer has just been released. How does the professor evaluate this plan?

Dr hab. n. med. Wojciech Rogowski: The European Beating Cancer Plan gives hope for the improvement of European trends in cancer incidence. Much space is devoted to preventive measures, i.e. primary and secondary cancer prevention. Of course, the implementation of the plan itself at the national level is a separate issue.

This plan includes many actions of value from a public health perspective, but does not include harm reduction programs for nicotine-dependent patients. These programs can significantly reduce the risk of smoking-related diseases, in light of the results of new independent research. The most recent example of such data is a study by the Japanese Ministry of Health. The results suggest that smokers who quit smoking completely by switching to heat-not-burn products may have up to a 10-fold reduction in the risk of tumor induction, compared to continuing smoking.

How many smokers manage to quit smoking?

American research has shown that about 67 percent. active smokers were interested in quitting smoking, and 50 percent. is taking steps to quit smoking. Meanwhile, the effect was achieved in about 7 percent. So 7 out of 100 smokers managed to achieve a lasting effect, while the rest of them were unsuccessful.

These things put us at risk for cancer. Most important: smoking

And in Poland?

The latest data published in December 2020 by the Chemical Substances Office subordinate to the Ministry of Health indicate that neither the recently introduced ban on the sale of flavored cigarettes in Poland, nor the lockdown related to the COVID-19 epidemic have significantly affected the habits of smoking people. Worryingly, in women and young adults, lockdown often favored a return to smoking after a period of abstinence.

“Reducing health risks in active smokers” is a relatively new concept. How to understand them?

It is a set of actions that should be taken to reduce the risk of smoking. We all know that smoking is harmful and can lead to death directly, either from smoking or from a variety of diseases. Such a disease is, among others lung cancer or cardiovascular diseases.

Smokers have a much higher risk of lung cancer or cardiovascular disease. If the smoker takes measures to quit and if these measures are successful, then the risk will gradually decrease. In a significant proportion of smokers, nicotine addiction is so strong that pharmacotherapy and psychotherapy do not bring the expected results.

And then what?

Then, the recommended procedure is various types of medically tested nicotine products, reducing the symptoms of withdrawal syndrome and making it easier for the patient to give up smoking. It is worth emphasizing that quitting smoking brings health benefits, regardless of the age of the smoker and the number of pack-years he has behind him.

But what can a smoker who is unable to quit but is concerned about his health to do?

The best solution for the patient is always to completely abandon the addiction. If someone really wants to quit smoking but is unable to cope with drug treatment, nicotine replacement therapy and tested, smoke-free alternatives are available. Two such products: oral snus and the system of heating specially prepared tobacco, received a positive opinion of the US FDA and were found to be significantly less harmful compared to continuing to smoke cigarettes.

How to successfully quit smoking? Here are the top eight ways

However, the key is to completely quit smoking, which is the most toxic form of nicotine consumption. Of course, alternative products dedicated to smokers are also not indifferent to health and attempts to completely quit smoking should be continued by the patient. On the other hand, people who are not heavy smokers should absolutely not reach for this type of product.

And what toxins does the smoker avoid when switching from cigarettes to, for example, tobacco heating systems?

The American FDA states on its website that the average reduction of aerosol carcinogens emitted by one of such devices was estimated at 93%. compared to cigarette smoke. The research has also shown that compared to the smoke from a classic cigarette in an aerosol from the “heat not burn” device, it is reduced by an average of 92 percent. the level of cardiotoxic and respiratory toxic substances.

And were you able to carry out any tests over a longer period of time?

As I mentioned, such devices have only been on the market for a few years, while the process of carcinogenesis, i.e. the formation of cancer, is long, so at the moment the observation time is too short to assess the actual reduction of the risk of cancer development after switching from smoking to using this type of device. Therefore, public health authorities in several countries have conducted studies aimed at estimating the risk of developing cancer on the basis of accurate toxicological data.

Why is sugar white death? Is it as harmful as cigarettes and alcohol?

And what are the results?

The research was conducted by the National Institute of Public Health in the Netherlands and the Ministry of Health of Japan. The results suggest even more than 10 times lower risk of cancer development in the case of inhalation of the aerosol from the “heat not burn” device compared to inhalation of cigarette smoke. However, we will probably have accurate clinical data only in 6-7 years. The longer the observation time, the better the chances for more complete data and the more reliable the results.

These devices appear to be less harmful and are produced in a controlled and standardized manner. We already know from independent studies that they enable a significant reduction of toxins compared to cigarette smoke, which may translate into a lower incidence of smoking-related diseases in a smoker who completely quits smoking and satisfies the nicotine craving using a “heat not burn” device. I emphasize that such an effect can only occur if you completely give up smoking.

What about e-cigarettes?

We have longer observations here, but the problem is the huge variation in the chemical composition of thousands of liquids. My biggest doubts are the health risks associated with home-made liquids, which are not tested by anyone. In my opinion, the e-cigarette market is out of control. It cannot be denied that there are certified or licensed e-cigarettes, produced in a controlled manner, where the composition of the liquid is known, the amount of nicotine is known and we know more or less what we are dealing with. But, unfortunately, most of the e-cigarette market is wild.

You can assemble an e-cigarette by yourself by purchasing device components, liquid ingredients and nicotine. In particular, legally available “Do It Yourself” kits, ie kits for home preparation of liquid, may be subject to the risk of toxic interactions of some ingredients and result in health consequences that are difficult to predict. Therefore, for example, in some states of the USA there are restrictions that prohibit the sale of e-cigarettes, but they are very easy to bypass them.

Liquids of unknown composition and home experimentation kits should be distinguished from medically tested nicotine inhalers, which can be registered as medical products for heavy smokers. Only medically tested, certified devices and liquids with a fixed composition can be a less harmful alternative. This solution was adopted, among others in the UK, where medically tested devices of this type can be purchased from pharmacies.

We debunk the myths. Is one cigarette not addictive?

Young people are now starting to smoke from smokeless electronic devices. Are they safer?

There are no safe tobacco products. Very valuable research in this area has been carried out in Poland by NIZP-PZH. In a large group of young people surveyed, over 50 percent. teenagers currently using tobacco products admitted that the initiating product for them was a traditional cigarette, and for 30% e-cigarette. The nicotine initiation in the form of using much more expensive “heat not burn” devices was reported by 0,2 percent. subjects.

The most disturbing information from the study, however, was that 14 percent. teenagers reported adding illegal psychoactive substances (including methamphetamine, mephedrone, cocaine) to self-produced liquids, and 6 percent. has refused to answer this question. Therefore, an educational campaign should be conducted in schools from an early age, so that young people do not use any psychoactive substances. Moreover, phenomena related to e-cigarettes important for public health were observed in the USA. I mean pulmonary neurotoxicity, which was reported in 2019.

What is going on?

Neurotoxicity is damage to the nervous system. By April 2019, there were 35 reports in the United States of seizures in people who smoked e-cigarettes between 2010 and 2019. In August this year, there were 92 more. These prompted the FDA to start a study to assess the cause-and-effect relationship between e-cigarette use and seizures.

Do we already have the results of this study?

It still goes on. In addition, cases of severe lung injuries began to be registered in vaping people. The following symptoms were reported: cough, shortness of breath, fatigue, fever, chest pain and nausea. In the radiological image, both lungs were matted, and on the computed tomography an image of the so-called matte glass without signs of infection.

These symptoms worsened over the course of a few days or weeks, and some patients required hospitalization in a normal ward or even in the ICU. These cases did not apply to those who used e-cigarettes for years or switched from classic to e-cigarettes, and to adolescents who started their smoking adventure with vaping. The results of an investigation by the FDA and CDC showed that severe lung damage resulted from the use of illegally packaged liquids to which tocopherol acetate was added, in which psychoactive cannabinoids were dissolved.

And how is the active smoker switching to electronic devices?

According to research, smokers claim that the use of smokeless electronic devices is sometimes less satisfying than classic cigarettes. On the other hand, a recent study published by the Bureau of Chemical Substances shows that 86 percent. smokers who have turned to tobacco heating systems to quit smoking have been successful and have not actually returned to smoking. For comparison, in the case of e-cigarettes, the percentage of their effectiveness in this area was 20%.

Should heavy smokers be encouraged to switch to alternative products, then?

First of all, we should encourage smokers to quit smoking. Try cytisine or bupropion medication first, and when it does not help, nicotine replacement therapy. When nothing helps and the smoker continues to smoke, then a complete replacement of smoking with tested smokeless tobacco products may result in some reduction in the risk of developing tobacco-related diseases.

Of course, theoretically, the ideal solution would be to completely eliminate cigarettes from the market, but as recent experience of the South African government shows, it is extremely difficult. In 2020, South Africa introduced a total ban on the sale of cigarettes for several months in connection with the COVID-19 pandemic. As shown by the analyzes recently published by scientists, even during the ban, 93 percent. of smokers obtained their tobacco from illegal sources, which led to a flourishing of large-scale smuggling. Therefore, it is worth taking a look at the new regulatory solutions introduced by the USA or Great Britain in the field of reducing health damage related to nicotine addiction.

How can health risks be reduced in active smokers?

Leave a Reply