Diseases caused by smoking

Based on the 20-year follow-up of the British doctors's cohort, it was concluded that a young man who persists in smoking will run a 1 in 4 chance of being killed prematurely by tobacco. More recent studies, including the 40-year follow-up of the British doctors (5) and the second large study of the American Cancer Society(6) have forced a re-evaluation of the extent of the risk. It is now apparent that persistent smokers run a 1 in 2 risk of being killed by cigarettes, losing on average 8 years of life.

Smoking causes some 30 per cent of deaths from cancer, the great bulk of deaths from chronic respiratory disease, and is a major contributor to circulatory diseases. I§ble..,1 summarizes data from the American Cancer Society study of over 1 million men and women aged 35 years and over, giving mortality in cigarette smokers and lifelong non-smokers for the main fatal smoking-related diseases.(6) moking is recognized to cause 80 per cent or more of all lung cancers. In addition it is responsible for most cancers of the upper respiratory tract (lip, tongue, mouth, pharynx, and larynx) and for a smaller fraction of cancers of the bladder, pancreas, oesophagus, and kidney. Among both men and women, deaths from cardiovascular disease (ischaemic heart disease, aortic aneurysm, and stroke) outnumber those from all other causes, including lung cancer. Over 70 per cent of chronic obstructive lung disease is attributable to smoking. Findings from the British doctors's study (5) additionally indicate a causal effect of smoking on stomach cancer and leukaemia. Associations between smoking and a number of other diseases including cervical cancer, cirrhosis of the liver, suicide, poisoning, and cancer of the liver have been regarded as being due to confounding. (5)

Table 1 Fatal diseases associated with smoking: men and women aged over 35 years (standardized mortality rates per 100 000 per year)

As well as being the single largest cause of preventable premature death, cigarette smoking is a cause of a number of disabling but generally non-fatal conditions. (7) These include peripheral vascular disease, cataracts, Crohn's disease, gastric and duodenal ulcers, hip fracture in elderly people, and periodontitis, the major cause of tooth loss in adults. Breathing other people's smoke also causes a significant burden of disease in non-smokers, especially infants and children.

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