Editor's note: The National Cancer Prevention and Treatment Publicity Week (4.15) was initiated by the China Anti-Cancer Association in 1995 and has been successfully held for 29 sessions, and has become the oldest, largest and most influential cancer prevention and treatment brand science popularization activity in mainland China. Since 2018, the China Anti-Cancer Association has proposed to designate April 15 as "China Anti-Cancer Day" every year.
The 30th National Cancer Prevention and Treatment Publicity Week and China Anti-Cancer Day will be held nationwide from April 15 to 21, 2024. To this end, "Yiyuehui" specially invited Professor Guo Qisen from Shandong Cancer Hospital and Professor Guo Lu from the Affiliated Hospital of Shandong Second Medical University to popularize the relevant content of "Smoking and Tumors" for everyone!
Interviewees
Professor Guo Qisen
Chief physician, researcher and doctoral supervisor of the Department of Respiratory Medicine, Shandong Cancer Hospital
Member of the Lung Cancer Quality Control Committee of the National Cancer Quality Control Center
Vice Chairman of the Tumor Immunotherapy Committee of the China Medical Education Association
Vice Chairman of the Medical Oncology Branch of the China Association for the Promotion of International Exchange in Health Care
Vice Chairman of the Special Committee for Precision Diagnosis and Treatment of Tumors of the China Primary Health Care Foundation
Vice Chairman of the Oncology Drug Research Committee of the China Association of Traditional Chinese Medicine
He is a member of the Lung Cancer Professional Committee of the Oncology Branch of the Chinese Medical Association
Chairman of the Shandong Branch of the China Lung Cancer Prevention and Control Alliance
He is a member of the Standing Committee of the Rehabilitation Branch of the Chinese Society of Gerontology and Geriatrics
He is a member of the Clinical Chemotherapy Professional Committee of the Chinese Anti-Cancer Association
Director of the Chinese Society of Clinical Oncology (CSCO).
Chairman of the Chemotherapy Branch of Shandong Anti-Cancer Association
Former chairman of the Lung Cancer Branch of Shandong Anti-Cancer Association
Famous doctor of Shandong Famous Doctor Alliance
Hospital "Top 10 Well-known Experts, Top 10 Famous Doctors"
Prof. Lu Guo
Deputy Director of the Department of Medical Oncology, Deputy Chief Physician, and Master's Tutor of the Affiliated Hospital of Shandong Second Medical University
Deputy Director of the Department of Diagnostics of Shandong Second Medical University
Vice Chairman of the Youth Committee of the Chemotherapy Branch of Shandong Anti-Cancer Association
Member of the Tumor Drug Research Professional Committee of the China Association of Traditional Chinese Medicine
Member of the Precision Medicine Branch of Shandong Medical Association
Member of Shandong Pharmaceutical Biotechnology Society
Member of the Anti-tumor Drug Committee of Shandong Health Management Association
There is numerous irrefutable scientific evidence that smoking and secondhand smoke exposure are serious hazards to human health. As early as the middle of the 17th century, there was a record of "taking lung coke for a long time, not suffering from diaphragm, that is, vomiting red or yellow water and falling, or sick, and the drug was ineffective".
In 1947, the British Medical Research Council found that the death rate of lung cancer in the British population was 15 times higher than it had been 25 years earlier. Then he commissioned a survey by Hill, a biostatistician, and the results showed that the more you smoke, the higher the chance of lung cancer. In 1950, the results of this test were published in the British Medical Journal. In the 21st century, new scientific evidence on the health risks of smoking continues to emerge.
The team of academician Lin Dongxin of the Sun Yat-sen University Cancer Center and others found that cigarette smoke condensate (CSC) induces the occurrence and development of pancreatic cancer by promoting the m6A modification of miR-25-3p, confirming a new mechanism of smoking-induced pancreatic cancer risk.
A global large-scale study published by The Lancet, a top international medical journal, showed that in 2019, nearly 4.45 million cancer deaths worldwide were caused by risk factors such as smoking, alcohol consumption and obesity, accounting for 44.4% of all cancer deaths worldwide. This large study analysed the impact of 34 risk factors on cancer and confirmed the well-known fact that tobacco is the biggest risk factor for cancer, accounting for 33.9% of cancer cases, followed by alcohol at 7.4%. It also illustrates how behavioural changes can help reduce the threat of disease.
A team of researchers from Zhejiang University analyzed data from 23 cancer patients and up to 128423 cancer patients at MD Anderson Cancer Center, and found that smoking was significantly associated with cancer survival. Compared to those who had never smoked, the life expectancy of those who had previously smoked but quit was reduced by 3.7 years, while the life expectancy of those who still smoked was reduced by 5.9 years!
The risk of death increases significantly in patients who smoke earlier and for longer periods of time and continue to smoke after diagnosis. There is a direct link between smoking age and the number of cigarettes smoked and the risk of cancer death. Many people think that smoking is mainly responsible for an increased risk of lung cancer and mortality. Researchers looking at smoking and 23 different types of cancer found that smoking was associated with an increased risk of death from up to 20 cancers, with a statistically significant increase in the risk of death from nine cancers.
A research team from the Ontario Cancer Institute (OICR) in Canada analyzed the effects of 12,341 cancer genome single base substitution (SBS) signals from 18 different types of cancer on protein coding, and discovered a new way that smoking causes cancer - smoking increases "nonsense mutations", leading to the premature termination of protein coding, and this mutation is in the "tumor suppressor" In particular, without these tumor suppressors, abnormal cells can continue to grow without being controlled by the cellular defense system, and cancer can develop more easily.
Nature Reviews Clinical Oncology published a review of gastric cancer, summarizing the global distribution and disease burden of gastric cancer, detailing the risk factors associated with gastric cancer. Meta-analyses have shown that people who smoke now have a higher risk of developing stomach cancer than those who have smoked in the past, and this high risk is associated with > 20 cigarettes smoked per day and continuous smoking for more than 40 years. Another study found that a history of smoking, whether past or current, was a high risk factor for bowel stomach cancer, but not with diffuse stomach cancer.
Darragh Duffy's team at the Institut Pasteur in France published an article in Nature analyzing the Milieu Intérieur cohort, focusing on the effects of smoking on innate and adaptive immune responses, revealing the short- and long-term regulatory effects of smoking on immune responses. Emphasise that the effects persist even after smoking is stopped. The study highlights that smoking affects both innate and adaptive immune responses, where the effects on the latter are long-lasting due to epigenetic changes. This study has important implications for understanding the risk of smoking-related infections, tumors, and autoimmune diseases.
After the combustion and decomposition of cigarettes, there are more than 4,000 kinds of harmful substances in tobacco smoke, and there are at least 69 kinds of carcinogens, including nicotine, acrolein, nitrosamines, benzopyrene, polycyclic aromatic hydrocarbons and heavy metals, which can cause permanent mutations in key genes in the body and gradually accumulate, and the normal growth regulation mechanism is out of balance, leading to the occurrence of malignant tumors.
There is ample evidence that smoking can lead to lung cancer, laryngeal cancer, bladder cancer, stomach cancer, cervical cancer, ovarian cancer, pancreatic cancer, liver cancer, esophageal cancer, kidney cancer, etc.
There is evidence that smoking can increase the risk of acute leukemia, nasopharyngeal cancer, colorectal cancer, and breast cancer. In addition, according to the research results of Dr. Zhou Guangbiao and his team from the National Cancer Center of China, smoke from smoking can induce PD-L1 overexpression through aromatic hydrocarbon receptors (AhR), which leads to immune escape of tumors and promotes tumor progression.
Accumulating evidence suggests that smoking and its components have a significant impact on immune regulation, and that smoking has an effect on inflammation or tumor microenvironment formation, mainly by affecting immune effector cells, such as macrophages, neutrophils, and T lymphocytes, while immune dysregulation promotes inflammation and cancer. Quitting smoking significantly reduces the risk of developing these cancers and improves prognosis.
According to the statistics of the World Health Organization (WHO), the number of deaths due to smoking in the world is as high as 6 million every year, of which about 5.4 million smokers die, that is, an average of 1 smoker dies every 6 seconds, and half of the current smokers will die from smoking-related diseases in the future, and the annual death toll of non-smokers due to secondhand smoke exposure is about 600,000. If the global smoking epidemic is not effectively controlled, 8 million smoke-related deaths will reach 2030, 80% of which will occur in developing countries. Smoking prevalence is declining in most developed countries. The overall smoking prevalence in developing countries remains high, and the prevalence of smoking among adolescents is on the rise, and the smoking epidemic situation is severe. The average life expectancy of smokers is 10 years shorter than that of non-smokers. According to the 2020 Report on the Health Hazards of Smoking in China, more than 1 million people die each year due to tobacco in mainland China, and if effective action is not taken, it is expected to increase to 2 million per year by 2030 and 3 million per year by 2050.
The harm of smoking to the human body, including the harm of active smokers and passive smokers. Only about 10% of the smoke in the respiratory tract and lungs is directly inhaled by smokers, and about 90% of the smoke diffuses in the space around smokers, causing pollution of ambient air quality and forcing non-smokers to smoke passively. There are more than 40 carcinogens produced by smoking, which can directly cause cancer.
As far as lung cancer is concerned, foreign scholar Kubik reported that heavy smokers between the ages of 40 and 60 are 50 times more likely than non-smokers; the incidence of lung cancer among American women surpassed breast cancer in the 80s; the same trend has also emerged in British women's lung cancer; the incidence of lung cancer in Shanghai, mainland China, was 63.94 per 100,000 in 1984, an increase of 125.1% over 1965, and has increased year by year. Therefore, almost all doctors warn people that smoking is harmful to their health, and that smoking is in some sense equivalent to chronic suicide.
How much of a survival benefit can quitting smoking actually bring to cancer patients? The most obvious result is that quitting smoking reduces the risk of death from all cancers. Compared with patients who still smoke, patients who quit smoking had a lower risk of cancer death, and the longer they quit smoking, the more the risk of death was reduced: patients who quit smoking for 5 years, 5 years ~ 10 years, 10 years ~ 20 years and more than 20 years had a reduced risk of death by 3%, 5%, 11% and 15%, respectively! Of course, compared with patients who smoked after diagnosis, patients who had never smoked had the largest reduction in mortality risk of 20%. Some of the health hazards of smoking can be mitigated by quitting smoking. People who have successfully quit smoking have a lower risk of developing some cancers as they quit smoking for a longer period of time. Tobacco control, including the prevention of smoking and the promotion of smokers to quit smoking, has become the most important and feasible measure for disease prevention and individual health care in the population.
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