Cancer of the Cervix

has฀also฀been฀detected฀in฀non-smokers,฀probably฀because฀of฀environmental฀exposure฀ [416] .฀ Smoking฀cessation฀should฀reduce฀lesion฀size฀in฀cervical฀cancer฀ [417] .฀The฀increased฀risk฀for฀ cervical฀cancer฀is฀evident฀from฀the฀data฀presented฀in฀Table฀ 7.6 ฀summarising฀cancer฀inci- dence฀statistics฀from฀a฀follow-up฀study฀conducted฀over฀26฀years฀ [356] .

7.6.5 Prostatic Hyperplasia and Prostatic Cancer

Lower฀urinary฀tract฀symptoms฀have฀been฀reported฀to฀occur฀equally฀in฀various฀age฀catego- ries฀in฀smokers฀and฀non-smokers.฀In฀men฀aged฀40–49฀years,฀the฀symptom฀score฀correlated฀ with฀pack-years,฀with฀urinary฀tract฀infections฀being฀noted฀more฀commonly฀ [418] .฀Alcohol฀ Site฀of฀neoplasm฀ICD–7฀ Number฀n฀ Ex-smokers฀RR฀ 95฀CI฀ Current฀smokers฀RR฀ 95฀CI Total฀140-209 4,023 1.14฀0.95–1.35 1.20฀1.09–1.31 Oral฀cavity฀140-4 46 – 1.60฀0.74–3.45 Pharynx฀145–8 17 – 2.87฀0.85–9.69 Oesophagus฀150 25 3.60฀0.81–15.96 1.68฀0.53–5.25 Upper฀respiratory฀tract฀ 140-8,฀150,฀161 94 0.93฀0.23–3.83 2.14฀1.27–3.61 Stomach฀151 226 0.18฀0.02–1.26 1.25฀0.84–1.86 Colon-rectum฀153-4 559 1.16฀0.72–1.86฀ 0.88฀0.67–1.16 Liver฀155.0 41 – 0.70฀0.24–2.05 Gallbladder฀155.1-155.9 110 0.32฀0.04–2.33 0.66฀0.33–1.34 Pancreas฀157 144 2.47฀1.14–5.34 1.77฀1.09–2.87 Lung฀162.0,฀162.1,฀163 153 1.08฀0.34–3.44 4.82฀3.38–6.88 Breast฀170 996฀ 1.21฀0.88–1.67 0.95฀0.79–1.14 Cervix฀uteri฀171 138 1.01฀0.37–2.78 2.54฀1.74–3.70 Endometrium฀172 248 1.02฀0.52–2.01 0.81฀0.55–1.18 Ovaries฀175 216 1.14฀0.56–2.34 0.93฀0.62–1.39 Kidneys฀180.0 94 1.86฀0.75–4.65฀ 1.09฀0.59–2.01 Bladder฀181.0 102 2.51฀1.08–5.86 2.34฀1.43–3.83 Other฀urinary฀organs฀180.1,฀ 181.1-9 23 – 5.17฀2.03–13.2 Malignant฀melanoma฀190 101 0.89฀0.28–2.85 1.15฀0.68–1.95 Skin฀191 124 1.27฀0.46–3.47 1.14฀0.64–2.00 Brain฀193 122 1.53฀0.66–3.52 1.04฀0.63–1.73 Thyroid฀194 50 0.55฀0.07–4.00 0.98฀0.45–2.17 Non-Hodgkin’s฀lymphoma฀ 200 94 0.66฀0.16–2.69 0.87฀0.43–1.64 Hodgkin’s฀lymphoma฀201 18 – 1.92฀0.56–6.51 Myelomas฀203 71 2.38฀0.85–6.63 1.24฀0.60–2.57 Leukaemias฀204-9 110 1.03฀0.32–3.29 1.24฀0.71–2.18 All฀other฀organs 432 0.87฀0.47–1.59 1.06฀0.80–1.41 Table 7.6 ฀฀฀Relative฀risks฀RR฀with฀95฀conidence฀intervals฀CI฀for฀cancer฀incidence฀in฀the฀period฀ 1964–1989:฀ex-smokers฀and฀current฀smokers฀were฀compared฀with฀non-smokers฀at฀the฀start฀of฀the฀ study.฀The฀data฀were฀adjusted฀for฀age฀and฀place฀of฀residence฀ [356] consumption฀correlates฀more฀clearly฀than฀current฀cigarette฀smoking฀with฀the฀development฀ of฀benign฀prostatic฀hyperplasia฀BPH;฀however,฀at฀35฀or฀more฀cigarettesday฀the฀risk฀for฀ BPH฀was฀found฀to฀be฀increased฀OR฀=฀1.45;฀CI:฀1.07–1.97.฀Moderate฀alcohol฀consump- tion฀and฀avoidance฀of฀smoking฀may฀beneit฀BPH฀ [419] . Prostatic฀cancers฀are฀not฀among฀the฀neoplasias฀primarily฀caused฀by฀smoking.฀However,฀ a฀few฀follow-up฀studies฀ [420–422] ฀indicate฀that฀smoking฀may฀increase฀the฀risk฀slightly฀by฀ 18.฀In฀heavy฀smokers฀40฀or฀more฀cigarettesday,฀the฀relative฀risk฀rises฀to฀51฀or฀80฀ [422] .฀One฀study฀performed฀in฀more฀than฀340,000฀men฀revealed฀risk฀increases฀of฀21฀£25฀ cigarettesday฀and฀of฀45฀³26฀cigarettesday,฀indicating฀that฀cigarette฀smoking฀should฀ also฀be฀viewed฀as฀a฀risk฀factor฀for฀prostatic฀cancer฀ [423] .฀A฀Canadian฀study฀has฀conirmed฀ an฀increased฀risk฀for฀prostatic฀cancer฀among฀smokers฀OR฀=฀2.31;฀CI:฀1.09–4.89,฀with฀a฀ high฀BMI฀increasing฀the฀risk฀still฀further฀ [424] . A฀raised฀leptin฀level฀may฀be฀important฀for฀prostatic฀growth฀and฀angiogenesis,฀especially฀ since฀ prostatic฀ tissue฀ contains฀ leptin฀ receptors฀ [425] .฀ An฀ association฀ between฀ smoking฀ habits฀and฀the฀development฀of฀prostatic฀cancer฀was฀not฀conirmed฀in฀22,071฀men฀partici- pating฀in฀the฀Physicians’฀Health฀Study:฀the฀relative฀risks฀for฀prostate฀cancer฀were฀1.14฀CI:฀ 1.00–1.30฀for฀past฀smokers฀and฀1.10฀CI:฀0.84–1.44฀for฀current฀smokers฀20฀or฀more฀ cigarettesday฀ [426] .

7.6.6 Fertility Disorders

The฀literature฀contains฀growing฀evidence฀to฀indicate฀that฀smoking฀is฀harmful฀to฀both฀male฀ and฀female฀fertility฀because฀the฀carcinogens฀and฀mutagens฀present฀in฀cigarette฀smoke฀reach฀ the฀germline฀cells฀ [427] .฀In฀men,฀smoking฀diminishes฀semen฀quality,฀including฀sperm฀con- centration,฀motility฀and฀morphology.฀The฀associations฀between฀male฀smoking฀and฀semen฀ quality฀can฀be฀demonstrated฀more฀clearly฀in฀“healthy”฀men฀than฀in฀men฀from฀infertility-clinic฀ populations฀ [428] .฀The฀changes฀in฀semen฀quality฀were฀already฀evident฀in฀men฀above฀the฀age฀ of฀22฀years฀ [428] .฀However,฀these฀results฀have฀not฀been฀conirmed฀in฀a฀clinical฀trial฀in฀mar- ried฀couples฀ [429] .฀In฀a฀study฀conducted฀in฀young฀soldiers฀from฀the฀Czech฀Republic,฀smoking฀ was฀ found฀ to฀ produce฀ changes฀ in฀ sperm,฀ including฀ X฀ and฀ Y฀ chromosome฀ aggregation,฀ reduced-linearity฀of฀sperm฀motion,฀and฀more฀“round-headed”฀sperm฀see฀Fig.฀ 7.6 ฀ [430] . In฀women,฀cigarette฀smoking฀has฀been฀associated฀with฀an฀increase฀in฀the฀average฀time฀ to฀conception฀–฀5.1฀months฀for฀current฀smokers฀compared฀with฀4.3฀months฀for฀women฀who฀ never฀smoked฀ [431] .฀Since฀cotinine฀enters฀the฀follicular฀luid,฀the฀likelihood฀that฀the฀nico- tine฀metabolite฀has฀a฀tubal฀effect฀in฀normal฀ovulatory฀cycles฀is฀considered฀minimal฀and฀has฀ been฀rejected฀ [432,฀433] . Ovarian฀ function฀ and฀ fertility฀ were฀ assessed฀ in฀ a฀ cohort฀ of฀ 499฀ women,฀ and฀ ฀gonadotrophin-stimulated฀ovarian฀function฀was฀found฀to฀be฀reduced฀in฀smokers฀compared฀ with฀non-smokers฀ [434] .฀A฀history฀of฀increasing฀tobacco฀exposure฀was฀associated฀with฀ decreasing฀serum฀oestradiol฀levels,฀number฀of฀retrieved฀oocytes฀and฀number฀of฀embryos,฀ with฀the฀result฀that฀smoking฀adversely฀affected฀the฀implantation฀rate฀and฀ongoing฀preg- nancy฀rate฀ [434] .฀The฀increased฀miscarriage฀rate฀in฀smokers฀is฀also฀evidently฀attributable฀ to฀cadmium฀and฀polyaromatic฀hydrocarbons,฀which฀inluence฀trophoblast฀differentiation฀ [435] .฀It฀is฀currently฀under฀discussion฀whether฀nicotine฀also฀has฀such฀effects฀see฀Chap.฀8.฀