Psoriasis Skin and Mucosa
7.8.3 Skin Tumours
Thedevelopmentofsquamouscellcarcinomaoftheskinasaresultofsmokinghasnotbeen proven.PPP,aconditionassociatedwithimmunologicalchanges,wasfoundtobeassoci- atedwithsmokingin56outof59patients,allofwhomhadstartedsmokingbeforetheonset ofPPP [507] . Thedevelopmentofsquamouscellcarcinomaoftheskininsmokersiscontroversial, withacausalrelationshipbeingsupportedbysomepublishedevidence [544–546] and refutedelsewhere [545–551] .Theriskofsquamouscellcarcinomaispossiblyincreasedin menovertheageof60yearsRR=2.01;CI:1.21–3.34,withdailycigaretteconsumption, durationofsmokingandexposuretointensesunlightbeingcrucialforthedevelopmentof thecondition [546] .Theoppositeviewispresentedinastudyof73,366femalenurses: basalcellcarcinomawasmorelikelytodevelopinwomenwithred,blondeorlight-brown hair,andverymuchlesslikelytooccurinwomenwithnaturallydark-brownhair.Riskwas positivelyassociatedwithtendencytosunburnasachildoradolescentandwiththelife- timenumberofsevereepisodesofsunburn,butnotatallwithcigarettesmoking [547] . Onecase-controlstudyfrom1992in88mendidnotindevidencetosupportanassocia- tionbetweensmokingandthedevelopmentofskincancer [548] .Similarly,noassociation hasbeendetectedbetweencigarettesmokingandmelanoma [549] ;however,smokinghas beenlinkedwithformsofanogenitalskincancervulva,vagina,cervix,anus,penis [547] . Theriskforthedevelopmentofcarcinomaofthepenisisreportedtobeincreasedinciga- rette smokers 10 cigarettesday twofold [552] or threefold 45 pack-years [553] . Morethan50ofwomenwithcancerintheanalregionaresmokers [554] ,andsmokers havea7.7-foldincreasedriskforanalcancercomparedwithnon-smokers [555] .Cancer ofthevulvawasdetectedwhen10–20cigarettesdayweresmokedformorethan20years [556–558] . Cancerofthelipoccursinsmokersgenerallyinconjunctionwithexposuretostrong sunlight [559,560] ;however,otherauthorshavefoundnosuchassociation [561] .Heavy cigarettesmoking15pack-yearsand13othervariablesweretestedbyCoxmultivariate analysisfortheirabilitytopredictdeathin196patientswithclinicalStageImelanoma. Smokingmayberegardedasanadverseprognosticmarkerp=0.0065,andmelanoma lesionthicknesswasclearlygreaterinsmokersthaninnon-smokers [562] .7.8.4 Breast Cancer
Wheretheyhavebeenmadeatall,assessmentsofchangesinthefemalebreastinassocia- tionwithsmokingvarywidely.AccordingtooneCanadianstudyinwomenwithbiopsy- conirmed ibroadenoma, cigarette smoking was associated with a reduced risk of ibroadenomaRR=0.66;CI:0.40–1.10.Aninversecorrelationwasevenfoundinas muchastheriskwasslightlyhigherwheresmokinghabitswerelighterRR=0.49;CI: 0.24–0.98 [563] .Unequivocalevidencehasnotbeenfoundforthedevelopmentofbreast cancer in female smokers. Among 2,569 women with histologically conirmed breast cancer,theoddsratioscomparedwithwomenwhohadneversmokedwere0.84CI: 0.7–1.0forcurrentsmokersand1.14CI:0.9–1.4forex-smokers.Therewasalsono increaseincancerriskasafunctionofcigarettessmoked [564] .Similarindingshadalready beenreportedinanolderUSstudyin4,720womenwithbreastcancerOR=1.2;CI: 1.1–1.3 [565] .Comparisonoftheincidenceofbreastcancerascomparedwiththatoflung cancerovermorethan50years,theincidenceoflungcancerwasincreasedbymultiples overthesameperiodcf.Fig.5.1inChap.5. TheCaliforniaEnvironmentalProtectionAgencyCalEPAcompletedahealtheffects assessmentofexposuretoenvironmentaltobaccosmokeETSwhichresultedinCalifornia listingETSasatoxicaircontaminantinJanuary2006.Aspartoftheassessment,studies ontheassociationbetweenexposuretoETSandbreastcancerwerereviewed.Milleretal. analysed 26 published reports including three meta-analyses evaluating the data and reviewdtheassociationbetweenETSexposureandbreastcancer.Aweight-of-evidence approach was applied to evaluate the data and draw conclusions about the association between breast cancer and ETS exposure. The published data indicate an association betweenETSandbreastcancerinyoungerprimarilypremenopausalwomen.Thirteenof the14studiestencase-controlandfourcohortthatallowedanalysisbymenopausalsta- tusreportedelevatedriskestimatesforbreastcancerinpremenopausalwomen,sevenof whichwerestatisticallysigniicant.Ourmeta-analysesindicatedelevatedsummaryrela- tiverisksrangingfromOR1.6895C.I.1.31,2.15forall14studiesto2.2095C.I. 1.69,2.87forthosewiththebestexposureassessment.TheCalEPAwithitsexperts concluded that regular ETS exposure is causally related to breast cancer diagnosed in younger,primarilypremenopausalwomenandthattheassociationisnotlikelyexplained bybiasorconfounding [566] .7.9 Haematopoietic System
Evidenceindicatingapossibleassociationbetweensmokingandthedevelopmentofleukae- miawasnotpublisheduntil1986 [567] ,andsubsequentlythishasbeendemonstratednot onlyforleukaemiasinchildrenbutalsoinadults [568,569] .Severalcohortstudies [570–572] andcase–controlstudies [568,573] focussingonthisissuehavebeenpublished. Genetic defects in NAT2 acetylation [574] or in the cytochrome system CYP1A1, CYP2D6orCYP2C19 [575] hasnoinluenceonthedevelopmentofacutemyeloidor lymphoblasticformsofleukaemia. Resultspublished,todate,arehighlycontradictory,particularlybecauseseveralstudies have reported no association between smoking and leukaemia [576–583] . In a 20-year follow-upofmorethan17,500whitemales,comparedwithnon-smokers,seasonedsmokers hadanincreasedrelativeriskforlymphoblasticleukaemiaRR=2.7andotherunspeciied leukaemiaRR=1.5 [584] .Furtherstudieshaveconirmedthatsmokingconfersanincreased riskforvariousformsofleukaemiainadultmenandwomenOR=1.5;CI:1.1–2.0and1.4;Parts
» Tobacco Plants and Their Origin Use of Tobacco for Religious Purposes
» The Appropriation of Tobacco by Europeans
» Development of the Cigarette
» Objections to Smoking on Health Grounds
» Women Won Over by the Cigarette
» The Medical Use of Tobacco in the Nineteenth Century
» Tobacco Research in the Twentieth Century
» Tobacco Consumption in the Twentieth Century
» Cigarette Smoking in the USA Since 1965
» Cigarette-Related Mortality in Different Countries
» Smokers and Other Risk Factors
» Smoking Behaviour and Educational Level in the EU
» Non-Disclosure of Findings by the Tobacco Industry
» The Cigarette as a Vehicle for Nicotine Release
» Modifications of Nicotine Release
» Maintaining Nicotine Dependence Nicotine and Dependence
» Marketing of Cigarettes with a “Reduced” Health Risk
» Compensatory Behaviour by Smokers
» Optimising Nicotine Release Nicotine and Dependence
» Importance of Absorption Rate
» Ammonium and pH Manipulation
» Cigarettes with Reduced Tar Yield
» Agonists and Antagonists of the nAChR and its Subtypes
» Effects of Nicotine on Receptors in Different Organs
» Metabolic and Hormonal Effects of Nicotine
» Central Nervous System Effects of Nicotine
» Types of Dependence Nicotine Dependence
» Molecular Biological Aspects of Dependence
» Genetic Aspects Nicotine Dependence
» Withdrawal Symptoms Nicotine Dependence
» Immunological Reactions Caused by Cigarette Smoking
» Association Between Smoking and Lung Cancer
» Tobacco-Specific Carcinogens Genetic Factors That Increase the Risk for Bronchial Carcinoma
» The Cytochrome P450 and GST System and Carcinogenesis
» Peptide Receptors, Genetic Factors That Increase the Risk for Bronchial Carcinoma
» Exogenous Factors and Lung Cancer
» Pathophysiology of COPD Cigarette Smoking and COPD
» Genetic Factors Important Risk Factors for COPD
» Occupational and Environmental Factors
» Caveats Concerning the Informative Value of Studies
» Cigarette Smoking and Bronchial Asthma in Adults
» Bronchial Asthma in Children
» Other Lung Diseases Influenced by Cigarette Smoking
» Coronary Artery Disease and Myocardial Infarction
» Changes in Endothelial Function and Microcirculation
» Microcirculation and O Systemic Vascular Changes
» Arteriosclerotic and Inflammatory Vascular Reactions
» Genetic Factors Blood Coagulation and Fibrinolysis
» Nicotine and Ischaemic Heart Disease
» Cognitive Impairment Central Nervous System
» Influence on Cognitive Performance
» Intellectual Impairment in Childhood
» Smoker Personality Profiles and Genetic Inheritance of Smoking
» Peculiarities of the Smoker’s Personality
» Reasons for Increased Cigarette Consumption
» Comorbidity Between Depression and Smoking
» Extent of Cigarette Consumption
» Effects of Smoking in Forms of Dementia
» Smoking and Parkinson’s Disease
» Diabetic Retinopathy Ocular Diseases
» Graves’ Ophthalmopathy Ocular Diseases
» Macular Degeneration Ocular Diseases
» Ocular Tumours Ocular Diseases
» Retinal Detachment Ocular Diseases
» Lipid and Cholesterol Metabolism
» Insulin Resistance Diabetic Nephropathy
» Oesophageal Cancer Gastrointestinal Tract
» Gastrointestinal Ulcers Gastrointestinal Tract
» Cancers of the Gastrointestinal Tract
» Pancreatic Cancer Gastrointestinal Tract
» Toxic Substances and Inducers
» Kidney Cancer Urinary Tract Diseases
» Bladder Cancer Urinary Tract Diseases
» Prostatic Hyperplasia and Prostatic Cancer
» Fertility Disorders Urinary Tract Diseases
» Vitamin D and Oestrogen Metabolism
» Osteoporosis Disorders of Mineral Metabolism and Bone
» Hip Fractures Disorders of Mineral Metabolism and Bone
» Skin Changes Skin and Mucosa
» Skin Tumours Skin and Mucosa
» Breast Cancer Skin and Mucosa
» Effects of Smoking on the Placenta
» Malformations Possibly Caused by Smoking
» Smoking and Sudden Infant Death Syndrome SIDS
» Effects of Nicotine on the Foetus
» Medical Care Costs Attributable to Smoking During Pregnancy
» ETS in the Workplace and at Home
» Fibrinogen Cholesterol Endothelium and Platelets
» Markers of Inflammation Changes at the Molecular and Cellular Level
» Passive Smoking During and After Pregnancy
» Coronary Heart Disease Cardiovascular Disease
» Stroke and Subarachnoid Haemorrhage
» Respiratory Tract in Children and Teenagers
» Bronchial Carcinoma Respiratory Tract
» Indications and Diagnostic Considerations
» Self-Help Interventions by the Smoker
» Physician Advice for Smoking Cessation
» Group Behaviour Therapy Programmes
» Mass Media Communication Strategies
» E-Learning, Email and Internet for Smoking Cessation
» Evaluation of Nicotine Products
» Nicotine Chewing Gum Nicotine
» Nicotine Sublingual Tablet Nicotine Nasal Spray
» Treatment and Dosage Nicotine
» Nicotine Chewing Gum Adverse Events Associated with NRT
» Nicotine Patch Adverse Events Associated with NRT
» Nicotine Nasal Spray Adverse Events Associated with NRT
» Nicotine Inhaler Adverse Events Associated with NRT
» Nicotine Sublingual Tablet Adverse Events Associated with NRT
» Nicotine Lozenge Adverse Events Associated with NRT
» Drug Interactions During Smoking Cessation
» Contraindications for the Use of Nicotine Products
» Nicotine Formulations as OTC Products
» Contraindications and Drug Interactions
» Tranquillisers and Buspirone Other Pharmacotherapies
» Various Antidepressants Other Pharmacotherapies
» Opioid Antagonists Other Pharmacotherapies
» Silver Acetate Other Pharmacotherapies
» Therapeutic Monitoring in Smoking Cessation
» Ischaemic Heart Disease Special Therapeutic Situations
» Pregnancy Special Therapeutic Situations
» Weight Gain Special Therapeutic Situations
» Alcohol Consumption Special Therapeutic Situations
» Organic Depression Organic Depression and Schizophrenia
» Schizophrenic Patients Organic Depression and Schizophrenia
» Interactions Between Cigarette Smoking and Administration of Psychopharmaceuticals
» Pre-operative Smoking Cessation Special Therapeutic Situations
» Social Influence Inoculation Strategy
» Life Skills Strategy Prevention Programmes for Schools
» Class 2000 Health Promotion Programme
» Trier University Health Programme Long-Term Studies
» Role of Teachers in Primary Prevention
» Prevention by Restricting Sales of Tobacco Products to Minors
» Role of the Mass Media in Sales of Tobacco Products to Adolescents
» Role of Government and Community in Primary Prevention
» Effect of Tobacco Industry Advertising Messages
» Tobacco Advertising and Adolescent Smoking Initiation
» Advertising with “Light” Cigarettes
» Smoking Bans in Public Buildings and Public Spaces
» Tobacco Industry, Governmental and Non-governmental Organisations
» Politicians and Their Attitude to Smoking
» Scientists and the Tobacco Industry
» Governmental Control of Toxic Tobacco Constituents
» Bans on Advertising in Various Countries
» Tobacco Industry: Playing Down the Risks of Smoking and Passive Smoking
» Smoking and Non-smoking: Weighing the Benefits
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