CI:1.0–1.9 [568]
.Thewell-knownSeventhDayAdventiststudywasconductedinacohort of34,000subjectsknowntobenon-smokersonreligiousgrounds.Ex-smokersi.e.converts
whosmokedpriortotheirbaptismintothechurchhadarelativeriskof2.00forleukaemia and3.01formyeloma,andriskincreaseddose-dependentlywithincreasingnumbersofciga-
rettessmoked.Thecigarettesmoking–leukaemiarelationshipwasstrongestformyeloidleu- kaemiaRR=2.24;CI:0.91–5.53
[572] .ANorwegianstudyin26,000menandwomen
identiiedanassociationwithsmokingfornumerouscancertypes,butnotforleukaemia [585]
.Accordingtootherstudies,drinkinghabitsplayafarlargerrolethansmoking;for example,inthedevelopmentofacutemyeloidleukaemia
[586] .
InChina,smokingismanytimesmoreprevalentamongmenthanwomen1of youngwomensmoke
[587,588] ;paternalsmokingduringthepreconceptionalperiod
wasthereforestudied [589]
becausetheroleofmaternalsmokingduringpregnancyhad alreadybeeninvestigated
[590–594] .Controversyalsosurroundsthisaspect:whilesome
studieshaveacceptedthatanassociationexists [586,589,594–599]
,othershavefoundno causalassociationbetweenmaternalsmokingduringpregnancyandthedevelopmentof
childhoodleukaemias [593,597,598,600–609]
.AccordingtoJietal. [589]
,adeinite associationexistsbetweenpaternalsmokinghabits5pack-yearsbeforeconceptionand
thesubsequentdevelopmentofcancerinoffspringbeforetheageof5years.Compared withchildrenwhosefathershadneversmoked,thechildrenoffatherswhosmokedhad
increasedoddsratiosforthefollowingcancers: AcutelymphoblasticleukaemiaOR=3.8;CI:1.3–12.3
•
AcutemyeloidleukaemiaOR=2.3
•
LymphomaOR=4.5;CI:1.2–16.8
•
Non-Hodgkin’slymphomasOR=1.2;CI:1.0–1.4
•
[578] BraintumoursOR=2.7;CI:0.8–9.9
•
AllcancerscombinedOR=1.7;CI:1.2–2.5
•
Theseresultsareunderlinedbythosefromarecentlypublishedstudyinwhichchildren withlowbirthweightandwhosemotherssmokedduringpregnancywerefoundtohavean
increasedriskforthedevelopmentofbraintumours [610]
andacuteleukaemia [611]
.The causesarepostulatedtobetheharmfuleffectsofsmokingDNAadductformation
[612]
onspermcells [595,597,613]
butalsothetransplacentalpassageofsmokeconstituentsto reachthefoetus
[614–616] cf.Table
7.7 .Followinginvestigationsin2,359casesofacute
lymphoblasticleukaemiaoracutemyeloidleukaemia,otherworkershaverejectedanasso- ciationbetweenthedevelopmentofacuteleukaemiaandparentalsmokinghistoryduring
pregnancyOR=1.04;CI:0.91–1.19forpaternalandormaternalsmoking [617]
. Onthebasisofmodelcalculationsandlifetables,anassociationhasbeenestablished
betweenbenzeneinhalationbycigarettesmokersandleukaemia:itisestimatedthatben- zene is responsible for one-tenth to one-half of smoking-induced leukaemia mortality
[618] .Earlierstudieshaveconirmedthaturinarylevelsofbenzene-relatedcompounds
e.g.catechol,hydroquinoneandtrans-trans-muconicacidarehigherinsmokersthanin non-smokers
[619] .
Overall,evidenceisaccumulatingtosupporttheassociationbetweensmokinghabits andthedevelopmentofcancersofthehaematopoieticsystem.
7.10 Concluding Remarks
Inadditiontotheharmcausedbysmokingprincipallytothecardiovascularsystemand
•
respiratorytract,renalchangesalsoconstituteaserioushealthproblem,especiallyin patientswithdiabetes.
Even adolescent smokers already display fertility disturbances, the implications of
•
whichincludingchildhoodcancersinoffspringaredificulttogaugeatpresent. Osteoporosisandcanceroftheoropharynxseeninalcoholicswhosmokeareknown
•
sequelaeoftobaccoconsumption,whereasnodeiniteassociationexistsbetweenbreast cancerandsmoking.
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