Haematopoietic System ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition

CI:฀1.0–1.9฀ [568] .฀The฀well-known฀Seventh฀Day฀Adventist฀study฀was฀conducted฀in฀a฀cohort฀ of฀34,000฀subjects฀known฀to฀be฀non-smokers฀on฀religious฀grounds.฀Ex-smokers฀i.e.฀converts฀ who฀smoked฀prior฀to฀their฀baptism฀into฀the฀church฀had฀a฀relative฀risk฀of฀2.00฀for฀leukaemia฀ and฀3.01฀for฀myeloma,฀and฀risk฀increased฀dose-dependently฀with฀increasing฀numbers฀of฀ciga- rettes฀smoked.฀The฀cigarette฀smoking–leukaemia฀relationship฀was฀strongest฀for฀myeloid฀leu- kaemia฀RR฀=฀2.24;฀CI:฀0.91–5.53฀ [572] .฀A฀Norwegian฀study฀in฀26,000฀men฀and฀women฀ identiied฀an฀association฀with฀smoking฀for฀numerous฀cancer฀types,฀but฀not฀for฀leukaemia฀ [585] .฀According฀to฀other฀studies,฀drinking฀habits฀play฀a฀far฀larger฀role฀than฀smoking;฀for฀ example,฀in฀the฀development฀of฀acute฀myeloid฀leukaemia฀ [586] . In฀China,฀smoking฀is฀many฀times฀more฀prevalent฀among฀men฀than฀women฀1฀of฀ young฀women฀smoke฀ [587,฀588] ;฀paternal฀smoking฀during฀the฀preconceptional฀period฀ was฀therefore฀studied฀ [589] ฀because฀the฀role฀of฀maternal฀smoking฀during฀pregnancy฀had฀ already฀been฀investigated฀ [590–594] .฀Controversy฀also฀surrounds฀this฀aspect:฀while฀some฀ studies฀have฀accepted฀that฀an฀association฀exists฀ [586,฀589,฀594–599] ,฀others฀have฀found฀no฀ causal฀association฀between฀maternal฀smoking฀during฀pregnancy฀and฀the฀development฀of฀ childhood฀leukaemias฀ [593,฀597,฀598,฀600–609] .฀According฀to฀Ji฀et฀al.฀ [589] ,฀a฀deinite฀ association฀exists฀between฀paternal฀smoking฀habits฀5฀pack-years฀before฀conception฀and฀ the฀subsequent฀development฀of฀cancer฀in฀offspring฀before฀the฀age฀of฀5฀years.฀Compared฀ with฀children฀whose฀fathers฀had฀never฀smoked,฀the฀children฀of฀fathers฀who฀smoked฀had฀ increased฀odds฀ratios฀for฀the฀following฀cancers: Acute฀lymphoblastic฀leukaemia฀OR฀=฀3.8;฀CI:฀1.3–12.3 •฀ Acute฀myeloid฀leukaemia฀OR฀=฀2.3 •฀ Lymphoma฀OR฀=฀4.5;฀CI:฀1.2–16.8 •฀ Non-Hodgkin’s฀lymphomas฀OR฀=฀1.2;฀CI:฀1.0–1.4฀ •฀ [578] Brain฀tumours฀OR฀=฀2.7;฀CI:฀0.8–9.9 •฀ All฀cancers฀combined฀OR฀=฀1.7;฀CI:฀1.2–2.5 •฀ These฀results฀are฀underlined฀by฀those฀from฀a฀recently฀published฀study฀in฀which฀children฀ with฀low฀birth฀weight฀and฀whose฀mothers฀smoked฀during฀pregnancy฀were฀found฀to฀have฀an฀ increased฀risk฀for฀the฀development฀of฀brain฀tumours฀ [610] ฀and฀acute฀leukaemia฀ [611] .฀The฀ causes฀are฀postulated฀to฀be฀the฀harmful฀effects฀of฀smoking฀DNA฀adduct฀formation฀ [612] ฀ on฀sperm฀cells฀ [595,฀597,฀613] ฀but฀also฀the฀transplacental฀passage฀of฀smoke฀constituents฀to฀ reach฀the฀foetus฀ [614–616] ฀cf.฀Table฀ 7.7 .฀Following฀investigations฀in฀2,359฀cases฀of฀acute฀ lymphoblastic฀leukaemia฀or฀acute฀myeloid฀leukaemia,฀other฀workers฀have฀rejected฀an฀asso- ciation฀between฀the฀development฀of฀acute฀leukaemia฀and฀parental฀smoking฀history฀during฀ pregnancy฀OR฀=฀1.04;฀CI:฀0.91–1.19฀for฀paternal฀andor฀maternal฀smoking฀ [617] . On฀the฀basis฀of฀model฀calculations฀and฀life฀tables,฀an฀association฀has฀been฀established฀ between฀benzene฀inhalation฀by฀cigarette฀smokers฀and฀leukaemia:฀it฀is฀estimated฀that฀ben- zene฀ is฀ responsible฀ for฀ one-tenth฀ to฀ one-half฀ of฀ smoking-induced฀ leukaemia฀ mortality฀ [618] .฀Earlier฀studies฀have฀conirmed฀that฀urinary฀levels฀of฀benzene-related฀compounds฀ e.g.฀catechol,฀hydroquinone฀and฀trans-trans-muconic฀acid฀are฀higher฀in฀smokers฀than฀in฀ non-smokers฀ [619] . Overall,฀evidence฀is฀accumulating฀to฀support฀the฀association฀between฀smoking฀habits฀ and฀the฀development฀of฀cancers฀of฀the฀haematopoietic฀system.

7.10 Concluding Remarks

In฀addition฀to฀the฀harm฀caused฀by฀smoking฀principally฀to฀the฀cardiovascular฀system฀and฀ •฀ respiratory฀tract,฀renal฀changes฀also฀constitute฀a฀serious฀health฀problem,฀especially฀in฀ patients฀with฀diabetes. Even฀ adolescent฀ smokers฀ already฀ display฀ fertility฀ disturbances,฀ the฀ implications฀ of฀ •฀ which฀including฀childhood฀cancers฀in฀offspring฀are฀dificult฀to฀gauge฀at฀present. Osteoporosis฀and฀cancer฀of฀the฀oropharynx฀seen฀in฀alcoholics฀who฀smoke฀are฀known฀ •฀ sequelae฀of฀tobacco฀consumption,฀whereas฀no฀deinite฀association฀exists฀between฀breast฀ cancer฀and฀smoking. 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