Tobacco- Why It Should Not Be Used

Prof. Shad Salim AkhtarMBBS, MD, MRCP(UK), FRCP(Edin), FACP(USA), FICA (USA)

Fellow Association of Members UICCMember Global Cancer Control Committee UICCOverseas Advisor Royal College of Physicians of UKConsultant Medical Oncologist & DirectorHakim Sanaullah Specialist Hospital & Cancer Center, Sopore, Kashmir, J &K

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Nicotiana tabacum

When Was Tobacco Cultivated?When Was Tobacco Cultivated?

149214926000 BC6000 BC1 BC1 BC15311531

1492-10-12: On this bright morning Columbus and his men set foot on the New World for the first time, landing on the beach of San Salvador Island or Samana Cay in the Bahamas, or Gran Turk Island. The indigenous Arawaks, possibly thinking

the strange visitors divine, offer gifts. Columbus wrote in his journal, “the natives brought fruit, wooden spears, and certain dried leaves which gave off a distinct fragrance.” As each item seemed much-prized by the natives; Columbus accepted the gifts and ordered them brought back to the ship.

The fruit was eaten; the pungent "dried leaves" were thrown away.”

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1492-11: Rodrigo de Jerez and Luis de Torres, in Cuba searching for the Khan of Cathay (China), are credited with first observing smoking. They reported that the natives wrapped dried tobacco leaves in palm or maize "in the manner of a musket formed of paper." After lighting one end, they commenced "drinking" the smoke through the other.

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Jerez Becomes First European

Smoker

Jerez became a confirmed smoker, and is thought to be the first outside of the Americas. He brought the habit back to his hometown, but the smoke billowing from his mouth and nose so frightened his neighbors he was imprisoned by the holy inquisitors for 7 years. By the time he was released, smoking was a Spanish craze.

Types of TobaccoTypes of TobaccoManufactured CigarettesManufactured Cigarettes

BidisBidisCigarsCigarsKreteksKreteks

PipesPipesClayClayWaterWater

SticksSticksChewing TobaccoChewing TobaccoSnuffSnuff

Betel leaves

Betel nut

Lime

is still a cigarette, and still as dangerous!

3 times CO and 5 times Tar compared to a cigarette

a cigarette by any other name …

“Short, snappy, easily attempted, easily completed or just as easily discarded before completion – the cigarette is the symbol of the machine age."New York Times, 1925

Quantum of the ProblemQuantum of the ProblemNumber of regular smokersNumber of regular smokers 1.3 billion1.3 billion Third of the word population aged >=15yrsThird of the word population aged >=15yrs

47.5% men and 10.3% women smoke47.5% men and 10.3% women smoke

82-90,000 young people start 82-90,000 young people start smoking dailysmoking daily15 billion cigarettes are smoked daily15 billion cigarettes are smoked daily5.5 trillion consumed in 20005.5 trillion consumed in 2000Other tobacco (smokeless tobacco) use Other tobacco (smokeless tobacco) use data???data???

Ill EffectsIll Effects

HealthHealthEconomicEconomicSocialSocial

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Tobacco CarcinogenesisTobacco Carcinogenesis

>4000 chemicals>4000 chemicals>60 carcinogenic>60 carcinogenic

Hecht SS: Nat Rev Cancer 2003;3:733

Tobacco CarcinogensTobacco Carcinogens

Polycyclic aromatic hydrocarbons (PAH)Polycyclic aromatic hydrocarbons (PAH) Benzo[a]pyrene first to be recognizedBenzo[a]pyrene first to be recognized

Causes mutaion in TP53 tumor suppressor geneCauses mutaion in TP53 tumor suppressor gene

Nitrosamines (TSNA)Nitrosamines (TSNA) Most prevalent strong carcinogens in Most prevalent strong carcinogens in

unburned and smokeless tobaccounburned and smokeless tobacco

Aromatic aminesAromatic aminesWeaker carcinogens like acetaldehydeWeaker carcinogens like acetaldehyde

JS Levitz et al: Med Clin N Am 2004; 88:1655

Tobacco SmokeTobacco Smoke Also found inAlso found inAcetoneAcetone Paint StripperPaint Stripper

AmmoniaAmmonia Floor CleanerFloor Cleaner

ArsenicArsenic Ant poisonAnt poison

ButaneButane Lighter fuelLighter fuel

CadmiumCadmium Car BatteriesCar Batteries

Carbon MonoxideCarbon Monoxide Car exhaust fumesCar exhaust fumes

DDTDDT InsecticideInsecticide

Hydrogen CyanideHydrogen Cyanide Gas ChambersGas Chambers

MethanolMethanol Rocket FuelRocket Fuel

NaphtaleneNaphtalene Moth BallsMoth Balls

TouleneToulene Industrial SolventIndustrial Solvent

Vinyl ChlorideVinyl Chloride PlasticsPlastics

LeadLead Lead based paintsLead based paints

AcrolienAcrolien A chemical weaponA chemical weapon

FormaldehydeFormaldehyde Embalming fluidEmbalming fluid

Tobacco CarcinogenesisTobacco Carcinogenesis

>4000 chemicals>4000 chemicals>60 carcinogenic>60 carcinogenicNicotine content important to cause Nicotine content important to cause addictionaddiction Not carcinogenicNot carcinogenic ToxicToxic

Hecht SS: Nat Rev Cancer 2003;3:733

Combination needed

Nicotine Delivery Device

Addicting Nicotine4000 Chemicals60 Carcinogens

Perfect Killing Machine

Hecht SS: Nat Rev Cancer 2003;3:733

Aortic aneurysmStrokeSudden cardiac death

Preterm deliveryReduced fertilityReduced oxygen to placentaSudden infant death syndromeEarly menopauseIrregular menstrual bleedingPremature wrinkling and aging

Smoking-Related Health Risks-Cancers

CancerBladderCervicalKidneyLarynxLungMouthPancreaticThroat

90% of new smokers begin as teenagers; more than 5 million of whom will eventually die as a result

Source: CDC Office of Smoking and Health; National Center for Tobacco-Free Kids

Of young adults who started smoking in their teens and continue to smoke cigarettes regularly:

• about 25% will die prematurely in middle age

• about 25% will die prematurely in old age

Smoking and the Risk of Premature Death

Tobacco Related DeathTobacco Related Death8.8% deaths globally8.8% deaths globally5 million per year5 million per year13,500 per day13,500 per dayEvery 6.5 seconds someone Every 6.5 seconds someone dies from tobacco usedies from tobacco useDeath toll to rise to 10 million per yearDeath toll to rise to 10 million per year 7 million in non industrialized countries7 million in non industrialized countriesHalf the people smoking today will be Half the people smoking today will be eventually killed by tobaccoeventually killed by tobacco

Every 6.5 seconds Every 6.5 seconds someone dies someone dies from tobacco usefrom tobacco use

The World Health Organisation The World Health Organisation describes smoking as an: describes smoking as an: epidemic epidemic that will cause that will cause 1/3 of all adult deaths1/3 of all adult deaths world-wide by 2020world-wide by 2020

Bryan Curtis started smoking at 13, never thinking that 20 years later it would kill him and leave a wife and children alone. In his last weeks, he set out with a message for young people.

32 yrs

33 yrs

Ill EffectsIll EffectsHealthHealthEconomicEconomicSocialSocial

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What is the economic impact of What is the economic impact of smoking?smoking?

Cost of smoking--- directCost of smoking--- directLoss of income due to premature Loss of income due to premature deathdeathCost of medical care Cost of medical care Loss of propertyLoss of propertyLoss of time of family for care takingLoss of time of family for care taking

Direct Medical Costs:Direct Medical Costs:Consequences of SmokingConsequences of Smoking

Physicians$20.2 Billion

Hospitals$39.9 Billion

Nursing Homes$9.8 Billion

Home Health Care$1.9 Billion

Prescription Drugs$8 Billion

Estimated $80+ BillionTotal Direct MedicalCare Costs in 1993

Economic Impact of SmokingEconomic Impact of Smoking

Every year 1,000,000 fires started by children using cigarette lighters

Ill EffectsIll Effects

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HealthHealthEconomicEconomicSocialSocial

Teens who smoke are —

• 3 times more likely to use alcohol

• 8 times more likely to use marijuana

• 22 times more likely to use cocaine — than teens who don’t

More than 3,000 kids under 18 try smoking every day; that’s more than

1,000,000 every year.

CDC, 1997

We react to one but to the other!!!!!

Tobacco CarcinogenesisTobacco CarcinogenesisMainstream smokeMainstream smoke Inhaled through the column of Inhaled through the column of

cigarettecigarette

Sidestream (passive, second Sidestream (passive, second hand smoke)hand smoke) Emitted from the burning cone Emitted from the burning cone

of the cigaretteof the cigarette Has similar chemicals but Has similar chemicals but

higher level of carcinogenshigher level of carcinogens “Particulate phase” only 5% of all output is visible

Passive or second hand Passive or second hand smokesmokeOne of the most dangerous One of the most dangerous cancer-causing agents in cancer-causing agents in humanshumans

Group A carcinogenGroup A carcinogen

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Parents warned about new 'tobacco sticks'A new tobacco product being sold in Kansas has prompted warnings from state health officials, who say the tiny "smokeless tobacco sticks" could pose a danger to children. Altria Group Inc., the parent company of Philip Morris USA and U.S. Smokeless Tobacco Co., recently began test-marketing the tobacco-coated sticks at select retailers in Kansas, including Wichita, said company spokesman Ken Garcia. The sticks, sold in matchbook-like packs under the brand names Marlboro and Skoal, are aimed at adult smokers and snuff users who want a smokeless, spit-free alternative, …..BY SUZANNE PEREZ TOBIAS

Thu, Jun. 02, 2011

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Murder!Murder!